Descemet’s folds are wrinkles or creases that form in Descemet’s membrane, a thin, strong layer within the cornea. This membrane is positioned between the corneal stroma, which makes up most of the corneal thickness, and the endothelium, the innermost layer of cells. It contributes to the cornea’s structural integrity and its ability to remain clear.
Common Causes of Descemet’s Folds
Descemet’s folds often arise from stress or swelling within the cornea. A common origin is post-surgical complications, particularly following intraocular procedures like cataract surgery or corneal transplantation. During these surgeries, tissue manipulation can lead to mechanical stress on Descemet’s membrane, causing folds.
Inflammation inside the eye, known as uveitis, can also cause Descemet’s folds. This inflammation can cause swelling in the cornea, placing pressure on Descemet’s membrane, causing it to fold. Infections of the cornea or anterior chamber are another source of inflammation that can induce these folds.
Elevated intraocular pressure, a characteristic of conditions like glaucoma, can also cause Descemet’s folds. In congenital glaucoma, for instance, increased pressure can stretch the cornea, causing breaks or folds in Descemet’s membrane, sometimes referred to as Haab’s striae. Physical trauma to the eye, such as a blunt injury or chemical exposure, can directly damage Descemet’s membrane, causing folds.
Impact on Vision and Eye Health
The presence of Descemet’s folds can indicate an underlying eye condition, though they are often asymptomatic. When symptoms do occur, they can include visual disturbances such as blurred vision, reduced clarity, or glare. The severity of these visual issues depends on the extent of the folds and the underlying cause.
For example, if the folds are associated with corneal swelling affecting the outer corneal layers, vision can be moderately to severely blurred. Sometimes, the folds themselves don’t cause significant vision impairment, but signal corneal stress or edema.
Detection and Clinical Approach
Eye care professionals primarily identify Descemet’s folds through a slit-lamp examination. This allows clinicians to observe the cornea in detail and visualize the wrinkles or creases in Descemet’s membrane. Additional imaging techniques, such as optical coherence tomography (OCT), can provide high-resolution images of the corneal layers, confirming the folds and providing detail.
Treatment for Descemet’s folds focuses on addressing the underlying cause rather than the folds themselves. For instance, if post-surgical swelling is the cause, the folds often resolve as the swelling subsides. Medical management might involve topical medications to reduce inflammation and promote healing. In cases of significant endothelial damage, surgical interventions like Descemet’s stripping endothelial keratoplasty (DSEK) or Descemet’s membrane endothelial keratoplasty (DMEK) might be considered.
Monitoring the folds and the associated eye condition is an important part of the clinical approach. Prompt management of the underlying cause helps prevent long-term vision problems. For example, in cases of congenital glaucoma, early diagnosis and treatment can help prevent severe amblyopia due to pronounced astigmatism that can result from the folds.