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Epicapsular stars represents the incomplete involution of the tunica vasculosa lentis, a vascular network that surrounds the lens during embryogenesis.
Usually they are not visually significant and may occur unilaterally or billateraly and vary in number.
Epicapsular stars are sometimes amorphous and occur primarily within the pupillary area as a small brown pigmentary masses.
We report the case of an an 18-year-old female, presented to the ophthalmology clinic for red, itchy, watery and burning eyes.
The ophtalmological examination showed fortuitously an exceptional shape of epicapsular stars.
An 18-year-old female, without antecedents presented to the ophthalmology clinic for allergic conjunctivitis.
Ophtalmological examination showed a 20/20 best-corrected visual acuity.
Slit-lamp examination of her left eye revealed, fortuitously, multiple tiny, stellate-shaped, pigment deposits on the anterior lens capsule suggestive of epicapsular stars.
These pigmentations were clustered in an exceptional shape reminiscent of the letters "J" and "Y".
The fundus examination was unremarkable.
We didn't need any further investigations, because the diagnosis is clinical, and the patient has no visual disability.
Epicapsular stars result from incomplete apoptosis of the anterior portion of "tunica vasculosa lentis", the primary blood supply of lens during embryogenesis, is the most commonly seen ocular "congenital anomaly".[1]
It is classified as follows: Type 1, attached to iris only; Type 2, iridolenticular adhesions; and Type 3, attached to the cornea.
The most rare entity of Type 2 is epicapsular stars, which presents as multiple, star-shaped, brown-colored opacities over the anterior lens capsule, also known as the chicken tracks.
They could affect one or both eyes, be isolated or clustered, and are usually asymptomatic like in our case.
As the patient experienced no visual disability , no surgical intervention or any treatment was advised, but has still followed up regularly.
As epicapsular stars are congenital, they do not exhibit any change over time, and tend not to affect vision
If they are confluent and located across the visual axis, they can impede vision during development and cause amblyopia, however this is a rare occurrence.
In cases where they are clinically significant, they can be surgically removed if they are deemed to be affecting vision.