Differential diagnosis of linear corneal images on confocal microscopy

Purpose. This study aimed to detect corneal conditions presenting with line ar images on white light confocal microscopy and to analyze their distingui shing characteristics. Methods. In 1996 and 1997, 153 eyes of 110 patients with various corneal conditions were examined. In vivo examination of the c ornea was performed by using a white-light tandem scanning confocal microsc ope. Images were captured by using a video camera and stored on S-VHS video tapes. In this retrospective study, patient charts and confocal microscopi c video records were reviewed. Conditions with linear images were looked fo r, and the images were analyzed and compared. Results, The only structures presenting as linear images on confocal microscopy in normal subjects consi sted of corneal nerves. The following pathologic conditions also had linear images on confocal microscopy: corneal vascularization, mycotic keratitis, lattice corneal dystrophy, and posterior polymorphous dystrophy. Each cond ition could be identified based on its reflectivity, delineation, size, bra nching pattern, and location in the cornea. Conclusion. Different corneal c onditions present with linear images on confocal microscopy. Correct identi fication is critical to avoid misdiagnosis.