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Table of Contents
IMAGES IN MEDICINE
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 149-150

“Contact Lens” cornea in peripheral ulcerative keratitis


Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China

Date of Submission01-Jan-2020
Date of Decision02-Feb-2021
Date of Acceptance15-Feb-2021
Date of Web Publication11-Mar-2021

Correspondence Address:
Sunny Chi Lik Au
9/F, MO Office, Lo Ka Chow Memorial Ophthalmic Centre, Tung Wah Eastern Hospital, 19 Eastern Hospital Road, Causeway Bay, Hong Kong
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_1_20

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How to cite this article:
Lik Au SC, Chuen Ko ST. “Contact Lens” cornea in peripheral ulcerative keratitis. Apollo Med 2021;18:149-50

How to cite this URL:
Lik Au SC, Chuen Ko ST. “Contact Lens” cornea in peripheral ulcerative keratitis. Apollo Med [serial online] 2021 [cited 2021 Sep 24];18:149-50. Available from: https://www.apollomedicine.org/text.asp?2021/18/2/149/311110

A 41-year-old female with a known history of rheumatoid arthritis (RA) developed right eye peripheral ulcerative keratitis (PUK) without scleral involvement. It started over from the interpalpebral zone and extended circumferentially to entire cornea despite traditional systemic immunosuppressants. Biologics adalimumab-based combination medical therapy together with amniotic membrane transplant was needed eventually to control the progression. Furrows left behind from peripheral corneal ulceration gave the appearance of the “Contact lens” cornea [Figure 1].
Figure 1: Slit lamp photo of the right eye with 360° circumferential peripheral corneal thinning over the limbus. Furrows over peripheral cornea makes the central cornea stand out as an elevation, simulating a contact lens

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Unilateral PUK can be idiopathic as in Mooren's ulcer or associated with systemic connective tissue diseases[1] commonly RA.[2] RA associated PUK may present together with episcleritis or scleritis, whereas Mooren's ulcer is barely limbitis. Although the pathophysiology of both is immune complex deposition triggering immune response, topical steroid eye drops would worsen the thinning in RA cases in contrast to Mooren's ulcer. Topical lubricants, preferably preservative-free, are important; whereas oral tetracycline or vitamin C would promote healing through the anti-collagenase effect.[3] In essence, systemic steroids and immunosuppressant are fundamental in controlling the progression of corneal thinning to prevent a corneal perforation. Newer biologics, via different routes, are evolving and combination therapy of different immunosuppressants with disease-modifying anti-rheumatic drugs showed promising results to recalcitrant cases.[4]

Failing conservative therapy, refractory cases could go for the surgical treatment such as conjunctival recession or amniotic membrane transplants.[5] Ultimately, tectonic corneal graft will be needed if perforation happened.[6]

In summary, there is a long treatment ladder to escalate for RA associated PUK, but caution is needed for the use of topical steroid eye drops.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Yagci A. Update on peripheral ulcerative keratitis. Clin Ophthalmol 2012;6:747-54.  Back to cited text no. 1
    
2.
Lyne AJ. “Contact lens” cornea in rheumatoid arthritis. Br J Ophthalmol 1970;54:410-5.  Back to cited text no. 2
    
3.
Ralph RA. Tetracyclines and the treatment of corneal stromal ulceration: A review. Cornea 2000;19:274-7.  Back to cited text no. 3
    
4.
Cao Y, Zhang W, Wu J, Zhang H, Zhou H. Peripheral ulcerative keratitis associated with autoimmune disease: Pathogenesis and treatment. J Ophthalmol 2017;2017:7298026.  Back to cited text no. 4
    
5.
Prahs PM, Herrmann W, Hufendiek K, Gabel VP. Amniotic membrane transplantation for the treatment of rheumatoid arthritis–Associated corneal ulcers. Invest Ophthalmol Vis Sci 2006;47:3950  Back to cited text no. 5
    
6.
Livny E, Mimouni M, Bahar I, Molad Y, Gershoni A, Kremer I. Corneal melting in rheumatoid arthritis patients treated with a tectonic reinforcing corneolimbal graft: An interventional case series. Int Ophthalmol 2018;38:1317-24.  Back to cited text no. 6
    


    Figures

  [Figure 1]



 

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