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A 24-year-old man presents for routine examination and is found to have best corrected visual acuity of 20/25 OU.  On slit lamp examination, you observe intraepithelial cysts especially concentrated in the interpalpebral zone in both eyes.  The patient denies any prior eye disease or trauma and is currently taking no eye medications.

The most likely cause for these findings is:

b -- corneal dystrophy The patient most likely has Meesmann’s dystrophy.  This usually has minimal symptoms and appears relatively early in life.  The pathology shows that the epithelial cells contain PAS-positive material (so called “peculiar substance”) and has a thickened epithelial basement membrane. Elevated IOP, uveitis, and a herpes infection would most likely be associated with pain and not have these clinical findings.