Severe Corneal and Conjunctival Keratinization with Rapid Response to Topical Vitamin A Ointment

Abstract

A 56-year-old man with a history of Stevens-Johnson syndrome secondary to phenobarbital use presented with severe keratinization of his left cornea and conjunctiva (Fig A) after not using his scleral contact lens for 3 months secondary to upper lid retraction (margin reflex distance-1, 7.5 mm) due to prior eyelid surgery resulting in 4 mm of lagophthalmos. His eyes felt comfortable, but vision declined from 20/100 to count fingers. After previously failing to improve with topical prednisolone and cyclosporine, topical vitamin A ointment was started with significant improvement after 3 weeks (Fig B).