Flat cornea and diplopia

Abstract

A 50-year-old black man enters with a chief complaint of monocular diplopia and blurred vision (20/100) of the right eye that was noted when he got up this morning. He denies prior injury, disease or surgery of the eye; denies working with chemicals; and denies the use of ocular or systemic medication. Examination reveals normal eye examination OD, except a 2.25-diopter hyperopic shift and corneal topography that shows a small flattened area of the central cornea. Refraction improves vision to 20/25 blurred, but does not eliminate the diplopia. With a piano hard contact lens over the eye, and the eye refracted again, vision of 20/15 is obtained and monocular diplopia is eliminated. What is your diagnosis? What do you believe the etiology is? What further tests would you consider? What treatment would you advise?.