Posterior Polymorphous Dystrophy (PPD) is a rare, innocuous and asymptomatic
condition in which corneal endothelial cells display characteristics similar to
epithelium. It is often bilateral and frequently asymmetric. We report a case of a
10-year-old girl with a family history of glaucoma who presented with right eye
blurring of vision since few years. She had frequent spectacle-prescription changing
due to unimproved visual acuity. Cycloplegic refraction revealed high astigmatism
and moderate amblyopia over the right eye. Her best corrected vision was 6/9 for
the right and left eyes. Slit-lamp examination showed a vesicular-like lesion at the
periphery of corneal endothelial layers in both eyes. Endothelial cell density was
much reduced on the right eye compared to the left, with more severe astigmatism.
Other ocular examinations were unremarkable. Patient was instructed to patch
her better left eye periodically. Although patients with Posterior Polymorphous
Dystrophy (PPD) present at the age of adulthood, the age at diagnosis is highly
variable. It is rare and inherited through an autosomal dominant pattern. PPD may
rarely lead to astigmatism, by which was present in the patient due to the features
of non-keratoconic and keratoconic cornea on the right and left eye, respectively.
Endothelial cell counts were reduced more on the right eye compared to the left,
which later may worsen her visual acuity thus indicating corneal transplant in the
future. Patient also had a strong family history of glaucoma. Hence, screening of
associated disease of corneal endothelial dystrophy in the family may be necessary.