Salzmann Nodules, also known as Salzmann’s Nodular Degeneration, are benign growths that develop on the cornea, the clear front surface of the eye. These growths are non-inflammatory and are characterized by elevated, grayish-white or bluish nodules. Whether these nodules require removal is highly individualized, depending on the symptoms a person experiences and the effect they have on vision. For many, the condition is mild and may only require observation, while for others, surgical intervention becomes necessary to restore visual function and comfort.
Understanding Salzmann Nodules
Salzmann Nodules are essentially hyaline plaques, which are deposits of abnormal, disorganized material that accumulate just beneath the outermost layer of the cornea, the epithelium. These deposits tend to displace or even replace Bowman’s layer, the thin, protective sheet of tissue below the epithelium. The nodules usually begin in the peripheral cornea but can slowly progress toward the visual axis.
They are strongly associated with prior or chronic irritation and inflammation of the eye surface. Common risk factors include chronic dry eye disease, a history of corneal inflammation (keratitis), prior eye trauma, or past corneal surgery. Women, particularly those in their fifth or later decades of life, are also more frequently affected by this condition.
The presence of these elevated bumps on the normally smooth corneal surface can lead to several noticeable symptoms. Patients frequently report a persistent foreign body sensation or irritation, as the nodules catch on the inner surface of the eyelid with every blink. The irregular surface curvature created by the nodules can cause blurred or fluctuating vision and induce irregular astigmatism, particularly when the nodules are located near the center of the cornea.
Indications for Removal
Removal of Salzmann Nodules is reserved for cases where the condition actively compromises the patient’s quality of life or visual health. The primary reason for intervention is a significant decrease in visual clarity that cannot be corrected with new glasses or contact lenses. This loss of vision often stems from the nodules causing substantial irregular astigmatism or when they directly obstruct the central visual axis. Corneal topography, a mapping of the corneal curvature, is often used to confirm this irregular surface shape.
A second major indication for removal is chronic, severe ocular discomfort, such as a persistent foreign body sensation or recurrent corneal erosions. The constant irritation from the elevated nodules can sometimes lead to micro-trauma of the overlying epithelium, resulting in painful erosions.
Interference with contact lens wear is another practical reason for considering surgical removal. The irregular shape of the cornea due to the nodules can make it impossible to properly fit a contact lens, or it can cause the lens to be uncomfortable. Furthermore, removal may be recommended prior to other eye surgeries, like cataract extraction, because the irregular corneal surface can introduce errors in the precise measurements needed for intraocular lens selection.
Non-Surgical Management
For people whose Salzmann Nodules are small, peripheral, or not causing significant symptoms, the initial approach is observation and conservative treatment. Since many cases are linked to chronic surface irritation, non-surgical management focuses on improving the health of the ocular surface and managing underlying conditions.
This often involves the consistent use of preservative-free lubricating eye drops, gels, or ointments to keep the corneal surface moist and reduce friction. Addressing coexisting issues, such as meibomian gland dysfunction or severe dry eye, through warm compresses and eyelid hygiene is also beneficial.
In cases where discomfort or inflammation is more prominent, a doctor may prescribe topical medications. These can include short courses of topical steroids or nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce surface inflammation. Therapeutic soft or rigid contact lenses may also be used as a temporary bandage to cover the irregular surface, protecting the cornea and relieving the sensation of a foreign body. If the nodules developed while wearing contact lenses, reducing or stopping lens use is often recommended.
Surgical Treatment Options
When the indications for removal are met, the goal of surgery is to precisely eliminate the nodular tissue and restore a smooth, regular corneal surface. The two primary surgical methods are mechanical debridement, often called superficial keratectomy (SK), and Phototherapeutic Keratectomy (PTK).
Mechanical debridement is performed by gently peeling the nodule off the underlying corneal layer using a blade or fine forceps. This technique is successful because the nodules are typically loosely attached to the cornea, allowing them to be stripped away without significant damage to the deeper tissue. The procedure is usually done on an outpatient basis using topical anesthetic drops.
Phototherapeutic Keratectomy uses an excimer laser to precisely vaporize and smooth the corneal tissue. PTK is often used following mechanical debridement to polish any residual irregularity or haze on the corneal surface, especially if the nodule was deep or multiple nodules were removed. The laser is effective at creating a uniform curvature, which is important for minimizing irregular astigmatism.
In complex cases, surgeons may apply a small amount of a medication called mitomycin-C (MMC) immediately after removal to prevent recurrence. This anti-scarring agent is used for a brief period before being thoroughly washed off. After either procedure, a protective bandage contact lens is typically placed on the eye for several days until the surface layer of the cornea has completely healed.