Corneal epithelial cell migration in humans: 'Hurricane and blizzard keratopathy'

Replicative turnover of the corneal epithelium is believed to occur from a population of stem cells located at the corneo-scleral limbus. During the healing of corneal epithelial wounds, sheets of epithelial cells move centripetally from the limbus and circumferentially along the limbus to cover the defect. A whorled or vortex pattern, similar to that seen in cornea verticillata, has been reported to occur on the corneal surface as an effect of topical steroid medication, during the healing of grafted corneas. This condition has been termed 'hurricane keratopathy'. We have noted this appearance in 6 patients who did not have corneal grafts. In all our patients the whorled pattern was best visible on fluorescein staining. This feature differentiates 'hurricane keratopathy' from cornea verticillata secondary to deposition of substances in corneal epithelial cells. Further, in all our patients the vortex was clockwise. Examination of illustrations of 'hurricane keratopathy' and cornea verticillata reported in the literature reveals that the whorled pattern is almost always clockwise. We believe that this specific pattern is likely to be due to the effect of the electromagnetic fields of the eye on the migrating epithelial cells and present a theory to explain this phenomenon. In 3 eyes of 2 other patients with chronic epitheliopathies we observed a random distribution of cells that did not conform to any specific pattern. We have termed this condition 'blizzard keratopathy'.