Traumatic epithelial downgrowth after radial keratotomy

A 40-year-old white man who had radial keratotomy (RK) in both eyes in 1993 experienced pain, extreme photophobia, and mild loss of uncorrected visual acuity in the right eye after being struck by a nail. The patient presented with a small, deep stromal lesion and was initially treated with a variety of antibiotic regimens without improvement in the lesion's appearance. Upon referral, confocal microscopy was performed and clearly demonstrated epithelial cells in the deep stroma and on the endothelial surface. After all medications were stopped, the mild symptoms resolved and the clinical appearance remained stable. Patients with RK incisions are at risk for traumatic epithelial downgrowth even many years after surgery. With confocal microscopy, epithelial downgrowth can be definitively diagnosed. Management of this condition remains controversial.