Oral Nsaid-Induced Corneal Melt In A Medically Free Male Patient: A Case Report.

Published 2022 - 40th Congress of the ESCRS

Reference: PO041 | Type: Case report | DOI: 10.82333/ts5d-4r34

Authors: Shaikha Hamed Aldossari* ¹ , Mohammed AlMutlaq ² , Reham Aljehani ³ , Khaled Alabduljabbar ¹

¹Residency,King Khaled Eye Specialist Hospital,Riyadh,Saudi Arabia, ²King Khaled Eye Specialist Hospital,Riyadh,Saudi Arabia, ³Jeddah Eye Hospital,Jeddah,Saudi Arabia

To report a possible association between administration of oral NSAIDs and corneal melt.

Corneal melt and perforation can develop due to different causes including use of toxic topical drops. An example is topical non-steroidal anti-inflammatory drugs (NSAIDs) as it can impair corneal wound healing, leading to the development of corneal ulcers and corneal perforation. Topical NSAIDs-induced corneal ulcers have been reported in the literature. However, use of oral NSAIDs is not well-known to cause corneal melt and perforation.

A 79-year-old man, presented to our emergency room complaining of tearing and irritation for the past 15 days. This eye has been blind for long time due total cupping from undiagnosed advanced glaucoma. Patient denied any medical problems but reports using self-prescribed oral Diclofenac 100mg once daily for 1 year. He also denied history of trauma or contact lens use. Systemic review was unremarkable.

On examination, visual acuity was poor light perception right eye, 20/40 left eye.

Slit lamp examination of the right eye revealed complete corneal melt (almost 9x9mm), intraocular lens (IOL) protruding with its haptics centrally, distorted iris and no view to the fundus. Left eye revealed anterior blepharitis, clear and quiet conjunctiva and sclera. Corneal thinning was noted superiorly from 11 to 12 peripherally with clear cornea and no leak. Rest of slit lamp examination was unremarkable. Patient was found to have a large corneal perforation with exposed IOL secondary to corneal melt in the right eye.

Options of evisceration versus tectonic penetrating keratoplasty were discussed with the patient and the decision was to undergo tectonic penetrating keratoplasty. Patient was admitted to the hospital and undergone emergent tectonic penetrating keratoplasty to salvage the eye given his poor visual potential.

All blood workup and diagnostic imaging were unremarkable.

This case report proposes a possible association between oral administration of NSAIDs and corneal melt. Therefore, healthcare workers should consider this risk when administering oral NSAID for long duration.