Delhi Journal of Ophthalmology

Complete Fleischer’s Ring

Kshama Popat
Cornea and Anterior Segment Consultant, Thakorbhai V. Patel Eye Institute (TVPEI), Shri M. L. Vaduwala Eye Hospital, Vadodara, India

Corresponding Author:

Kshama Popat 
FMRF (Cornea), MS (Ophthalmology) 
Cornea and Anterior Segment Consultant,
Thakorbhai V. Patel Eye Institute (TVPEI), Shri M. L. Vaduwala Eye Hospital, Vadodara, India
Email: forgive_02@yahoo.com

Received: 08-APR-2020

Accepted: 15-JUN-2020

Published Online: 20-DEC-2020

DOI:http://dx.doi.org/10.7869/djo.608

Abstract
Fleischer’s Ring is a hemosiderin or iron ring seen at the base of cone in moderate to advanced cases of keratoconus. It occurs due to deposition of iron from tear film. It is best visualized on cobalt blue filter which is highlighted here along with the slit lamp biomicroscopy image.

Keywords :Keratoconus, Fleischer’s ring

Fleischer’s Ring
Fleischer’s Ring is a hemosiderin or iron ring seen at the base of cone in moderate to advanced cases of keratoconus.1 It occurs due to deposition of iron from tear film. Iron gets deposited in the form of hemosiderin in the basal epithelial cells at the level of base of the cone. Duration at which, Fleischer’s ring appears is variable – it can be seen in subclinical or forme fruste cases also, but in general, it occurs in keratoconus at mild-moderate stage. It is best visualized on cobalt blue filter as seen in (Figure 1a). Slit image of same is seen in (Figure 1b). Surgical significance being it should be entirely included in trephining while doing keratoplasty for keratoconus to prevent recurrence in the graft.2


Figures 1: Complete Fleischer's Ring as seen with cobalt blue filter on slit lamp in Fig 1a and same on slit lamp image in Figure 1b

References
  1. Romero-Jimenez M, Santodomingo-Rubido J, Wolffsohn JS. Keratoconus: a review. Cont Lens Anterior Eye. 2010; 33(4): 157-66.
  2. De Toledo JA, de la Paz MF, Barraquer RI, Barraquer J. Long-term progression of astigmatism after penetrating keratoplasty for keratoconus: evidence of late recurrence. Cornea. 2003;22(4):317-23.

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Popat KComplete Fleischer’s Ring.DJO 2020;31:107

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Popat KComplete Fleischer’s Ring.DJO [serial online] 2020[cited 2021 Jan 26];31:107. Available from: http://www.djo.org.in/articles/31/2/Complete-Fleischers-Ring.html