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Oculoplastics

Cornea & External Diseases

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Non Infectious
Rheumatoid arthritis-associated peripheral ulcerative keratitis.

  • Occasionally develops in patients who have systemic autoimmune disease such as rheumatoid arthritis, polyarthritis nodosa, ulcerative colitis, systemic lupus erithematosus, systemic vasculitis and Wegener's granulomatosis.
  • Clinical features:
    • History of connective tissue disease.
    • Corneal finding may precede other systemic signs.
    • Symptoms are not specific, including:
      • Foreign body sensation
      • Pain
    • Signs:
      • Maybe bilateral, but most commonly unilateral
      • Peripheral corneal furrowing or melting
      • Stromal thinning
      • Sterile infiltrate may be present
      • Maybe associated with mildly inflamed conjunctiva
      • Descemetocele in progressive keratolysis
      • May be complicated with corneal perforation
  • Treatment goal:
    • Arresting the melting or keratolysis process
    • Maintaining the integrity of the eye
  • Management:
    • Consult the rheumatologist to ensure adequate systemic immunosuppressant treatment for systemic disease.
    • Promote re-epithelialization by ocular surface lubrication, patching or bandage soft contact lens.
    • Topical or systemic collagenase inhibitor.
    • Cautious use of topical corticosteroid.
    • Cyanoacrylate glue protected with bandage soft contact lens for impending perforation case.
    • Conjunctival recession.
    • Conjunctival flap should be avoided as first line surgery.

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