# Case Report of Schnyder Corneal Dystrophy—A Rare Lipid Metabolic Disorder of the Cornea

## TL;DR

This case report describes a rare corneal disorder caused by lipid buildup, diagnosed in a patient with rheumatoid arthritis and managed with supportive care.

## Contribution

The report highlights the diagnostic challenges of Schnyder corneal dystrophy and its coexistence with rheumatoid arthritis.

## Key findings

- Bilateral corneal stromal deposits resembling snowflakes were observed in a 55-year-old female.
- Advanced imaging confirmed hyperreflective stromal deposits, aiding in the diagnosis of SCD.
- The case emphasizes the need for multidisciplinary care due to the coexistence of SCD and rheumatoid arthritis.

## Abstract

Background: Schnyder corneal dystrophy (SCD) is a rare autosomal dominant disorder characterized by bilateral corneal opacification due to abnormal cholesterol and phospholipid deposition. Mutations in the UBIAD1 gene, identified as causative in 2007, underline the condition, although its exact pathogenesis remains unclear. Case Presentation: A 55-year-old female presented with persistent photophobia, blepharospasm, and corneal discomfort. She also reported joint pain related to rheumatoid arthritis (RA), managed with Ro-Actemra (tocilizumab). The ophthalmological evaluation revealed bilateral corneal stromal deposits resembling snowflakes, with visual acuities of 0.8 (right eye) and 0.7 (left eye). Multimodal imaging confirmed stromal hyperreflective deposits. Based on the clinical findings, SCD was diagnosed, although no genetic testing was performed. Symptomatic management with artificial tears was initiated. Discussion: This case illustrates the diagnostic challenges of SCD, particularly in the absence of corneal crystals, a hallmark feature that is not universally present. Advanced imaging techniques aided diagnosis, and the coexistence of SCD and RA highlights the need for multidisciplinary care. Treatment options remain limited, although emerging therapies targeting oxidative stress and lipid metabolism show promise. Conclusions: This case highlights the importance of integrating ophthalmological and systemic care in SCD management and underscores the need for further research to expand diagnostic and therapeutic strategies for this rare disorder.