Descemet's membrane and the corneal endothelium are characteristically unaltered, however. One theory behind the development of Salzmann's degeneration suggests that the inciting corneal inflammation creates an irregular surface, allowing for uneven tear film distribution and exposure. A process known as hyalization ensues, which is the same process responsible for the development of conjunctival pinguecula. As the nodules grow in size, there is progressive damage and scarring at the level of Bowman's membrane. This ultimately results in epithelial erosion and potential impairment of acuity.
Prophylactic antibiosis is advisable if epithelial defects are significant.
In more severe cases, superficial keratectomy may be utilized to remove the nodules from the anterior cornea. If significant scarring is present, or if chronic epithelial breakdown makes the condition unmanageable, lamellar or penetrating keratoplasty may be the only recourse. The critical issue in managing Salzmann's degeneration is proper diagnosis. Consult a corneal specialist in those cases where diagnosis is elusive. It may be tempting to use topical corticosteroids in Salzmann's degeneration, particularly if the patient is symptomatic.