Unilateral Idiopathic Lipid Crystalline Keratopathy: A Clinicopathological Report

Lipid keratopathy refers to corneal lipid infiltrations. We report a 54-year-old female without any systemic disorder presented with a slowly progressive yellow-white infiltrate in the inferotemporal part of the left cornea for six years. Due to a visual axis involvement leading to decreased visual acuity, the patient underwent penetrating keratoplasty on the left eye. The excised corneal button specimen was sent for pathological evaluation. Anterior segment optical coherence tomography (AS-OCT) and confocal scanning microscopy showed an intra-stromal hyper-reflective material consistent with lipid crystalline keratopathy diagnosis. Histopathology revealed an excessive amount of fat droplets in corneal stroma presented as clear areas in hematoxylin and eosin (H & E) staining in keeping with Oil Red O staining. Idiopathic lipid crystalline keratopathy is a diagnosis of exclusion. For such a diagnosis, the serum lipid profile should be checked to rule out fat metabolic disorders and ocular diseases causing chronic inflammation leading to secondary corneal lipid depositions.