Peripheral Corneal Melt in Rheumatoid Arthritis

A 38-year-old lady presented with history of redness, blurring of vision, irritation, and photophobia in the left eye of two weeks duration. She gave past history of similar problem in the right eye two years back and the eye became small with loss of vision in spite of taking treatment from an eye specialist. She had joint pains in both knees and wrists for the past four years. Examination of right eye showed phthisis bulbi with no perception of light. Left eye showed peripheral corneal ulcer and thinning of cornea (5-7 o’ clock position) with 6/36 vision. She had keratoconjunctivis sicca also. She was treated with ciprofloxacin, homatropine and carboxymethyl cellulose eye drops. After the investigations for the joint pains, she was diagnosed as a case of rheumatoid arthritis by the physician and started on diclophen and prednisolone tablets. The peripheral corneal ulcer did not respond to treatment; cornea showed melting and mild iris bulge was noted at 6 o ’ clock position inside the limbus. Intravenous acetazolamide was given and the pupil was constricted with pilocarpine eye drops. Since donor cornea was not available, the conjunctival pedicle graft from the lower bulbar conjunctiva was done under topical anaesthesia and the eye was patched. On the next day, the anterior chamber formed well without any anterior synechae. Ciprofloxacin eye drops, carboxymethyl cellulose eye drops and tablet acetazolamide were given postoperatively. Patient was discharged three weeks after admission on ciprofloxacin and carboxymethyl cellulose eye drops. She was advised the need of corneal transplantation when donor cornea is available. Unfortunately, she defaulted further follow up after four weeks.