Corneal Perforation Revealing A Gougerot Sjogren Syndrome

Gougerot-Sjögren syndrome is an autoimmune inflammatory disease that targets the exocrine glands. The salivary and lacrimal glands, infiltrated by T lymphocytes leading to their destruction, decrease their secretions: this results in xerophthalmia and xerostomia. The ophthalmological manifestations can be indicative of the pathology.

Ocular manifestations in autoimmune diseases are mainly dry syndrome, scleritis and keratitis. Corneal perforation is rare and constitutes a real therapeutic emergency.
The aim of our work is to recall the clinical aspects and the diagnostic approach, to insist on the seriousness of the disease and to update the therapeutic aspect.

We report the case of a 56-year-old woman who presented with a notion of inflammatory polyarthralgia for 4 years with self-medication by oral NSAID who presented a reduced visual acuity with foreign body sensation in both eyes for a month.

The ophthalmological examination found a visual acuity of 1/10 in both eyes, a slight conjunctival hyperemia in both eyes.

The right eye presented a corneal ulcer of 1mm/1mm that was para central with diffuse KPS.

The left eye had a para central corneal ulcer of 1.5mm/1mm with diffuse KPS.

Corneal sampling with mycological, parasitological and bacteriological study were carried out and were negative. Schirmer's test was 2mm ODG.

The patient was put on lubricating agents with high-dose corticosteroid therapy.

The evolution was marked by a healing of the ulcer on the right, with corneal perforation after 20 days on the left eye, the clinical examination of the left eye finds: a visual acuity to count the near fingers a corneal perforation <1mm, a positive spontaneous Seidel and an anterior chamber in athalamie.

A treatment with cyanoacrylate glue was performed along with medical treatment.

The biological tests found: rheumatoid factor, antinuclear antibodies and native anti-DNA antibodies, all negative.

A labial biopsy performed found a lymphoplasmacytic infiltration of the exocrine gland in favor of a primitive Gougerot Sjogren syndrome.

Aseptic corneal ulcers are rare but serious complications can occur. The risk is the evolution towards corneal perforation. The diagnosis and management of these ulcers remain a real challenge for ophthalmologists.