Salzmann nodules occur at the limbus or peripheral cornea and can disrupt the ocular surface, even causing an irregular ocular surface and induced astigmatism. For cataract patients, if the pre-operative topography shows an effect in the central corneal zone, then the Salzmann nodule should be removed first. Then after healing, serial topography should be done to monitor the cornea until it is stable. If the Salzmann nodule is closer to the corneal periphery then it can be removed at the time of cataract surgery without having much of an effect on the post-operative refractive result.
Since the Salzmann nodules grow on Bowman’s layer of the cornea, this provides a nice plane for dissection. The technique is simple: get under the Salzmann nodule with sharp dissection, then use forceps to grasp it firmly and then peel it towards the limbus. The entire lesion should come off in one piece.
Click below to watch a video of this technique: