Sterile Corneal Ulcer in a Patient with Scleroderma-A Case Report

Abstract

Purpose: To report a case of scieroderma with sterile corneal ulcer masqueraded as infectious keratitis. Method: Interventional case report. Results: A 51-year-old woman with scleroderma had dry eye and blepharospasm. After injecting botulinum toxin type A in the left eye, her eye became red and painful. Though topical artificial tear and antibiotics were used and therapeutic soft contact lens were worn, corneal erosion persisted in the left eye. Paracentral corneal melting, ring infiltrate and hypopyon developed 3 weeks later. Topical antibiotics were given but of no effect. Later, the results of corneal smears and cultures of bacteria, fungus, acanthamoeba and virus were all negative. Topical dexamethasone 0.1%, cyclosporine 0.05%, and autologous serum 20% were given 4 times daily in combination with oral prednisolone and tetracycline. Owing to progression of corneal melting and lagophthalmos, amniotic membrane transplantation and tarsorrhaphy were performed. Corneal melting halted and inflammation subsided gradually in 3 months. Conclusion: Scleroderma may involve sterile corneal ulcer presenting with corneal melting, ring infiltrate and hypopyon. Combination of topical steroid and cyclosporine, oral prednisolone and tetracycline, amniotic membrane transplantation and tarsorrhaphy may save the vision.