Idiopathic Corneal Warping As A Differential Diagnosis to Inferior Steepening

Corneal topography examination, Model. (Photo by: BSIP/Universal Images Group via Getty Images)
Corneal ectasia or contact-lens related corneal warpage can also contribute to inferior steepening.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of American Society of Cataract and Refractive Surgery (ASCRS), held in Las Vegas from July 23 to 27, 2021. The team at Ophthalmology Advisor will be reporting on a variety of research presented by the cataract and refractive surgery experts at ASCRS. Check back for more from the ASCRS 2021 Meeting.


Idiopathic corneal warpage has not been previously described, but a study presented at the American Society of Cataract and Refractive Surgery (ASCRS) 2021 meeting in Las Vegas, held July 23 to 27, suggests it can be a differential diagnosis when inferior steepening is noted on corneal topography. 

In a retrospective case series, researchers reviewed corneal warpage unrelated to contact lens wear. In 8 eyes of 4 patients, investigators obtained corneal and epithelial thickness maps from spectral-domain optical coherence tomography (OCT), as well as topography maps from either Scheimpflug imaging or Placido/scanning-slit topography/tomography. 

Patients presented with focal inferior topographic steepening. Six of these eyes had no history of contact lens wear; 2 had not worn contacts for at least 3 months. And 2 eyes had undergone previous LASIK. 

Investigators ruled out keratoconus and post-LASIK ectasia due to a lack of focal corneal thinning, posterior elevation, and compensatory epithelial thinning at the location of focal steepening. Rather, the steepening was associated with the “focal epithelial thickening that would be expected of corneal warpage.” 

“These cases represent a previously undescribed entity: idiopathic corneal warpage,” the study says. “Topography and OCT are synergistic tools in differentiating warpage from ectasia, both of which could present with inferior steepening.” 

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Vu PQ, Li Y, Huang D. Idiopathic corneal warpage documented by corneal topography and OCT epithelial maps. Poster presented at: 2021 ASCRS Annual Meeting; July 2021; Las Vegas, NV. Abstract 74013.