What Is Salzmann’s Nodular Degeneration?

Medically Reviewed by Dany Paul Baby, MD on August 24, 2022
4 min read

The human eye has a cornea covering its front that focuses light as it enters the eye. In cases of Salzmann’s Nodular Degeneration (SND), also known as nodular cornea degeneration, this usually clear cornea begins to develop small white bumps on top. 

In milder cases of Salzmann’s Nodular Degeneration, these small bumps don’t cause significant symptoms. In more severe cases where the bumps are bigger in size or appear closer to the center of the cornea, though, this condition can lead to some discomfort or vision loss.

SND was first discovered in 1925 by an eyecare specialist named Maximilian Salzmann. He identified patients who had white elevated spots on their corneas and gave this condition its name. 

Salzmann’s Nodular Degeneration is a rare condition that mostly affects people between the ages of 50 and 60, with females having a higher chance of developing the condition. However, there are observed cases in which SND has occurred in people ranging from 4 to 70 years. 

The exact cause of Salzmann’s Nodular Degeneration is still unknown. People who have experienced trauma to their eyes have a higher risk of developing this condition. Other factors that may increase the risk of developing Salzmann’s Nodular Degeneration include keratitis (inflammation of the cornea) and other chronic inflammatory diseases. 

It is also possible for Salzmann’s Nodular Degeneration to develop after corneal surgery, trachoma, or use of contact lenses. 

Other Risk Factors

The cause of Salzmann’s Nodular Degeneration is not widely understood, but studies indicate both genetic and environmental factors. Other studies suggest that Salzmann’s Nodular Degeneration can result because of reoccurring wound healing.

The most visible symptom of Salzmann’s Nodular Degeneration is the appearance of white, creamy bumps. These bumps are usually small but can become larger and appear in different locations on the surface of the eye. 

Other symptoms include a decrease in vision quality or some pain in the eyes. Vision is especially affected if the white spots appear near the cornea or grow larger in size. When this happens, discomfort is also more likely. 

Some people with Salzmann’s Nodular Degeneration may report no symptoms. About 15% of cases are asymptomatic. 

What Are the Complications of Salzmann’s Nodular Degeneration? 

Salzmann’s Nodular Degeneration may cause poor vision, and in severe cases, the white bumps can cause corneal erosion. This wearing down of the cornea can increase the risk of corneal infections, which can then lead to scarring of the cornea. This may result in worsening vision over time. 

Other complications can also affect those who have Salzmann’s Nodular Degeneration. One of these complications flattening of the cornea by the white bumps. A flattened cornea may result in farsightedness, a condition where nearby objects appear blurry. 

Another potential condition is astigmatism. Those who have Salzmann’s Nodular Degeneration affecting different parts of the cornea and requiring surgical treatment are at higher risk of developing astigmatism.

The most common method of diagnosing Salzmann’s Nodular Degeneration is by examining the eye with a slit lamp. An eyecare specialist assesses the curve of the cornea and measures its thickness. 

The slit lamp exam can also provide a better look at the white spots that appear on the cornea, which helps to diagnose this condition.

Treatment and management of Salzmann’s Nodular Degeneration will depend on the size, location, and cause of the white spots, as well as the symptoms and their severity. Patients who are asymptomatic require the least treatment. Most often, they simply receive annual examinations of their affected eyes and continuous observations.

Symptomatic patients with mild symptoms often require conservative management involving treatments like ocular lubricants, steroid eye drops, eyelid hygiene regiments, or warm compresses.

Those with severe symptoms may require surgical intervention, such as laser treatment. Laser treatment results in improved vision for 90% of patients. There is a 5 to 20% chance of this condition returning later on, though.

In cases where the removal of the white nodules is difficult, multiple laser treatments may be needed to create a smooth surface on the cornea. In these cases, it is more likely that this condition will return and affect vision again in the future. In rare cases where the white bumps have extended past the corneal tissue, treatment might involve dissection of the cornea. 

Salzmann’s Nodular Degeneration is a rare condition that mostly affects middle-aged women. While its cause is still unknown, SND is asymptomatic in about 15% of cases and is treatable in most of the remaining instances. 

Although it is rare, there is a chance that the illness will return, particularly the cases of patients who had severe symptoms. Regardless, it is critical to receive a proper diagnosis quickly, as this condition worsens with time.