1. What are the main characteristics of the condition described in this case and what is the prognosis?

2. What were the symptoms of lingering heat and damaged yin during the followup visit? What details should be paid attention to during the treatment?

3. What are the treatment principles for this disease? Regarding the herbal selection, what should we focus on if the etiology is yang deficiency?

1. This condition is characterized by the formation of a white nebula in the cornea with raised borders, a sunken center and a flower-like shape. The nebula in the cornea could be clearly seen by naked eyes. It is considered a serious disease. If not treated properly, it could result in purulent keratitis, upward rushing of yellow fluid, and a contracted pupil. If the ulceration in the cornea formed, it could result in corneal perforation and iridoptosis. This would form thick nebula even after recovery and would severely affect the visual acuity.

2. Afer the treatment, the stinging pain, photophobia and tearing had dissipated with improved visual acuity. The remaining symptoms included dryness in the eyes, a slightly biter and dry taste in the mouth and slightly yellow urine. The tongue was red with a yellow coating and the pulse was slightly rapid. The local and systemic body symptoms indicated lingering heat with yin damage. The treatment principle should focus on clearing the lingering heat, nourishing yin and eliminating the nebula.

3. This disease belonged to the category of nebula in the cornea. According to TCM theory: all cases involving nebula and corneal ulceration belong to heat. The treatment principle, therefore, should focus on clearing heat and eliminating the nebula. However, if the disease is caused by yang defciency, the treatment principle should focus on warming the channels and opening yang, therefore in addition to using nebula-eliminating herbs, special attention should be paid to more warming herbs such as shé tuì (Periostracum Serpentis) and hăi piāo xiāo (Endoconcha Sepiae).