Copenhagen 2016 Registration Programme Exhibitor Information Virtual Exhibition Satellite Meetings Glaucoma Day 2016 Hotel Star Alliance

10 - 14 Sept. 2016, Bella Center, Copenhagen, Denmark

This Meeting has been awarded 27 CME credits


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Corneal melt in a rheumatoid patient: not what it seems

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Session Details

Session Title: Presented Poster Session: Ocular Pathologies

Session Date/Time: Sunday 11/09/2016 | 15:00-16:30

Paper Time: 15:10

Venue: Poster Village: Pod 4

First Author: : N. Binti Kader Naina Mohd IRELAND

Co Author(s): :    E. McElnea   G. Fahy           

Abstract Details


Corneal melt in Rheumatoid Arthritis is well described and has various etiology. Lacrimal canaliculitis is uncommon and may be overlooked. It may occur as a complication of punctal plug insertion.


Department of Ophthalmology, University Hospital Galway.


A 74 year old female with a history of rheumatoid arthritis presented with paracentral corneal ulceration and stromal thinning which subsequently perforated. Soft punctal plugs of 0.7mm were inserted in the lower punctum bilaterally and she was treated with intensive topical preservative free lubricants. She returned however without a punctal plug at the right lower punctum and signs consistent with canaliculitis. The canaliculus was curetted. Six soft punctal plugs and one Herrick plug were removed. The ocular surface disease resolved when the canaliculitis resolved


Canaliculitis may be overlooked particularly in patients such as this where other causes may explain the ocular surface disease. In this case the insertion of multiple punctal plugs over a long period of time predisposed the patient to chronic canaliculitis and chronic ocular surface disease.


Punctal plugs of an appropriate size should be inserted into the canaliculi. Van Herrick plugs should be avoided. We should be conscious that punctal plugs may migrate into the canaliculus. Clear documentation in notes should occur when plugs are inserted.

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