Secondary Myxomatous Corneal Degeneration: Two Cases With Histopathologic Diagnosis and a Systematic Review Supporting Conservative Management.

PURPOSE Myxomatous corneal degeneration is a rare, often misdiagnosed lesion miming other corneal pathologies. We report 2 cases of secondary corneal myxomatous degeneration, along with systematic review of literature highlighting all reported cases of corneal myxomas.

METHODS Two cases were reported. A comprehensive search for corneal myxomatous degeneration in PubMed, Embase, Web of Science, and Scopus was conducted until December 2025.

RESULTS A 65-year-old man with history of bullous keratopathy presented with long-standing unilateral progressive corneal opacity and hand-motion vision. Anterior segment optical coherence tomography revealed a 600-μm thick subepithelial lesion. A 37-year-old male patient with suspected prior foreign body trauma also presented with a unilateral progressive conjunctival-corneal lesion and no light perception vision. Examination and anterior segment optical coherence tomography revealed a conjunctivalized fibrovascular growth with associated corneal surface irregularity. Both patients underwent superficial keratectomy with adjunctive mitomycin C, and no subsequent recurrence. Histopathological analysis demonstrated findings consistent with secondary myxomatous degeneration. The systematic review identified 20 studies of 35 patients. Most lesions were secondary to developmental anomalies, trauma, surgery, or corneal disease, whereas ∼23% were primary. Presentations commonly included decreased vision, high intraocular pressure, or progressive opacification, with lesions typically appearing as whitish or gelatinous elevations and managed through excision or keratoplasty.

CONCLUSIONS The current cases add to the spectrum of secondary corneal myxomatous degeneration, ranging from chronic degenerative to posttraumatic reactive process. Recognition of this entity is important as lesions can be successfully managed with superficial keratectomy and adjunctive mitomycin C rather than more invasive penetrating keratoplasty.