title: Corneal manifestations of X-linked ichthyosis in two brothers.
abstract: OBJECTIVE
  To report the unusual manifestation of X-linked ichthyosis in two brothers.
  
  
  METHODS
  Leukocyte separation and sterylsulfatase assay are performed to show the deficiency of sterylsulfatase.
  
  
  RESULTS
  Two brothers presented in our clinic with cutaneous alterations consistent with X-linked ichthyosis. Ocular examination disclosed fine, flour-like, punctate, evenly, and diffusely distributed opacities of the posterior corneal stroma, close to Descemet membrane in both patients. In one patient, superficial, small, granular opacities were detected. They were gray in color and seemed to involve the epithelium and the subepithelial and anterior stromal layers. In both patients, the deficiency of sterylsulfatase could be shown and confirmed the diagnosis.
  
  
  CONCLUSIONS
  Flour-like opacities in the posterior stroma have been shown to be a common manifestation of X-linked ichthyosis. Though the underlying biochemical defect in X-linked ichthyosis has been discovered, the question of how these opacities develop is still a subject of debate. Subepithelial stromal keratopathies or epithelial irregularities are uncommon and are rarely described in the literature. The superficial corneal changes seen in one of our patients are unusual and are not similar to those reported by other authors.
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Haritoglou
authors.forename: B
authors.initials: B
authors.lastname: Ugele
authors.forename: K R
authors.initials: KR
authors.lastname: Kenyon
authors.forename: A
authors.initials: A
authors.lastname: Kampik
mesh_terms: D000328:Adult; D001192:Arylsulfatases / Q000097:blood / Q000172:deficiency; D003318:Corneal Opacity / Q000209:etiology* / Q000473:pathology; D003319:Corneal Stroma / Q000473:pathology; D003937:Diagnosis, Differential; D019573:Epithelium, Corneal / Q000473:pathology; D006801:Humans; D016114:Ichthyosis, X-Linked / Q000150:complications* / Q000201:enzymology / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009679:Nuclear Family; D043266:Steryl-Sulfatase
chemical_list: D001192:Arylsulfatases; D043266:Steryl-Sulfatase