Epithelial Rejection Line

Clinical Features

• Average time to onset of rejection is 3 months.
• Symptoms: usually asymptomatic or minimal symptoms of irritation or blurry vision.
• Signs: elevated linear opacity in transplanted cornea across graft surface, which advances centrally over the course of several days.
• Usually self-limited.
• In this patient, the first appearance of the rejection line was 20 months after a combined allograft lamellar keratoplasty and limbal transplantation for severe corneal scarring following a chemical burn.
• Treatment: topical steroids are indicated because epithelial rejection may be a precursor to a more serious endothelial rejection.