Non-traumatic corneal perforation in HIV immunosuppressed patients. Case series of 4 patients

Abstract

Introduction: Non traumatic corneal perforations come as a result of tissue destruction from infectious and non infectious causes. Immunosuppression from HIV can lead to thinning of the cornea and can also cause sterile and non-sterile spontaneous corneal perforations. We are reporting a series of 4 cases of corneal perforation in HIV immunosuppressed patients. Clinical presentation: Case 1: Mrs. F E, a 27year old farmer presented with complain of left eye discharges of one-week duration. No history of previous eye diseases. On eye examination, visual acuity was counting finger 1m left eye.4 days later an inferonasal corneal perforation from a ruptured descemetocele was seen. HIV serology done was positive. The management was conservative. Case 2: Mr. M D.26 years old, presented with sudden onset of decreased vision in the left eye of 6 days duration. Eye examination showed a visual acuity of counting fingers and an epithelial defect localized inferiorly, which was ovoid. The ulcer perforated 4 days later. HIV test was positive and the defect was managed with a bandage contact lens and patient started on ART. Case 3: BB N, 13 months old boy, informant mother, who complained of the child was noticed to have swollen eyes, associated with purulent discharges for one month. On ocular examination; Visual acuity NCNSNM in both eyes; there was an infero- temporal perforation in the right eye and in left eye a central cornea abscess with a leaking descemetocele. HIV test was positive. The initial management was conservative. Case 4: Mr. B D. 50 years old, who presented with redness of the left eye of 3 months duration. He was a known seropositive on ARVs. Last CD4 count was 400/mm3. He had use traditional eye medication. On ocular examination, visual acuity was light perception in the left eye. The anterior segment examination in the left eye showed corneal changes with a descemetocele inferiorly and an infected ulcer at the inferior ¾ of limbus (endophthalmitis). The management was evisceration. Conclusion: Immunosuppression from HIV is a risk factor for spontaneous corneal perforation and should be routinely done and managed accordingly. Key words: Perforation, HIV, cornea.