J Korean Ophthalmol Soc.  2012 Jul;53(7):1035-1040. 10.3341/jkos.2012.53.7.1035.

Two Clinical Manifestations of Anterior Segment Associated with Systemic Lupus Erythematosus

• Wee SW
• Kim JC

• KMID: 2215866
• DOI: http://doi.org/10.3341/jkos.2012.53.7.1035

Abstract

PURPOSE
To report the clinical course and results of two cases of anterior segment manifestations associated with systemic lupus erythematosus (SLE).
CASE SUMMARY
The first case was a 63-year-old female patient who was diagnosed with corneal ulcer and symblepharon on her left eye and dry eye in both eyes. Although the patient was treated with topical antibiotics, autologous serum and artificial tears, amniotic membrane transplantation and symblepharon removal were subsequently required. At 1 month after medical and surgical treatment, the corneal ulcer improved, but a descemetocele was formed because of persistent corneal thinning. The second case was a 24-year-old female patient diagnosed with filamentary keratitis and recurrent corneal erosion in both eyes and uveitis in her left eye. After treatment with therapeutic contact lenses, topical antibiotics and steroids, her symptoms were slightly improved. After 6 months of treatment, filamentary keratitis and corneal erosion recurred to being intractable. The patient received systemic evaluation and was diagnosed with SLE. After a combined therapy of oral and topical treatments, filamentary keratitis and recurrent corneal erosion improved significantly.
CONCLUSIONS
Clinical manifestations of anterior segment associated with SLE rarely respond to topical treatment and are apt to recur easily; therefore, systemic treatment should be applied for better prognosis. Thus, the therapeutic strategy in intractable ocular diseases should be designed with consideration of accompanying systemic diseases.

Keyword

Descemetocele; Filamentary keratitis; Keratoconjunctivitis sicca; Recurrent corneal erosion; Systemic lupus erythematosus

MeSH Terms

Amnion
Anti-Bacterial Agents
Contact Lenses
Corneal Ulcer
Dimaprit
Eye
Female
Humans
Keratitis
Keratoconjunctivitis Sicca
Lupus Erythematosus, Systemic
Middle Aged
Ophthalmic Solutions
Prognosis
Steroids
Transplants
Uveitis
Young Adult
Anti-Bacterial Agents
Dimaprit
Ophthalmic Solutions
Steroids

Figure

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  Figure 1 (Case 1) Anterior segment photograph of the left eye at initial visit. (A) Corneal ulcer with diffuse punctate erosion (arrow), corneal neovascularization and opacities were noted on the inferior area (arrow head). (B) Symblepharon formation on temporal side.

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  Figure 2 (Case 1) 1 week after amniotic membrane transplantation and symblepharon removal on left eye. Corneal ulcer and diffuse punctate erosion were improved.

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  Figure 3 (Case 1) 1 month after amniotic membrane transplantation and symblepharon removal on left eye. (A) Central corneal thinning and opacity (arrow). (B) Descemetocele formation on central cornea (arrow head).

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  Figure 4 (Case 2) Anterior segment photograph of left eye at initial visit. (A) Filamentary keratitis and diffuse punctate corneal erosion. (B) Fine endothelial keratoprecipitates.

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  Figure 5 (Case 2) 1 month after treatment with therapeutic contact lens and topical medication on left eye. Filamentary keratitis and diffuse punctate corneal erosion partially improved.

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  Figure 6 (Case 2) 1 month after diagnosis with systemic lupus erythematosus (SLE) and treatment with combined oral and topical medication on left eye. Filamentary keratitis and diffuse punctate corneal erosion improved significantly.

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