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West Indian (Caribbean) Punctate Keratopathy: Clinical and In Vivo Confocal Microscopical Findings

Background: West Indian punctate keratopathy (WIPK) is characterized by stable, asymptomatic, white superficial corneal opacities. We examined this patient's lesions with in vivo confocal microscopy. Methods: A 47-year-old North American male patient presented with bilateral, dense, punctate, white opacities of the corneal epithelium. Confocal microscopy was performed using the Heidelberg Retina Tomograph II/Rostock Cornea Module. Results: The patient was of Afro-Caribbean descent. In vivo confocal microscopy showed hyporeflective areas with multiple small hyperreflective dots inside at the level of the basal corneal epithelium with an unaffected Bowman layer. There was no round cell infiltration. Conclusions: West Indian punctate keratopathy should be considered in the differential diagnosis of scattered spot-like opacities with a history of residence in the endemic West Indies. Inflammatory entities can be excluded by in vivo confocal microscopy.