An unusual case with a challenging combination of glaucoma, keratoconus, and ocular surface disease

Abstract

A 64-year-old gentleman presented for the first time with severe pain, redness, and blurred vision in his left eye with examination revealing corneal hydrops. Discussion with the patient revealed a complex history of bilateral keratoconus and glaucoma. He also had chronic kidney disease, diabetes, Parkinson’s, and mental health conditions. Management of the patient involved a delicate balance between building enough trust to allow examination of the anxious patient without pushing too hard that he would not come back for treatment. Treatment was further complicated when he developed Herpes Simplex Keratitis and a rise in his intraocular pressures. The patient was not comfortable being in a hospital environment as he felt that he would “catch something,” he would also refuse some examinations and tests. However, with a gentle approach and support from occupational therapy and community nursing teams, a way forward was found that enabled him to remain living independently.