Intended for healthcare professionals

Endgames Spot Diagnosis

A peaked cornea

BMJ 2017; 357 doi: (Published 06 April 2017) Cite this as: BMJ 2017;357:j1461
  1. José Ferreira Mendes, ophthalmology resident,
  2. Tiago Monteiro,, ophthalmologist
  1. Department of Ophthalmology, Hospital de Braga, Braga, Portugal
  1. Correspondence to J Ferreira Mendes jcfmendes88{at}

A 28 year old man with no medical history was referred to an ophthalmologist with a three year history of gradually worsening visual acuity. His left eye uncorrected distance visual acuity was 20/100, and corrected distance visual acuity was 20/60 (Snellen scale). With direct ophthalmoscopy, we could observe scissoring of the red reflex, and a penlight shone from the temporal side would show a conical reflection on the nasal cornea. Figure 1 shows a sagittal view of the left eye. Based on the clinical history, description of the ophthalmic examination, and sagittal view of the eye, what …

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