Corneal And Scleral Melt Following The Chronic Use Of Hydroquinone-Containing Skin-Lightening Cream

A 67-year-old woman of African descent presented with a two-week history of headache and pain in the left eye. The patient presented with sudden vision loss in the left eye accompanied by excessive tearing.
On examination, the uncorrected visual acuity was hand movements in the left eye and 6/60 in the right eye.
Biomicroscopy of the left eye revealed conjunctival injection, nasal limbal corneal thinning, and a corneal perforation sealed by a large iris prolapse plug temporally. The AC was shallow but formed, and fibrin was present.

This patient presented with bilateral severe corneal melting and perforation which we associated with hydroquinone. In the case of this patient, all evaluations of systemic and local causes were negative and the appearance of the ulcers were not typical for Moorens, leading us to seek an alternative diagnosis. The dermatological review during the hospitalization led to the diagnosis of ochronosis. The patient reported daily use of skin-lightening creams containing hydroquinone of unknown concentration for a period of at least two years.

The patient underwent tectonic corneal transplantation in the left eye followed by a second procedure. During this procedure, an amniotic membrane was placed over the tectonic patch, followed by a scleral patch, a second layer of amniotic membrane with a conjunctival layer sutured on top, the application of an additional amniotic membrane, and the application of a megasoft contact lens.