- 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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