Ophthalmology · Oculoplasty and Orbital Disease (Ptosis, Entropion, Thyroid Eye Disease, Orbital Tumors)

In Wilson's disease, the Kayser-Fleischer ring in the cornea results from copper deposition in which specific corneal layer, and at what location does it first appear?

  • A Descemet's membrane peripherally, first at superior limbus then inferior limbus
  • B Corneal stroma, first at the corneal center
  • C Bowman's layer, first at the superior limbus
  • D Corneal epithelium at the limbus circumferentially
Correct answer: A. Descemet's membrane peripherally, first at superior limbus then inferior limbus

Explanation

In Wilson's disease (hepatolenticular degeneration), excess copper deposits in Descemet's membrane peripherally. The KF ring first appears at the superior limbus (where aqueous humor pools, creating higher local copper concentration), then at the inferior limbus, and eventually becomes circumferential (360°). It appears as a golden-brown to gray-green ring at the corneal periphery. It is best seen with slit-lamp examination in early stages. KF rings are present in virtually all symptomatic neurological Wilson's disease patients and are diagnostically important. They regress with chelation therapy.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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