J Korean Ophthalmol Soc.  2014 Feb;55(2):298-303. 10.3341/jkos.2014.55.2.298.

Corneal Perforation in Phlyctenular Keratitis

• Ahn YS
• Lee JA
• Cho YK

• KMID: 2218427
• DOI: http://doi.org/10.3341/jkos.2014.55.2.298

Abstract

PURPOSE
Corneal perforation from phlyctenular keratoconjunctivitis is rarely reported worldwide and no case has been reported in Korea. We report a case of corneal perforation in a patient with phlyctenular keratoconjunctivitis along with a literature review.
CASE SUMMARY
A 15-year-old female presented to our clinic with repetitive tears, conjunctival injection, and discomfort in her right eye for several months. Slit-lamp examination revealed oily plugs at the meibomian gland orifices with collarettes, conjunctival injection and a round, whitish elevated lesion accompanying neovascularization of the inferotemporal side of the cornea. As an initial treatment, topical antibiotic was given but no signs of improvement were observed. Hence, topical steroid was applied on suspicion of phlyctenular keratitis and the patient's symptoms and corneal lesion improved. Two months later, the patient's symptoms relapsed and the lesion was found progressing towards the central cornea. The treatment was restarted and the symptoms improved but the corneal lesion continuously progressed towards the center, thinning the central cornea. Seventeen months from the time of initial diagnosis, the patient revisited prior to the scheduled appointment complaining of abrupt tears in her right eye. Slit-lamp examination revealed a corneal perforation at the center of the thinned cornea. Hence, we performed an emergent tectonic corneal patch graft. After the operation, opacity remained covering the visual axis at the central cornea, thus penetrating keratoplasty was performed 10 months later. Henceforth, the patient has remained free of symptoms and visual acuity has been recovered.
CONCLUSIONS
Usually phlyctenular keratoconjunctivitis responds well to treatment and does not have a significant influence on vision. However, occasionally phlyctenular keratoconjunctivitis may not respond to treatment and may spread to the central cornea causing loss of visual acuity and even corneal perforation in rare occasions. Therefore, in order to prevent such complications, prompt diagnosis and treatment are essential.

Keyword

Blepharitis; Corneal perforation; Penetrating keratoplasty; Phlyctenular keratoconjunctivitis; Tectonic corneal patch graft

MeSH Terms

Adolescent
Erlotinib Hydrochloride
Blepharitis
Cornea
Corneal Perforation*
Diagnosis
Female
Humans
Keratitis*
Keratoconjunctivitis
Keratoplasty, Penetrating
Korea
Meibomian Glands
Transplants
Visual Acuity

Figure

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  Figure 1. Greasy lid margin with oily plugs and collarettes are observed on upper (A, B) and lower eyelids (C, D).

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  Figues 2. A 1 × 1 mm sized round-shaped whitish elevated lesion with opacity accompanying neovascularization is shown at the inferotemporal side of the right cornea.

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  Figure 3. After two months, the corneal lesion recurred and progressed towards the central cornea.

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  Figure 4. Fifteen months from the point of the initial diagnosis, the corneal lesion continuously progressed towards the corneal center resulting in thinning of the central cornea.

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  Figure 5. Corneal perforation at the center of the thinned cornea was shown.

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  Figure 6. We performed an emergent tectonic corneal patch graft and the opacity remained covering the visual axis at the central cornea.

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  Figure 7. After penetrating keratoplasty, the patient has remained free of symptoms and visual acuity has been recovered.

Reference

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