Reversible corneal endothelial cell changes in diseases of the anterior segment

We have demonstrated the reversibility of corneal endothelial changes which accompany superficial keratopathy (superficial punctate keratitis, exposure keratopathy, chemical keratopathy and keratoconjunctivitis sicca), stromal keratitis and anterior uveitis (predominantly iridocyclitis). These changes include small subendothelial dark areas equal to or less than one cell in diameter and larger subendothelial dark areas up to two to four cells in diameter. These dark areas are similar but form two groups. The smaller ones may be due to oedema, some developing into larger dark areas, but it is also possible that smaller dark areas represent inflammatory cells or even local destruction of endothelial cells. The larger dark areas elevate the overlying endothelium. Either may be very numerous. They may be present together or separately. They become much less numerous and disappear with resolution or suppression of the acute keratitis or uveitis. The relief mode of corneal specular microscopy was used to distinguish these dark areas from other inflammatory and degenerative changes (such as fine inflammatory deposits, larger keratic precipitates, pigment deposits and guttatae at the level of the corneal endothelium).