TREATMENT OF CORNEAL PERFORATION SECONDARY TO UNDIAGNOSED SJOGREN’S SYNDROME WITH CONJONCTIVAL FLAP : A CASE REPORT

Published 2022 - 26th ESCRS Winter Meeting

Reference: P130 | Type: Abstracts | DOI: 10.82333/3crd-d364

Authors: Sophia Bousseta* ¹ , Ait el haj jihane ¹ , CHiguer salma ¹ , Mchachi Adil ¹ , Benhmidoune Leila ¹ , Rachid Rayad ¹ , El belhadji Mohamed ¹

¹IBN ROCHD university hospital center, Faculty of Medicine and Pharmacy CASABLANCA,Adult Ophthalmology Service, Hospital August 20, 1953,casablanca,Morocco

Purpose

Dry eye is a common problem affecting mainly the adult population and especially in sjogren’s syndrome .In severe cases, it can result in sterile corneal ulcer and perforation.

The treatment of non-traumatic perforations of the cornea is a real challenge for the choice of surgical technique as well as for management of the causal pathology

The clinical evolution is commented and the available therapeutic measures for this complication are discussed

Setting

A case of noninfectious corneal perforation in a 43 year old patient with Sjögren's syndrome is reported

Methods

A 43 year-old femal presented to the outpatient department with complaints of painful decrease in vision in both the eyes for the past seven days. The decrease in vision was associated with photophobia and redness, more in left eye than right. There was no history of any trauma to any eye.

Results

Examination disclosed vision of counting fingers at 50 cm on the left eye , and 2/10 ème on the right eye

Slit lamp examination revealed lusterless congested conjunctiva in both the eyes.

There was a sterile corneal ulcer of size 1.5x1.5 mm in right eye

And sterile corneal ulcer of size 5.5x4.0 mm in left eye with central corneal perforation measuring 2mm / 1.5mm with iris plugging the perforation

The anterior chamber was flat in left eye

the patient received a corticosteroid bolus and partial conjunctival flap on the left eye

He was started on topical antibiotic and preservative free artificial tears at two hourly interval and oral acetazolamid

On the next dayAnterior chamber was of normal depth when examined next day

Autoimmune screen disclosed a diagnosis of Sjögren’s syndrome, and the patient was commenced on systemic immunosuppression

1 month later, visual acuity was 3/10 left eye , and 8/10 right eye

with an anterior chamber reformed at left eye and regression of the ulcer at the right eye

Conclusion

Sjögren’s syndrome is an autoimmune disorder characterised by a variable degree of sicca symptoms including keratoconjunctivitis sicca and xerostomia

In the eye, it is considered predominately as an aqueous tear deficiency with an additional insufficient lipid layer component.

The purpose of a conjunctival flap is to restore the integrity of a chronically compromised corneal surface,63,64 and provide metabolic and mechanical support for corneal healing

A conjunctival flap will often provide comfort, reduce the ocular inflammation, and promote healing in these patients.