Keratoglobus: a close entity to megalophthalmos

BACKGROUND: Keratoglobus closely resembles buphthalmos and anterior megalophthalmos. FINDINGS: A 45-year-old man presented with gradually progressive, painless, diminution of vision in both eyes since childhood. On examination, visual acuity of right (RE) and left eye (LE) was 20/60 and 2/20 respectively. Clinical pictures of the patient are shown in panel A, B, C, D. Keratometry values were 46.47/47.94 D at 42/132° in RE and 46.90/47.23 D at 174/84° in LE, signifying steep, ectatic cornea. Axial lengths, anterior chamber depth and corneal thickness in RE/LE was 23.53/27.12 mm, 5.18/4.48 mm and 413/420 μm respectively. Iridodonesis was noted in left eye. Retinal evaluation of LE revealed retinal detachment (RD) with posterior staphyloma due to high myopia, hereas RE was within normal limits. Intraocular pressure was normal in both eyes. Final diagnosis was keratoglobus with LE myopic RD. The patient improved to 20/30 in right eye with no improvement in LE with scleral contact lens. CONCLUSION: Keratoglobus, Megalophthalmos and Buphthalmos are exceedingly close entities and it is very essential to make correct diagnosis, as management options differ significantly for all three diseases.