Apollo Medicine

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

“Contact Lens” cornea in peripheral ulcerative keratitis


Sunny Chi Lik Au, Simon Tak Chuen Ko 
 Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China

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




How to cite this article:
Lik Au SC, Chuen Ko ST. “Contact Lens” cornea in peripheral ulcerative keratitis.Apollo Med 2021;18:149-150


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 Jul 25 ];18:149-150
Available from: https://www.apollomedicine.org/text.asp?2021/18/2/149/311110


Full Text

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}

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

1Yagci A. Update on peripheral ulcerative keratitis. Clin Ophthalmol 2012;6:747-54.
2Lyne AJ. “Contact lens” cornea in rheumatoid arthritis. Br J Ophthalmol 1970;54:410-5.
3Ralph RA. Tetracyclines and the treatment of corneal stromal ulceration: A review. Cornea 2000;19:274-7.
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5Prahs 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
6Livny 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.