History

Most patients with map-dot-fingerprint dystrophy are asymptomatic.

The past eye history may be positive for recurrent corneal erosions.

Visual symptoms are usually mild and occasionally debilitating. Vision is variable and fluctuating due to migratory and intermittent corneal involvement. Refractions often are unstable and are not the fault of the doctor or the patient. Visual complaints include the following:

Blurred vision
Ghosting or monocular diplopia
Glare
Distortion

Pain symptoms include the following:

Foreign body sensation
Photophobia

Physical

Visual acuity among patients with map-dot-fingerprint dystrophy ranges from 20/15 to 20/200.

Refraction may have an uncertain endpoint due to irregular astigmatism.

On slit lamp examination, pathology is at the epithelial and basement membrane levels. Areas of pathology often are identified best by broad-beam illumination, fluorescein with cobalt blue light (to identify areas of negative staining), or retroillumination following dilation. Slit lamp findings include the following:

The corneal maps in map-dot-fingerprint dystrophy are irregular geographic shaped, faint gray-white patches that may contain clear oval areas. They vary greatly in size (usually 1 mm to several mm) and are seen best with broad oblique illumination.
The corneal dots in map-dot-fingerprint dystrophy are gray-white, puttylike opacities, which can be round, comma-shaped, or irregular. They are usually 0.05-1 mm in size.
The corneal fingerprints in map-dot-fingerprint dystrophy are clusters of contoured concentric lines, 0.25-4 mm in length. They are seen best with retroillumination.
Corneal blebs are clear, round, bubblelike defects, 0.05-0.2 mm in diameter. They are seen best with retroillumination. See the images below.

Corneal maps. Best seen with broad illumination beam.
View Media Gallery

Corneal dots. Cluster of corneal dots.
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Corneal fingerprints. Best seen in retroillumination.
View Media Gallery

Keratometry or computerized topography can be used to check for irregular astigmatism. A Placido disk or keratometer often demonstrates irregularity better than computerized topography.

Differential Diagnoses

Cogan DG, Donaldson DD, Kuwabara T, et al. Microcystic dystrophy of the corneal epithelium. Trans Am Ophthalmol Soc. 1964. 62:213-25. [QxMD MEDLINE Link].
Cogan DG, Kuwabara T, Donaldson DD, et al. Microcystic dystrophy of the cornea. A partial explanation for its pathogenesis. Arch Ophthalmol. 1974 Dec. 92(6):470-4. [QxMD MEDLINE Link].
Guerry D 3rd. Observations on Cogan's microcystic dystrophy of the corneal epithelium. Trans Am Ophthalmol Soc. 1965. 63:320-34. [QxMD MEDLINE Link].
Waring GO 3rd, Rodrigues MM, Laibson PR. Corneal dystrophies. I. Dystrophies of the epithelium, Bowman's layer and stroma. Surv Ophthalmol. 1978 Sep-Oct. 23(2):71-122. [QxMD MEDLINE Link].
Trobe JD, Laibson PR. Dystrophic changes in the anterior cornea. Arch Ophthalmol. 1972 Apr. 87(4):378-82. [QxMD MEDLINE Link].
Laibson PR, Krachmer JH. Familial occurrence of dot (microcystic), map, fingerprint dystrophy of the cornea. Invest Ophthalmol. 1975 May. 14(5):397-9. [QxMD MEDLINE Link].
Rodrigues MM, Fine BS, Laibson PR, et al. Disorders of the corneal epithelium. A clinicopathologic study of dot, geographic, and fingerprint patterns. Arch Ophthalmol. 1974 Dec. 92(6):475-82. [QxMD MEDLINE Link].
Weiss JS, Moller HU, Aldave AJ, Seitz B, et al. IC3D classification of corneal dystrophies--edition 2. Cornea. 2015. 34(2):117-159.
Boutboul S, Black GC, Moore JE, et al. A subset of patients with epithelial basement membrane corneal dystrophy have mutations in TGFBI/BIGH3. Hum Mutat. 2006 Jun. 27(6):553-7. [QxMD MEDLINE Link].
Evans CJ, Davidson AE, Carnt N, Rojas López KE, Veli N, Thaung CM, et al. Genotype-Phenotype Correlation for TGFBI Corneal Dystrophies Identifies p.(G623D) as a Novel Cause of Epithelial Basement Membrane Dystrophy. Invest Ophthalmol Vis Sci. 2016 Oct 1. 57 (13):5407-5414. [QxMD MEDLINE Link].
McKusick, VA. Corneal dystrophy, epithelial basement membrane; EBMD. Online Mendelian Inheritance in Man. Available at https://www.omim.org/entry/121820. September 17, 2015;
Wood TO, Griffith ME. Corneal epithelial basement membrane dystrophy. Trans Am Ophthalmol Soc. 1987. 85:281-92. [QxMD MEDLINE Link].
Werblin TP, Hirst LW, Stark WJ, et al. Prevalence of map-dot-fingerprint changes in the cornea. Br J Ophthalmol. 1981 Jun. 65(6):401-9. [QxMD MEDLINE Link].
Reidy JJ, Paulus MP, Gona S. Recurrent erosions of the cornea: epidemiology and treatment. Cornea. 2000 Nov. 19(6):767-71. [QxMD MEDLINE Link].
Brown N, Bron A. Recurrent erosion of the cornea. Br J Ophthalmol. 1976 Feb. 60 (2):84-96. [QxMD MEDLINE Link].
Guerry D III. Fingerprint-like lines in the cornea. Am J Ophthalmol. 1950. 33:724-726.
Akhtar S, Bron AJ, Meek KM, et al. Clinical and ultrastructural findings in mare's tail lines of the corneal epithelium. Br J Ophthalmol. 2004 Jul. 88(7):864-7. [QxMD MEDLINE Link].
Seitz B, Lisch W. Stage-related therapy of corneal dystrophies. Dev Ophthalmol. 2011. 48:116-53. [QxMD MEDLINE Link].
Hykin PG, Foss AE, Pavesio C, Dart JK. The natural history and management of recurrent corneal erosion: a prospective randomised trial. Eye (Lond). 1994. 8 ( Pt 1):35-40. [QxMD MEDLINE Link].
Buxton JN, Constad WH. Superficial epithelial keratectomy in the treatment of epithelial basement membrane dystrophy. Cornea. 1987. 6(4):292-7. [QxMD MEDLINE Link].
Itty S, Hamilton SS, Baratz KH, et al. Outcomes of epithelial debridement for anterior basement membrane dystrophy. Am J Ophthalmol. 2007 Aug. 144(2):217-221. [QxMD MEDLINE Link].
Forstot SL, et al. Diamond burr keratectomy for the treatment of recurrent corneal erosion syndrome. Ophthalmol Suppl: Poster. 1994.
Soong HK, Farjo Q, Meyer RF, et al. Diamond burr superficial keratectomy for recurrent corneal erosions. Br J Ophthalmol. 2002 Mar. 86(3):296-8. [QxMD MEDLINE Link].
Ohman L, Fagerholm P, Tengroth B. Treatment of recurrent corneal erosions with the excimer laser. Acta Ophthalmol (Copenh). 1994 Aug. 72(4):461-3. [QxMD MEDLINE Link].
Orndahl MJ, Fagerholm PP. Phototherapeutic keratectomy for map-dot-fingerprint corneal dystrophy. Cornea. 1998 Nov. 17(6):595-9. [QxMD MEDLINE Link].
Sridhar MS, Rapuano CJ, Cosar CB, et al. Phototherapeutic keratectomy versus diamond burr polishing of Bowman's membrane in the treatment of recurrent corneal erosions associated with anterior basement membrane dystrophy. Ophthalmology. 2002 Apr. 109(4):674-9. [QxMD MEDLINE Link].
Pogorelov P, Langenbucher A, Kruse F, Seitz B. Long-term results of phototherapeutic keratectomy for corneal map-dot-fingerprint dystrophy (Cogan-Guerry). Cornea. 2006 Aug. 25 (7):774-7. [QxMD MEDLINE Link].
McLean EN, MacRae SM, Rich LF. Recurrent erosion. Treatment by anterior stromal puncture. Ophthalmology. 1986 Jun. 93(6):784-8. [QxMD MEDLINE Link].
Dastgheib KA, Clinch TE, Manche EE, et al. Sloughing of corneal epithelium and wound healing complications associated with laser in situ keratomileusis in patients with epithelial basement membrane dystrophy. Am J Ophthalmol. 2000 Sep. 130(3):297-303. [QxMD MEDLINE Link].
Rezende RA, Uchoa UC, Cohen EJ, et al. Complications associated with anterior basement membrane dystrophy after laser in situ keratomileusis. J Cataract Refract Surg. 2004 Nov. 30(11):2328-31. [QxMD MEDLINE Link].
Kenyon KR, Paz H, Greiner JV, et al. Corneal epithelial adhesion abnormalities associated with LASIK. Ophthalmology. 2004 Jan. 111(1):11-7. [QxMD MEDLINE Link].
Paliwal P, Sharma A, Tandon R, Sharma N, Titiyal JS, Sen S, et al. TGFBI mutation screening and genotype-phenotype correlation in north Indian patients with corneal dystrophies. Mol Vis. 2010 Jul 29. 16:1429-38. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Corneal maps. Best seen with broad illumination beam.
Corneal dots. Cluster of corneal dots.
Corneal fingerprints. Best seen in retroillumination.
Pseudofingerprints (shift lines) in a patient with Fuchs corneal dystrophy.

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Author

David D Verdier, MD Clinical Professor, Department of Surgery, Division of Ophthalmology, Michigan State University College of Human Medicine

David D Verdier, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Cornea Society, Eye Bank Association of America, Michigan Society of Eye Physicians & Surgeons, Michigan State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AAO; OMIC; American Society of Ophthalmic Trauma (ASOT); Avellino, Bio-Tissue; Celularity; Dompe; Glaukos; Kala; Oyster Point; Sun Ophthalmics; Tarsus; TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue<br/>Received research grant from: Glaukos<br/>Received income in an amount equal to or greater than $250 from: AAO; OMIC; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab.

Chief Editor

Hampton Roy, Sr, MD † Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Map-dot-fingerprint Dystrophy Clinical Presentation

History

Physical

References

Tables

Contributor Information and Disclosures

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