Unusual Case Of Bilateral Corneal Keloid Secondary To Exposure Keratopathy.

To report an unusual case of bilateral corneal keloid secondary to exposure to keratopathy in a young patient with epilepsy in the absence of previous ocular trauma, surgery or infection.

Ophthalmology unit, tertiary medical center, Riyadh, Saudi Arabia

A 28-year-old known case of epilepsy presented to our ophthalmology clinic with symptoms of dryness. On examination, visual acuity was 20/20, and Intraocular pressure was within normal limits for both eyes. Upon corneal assessment, bilateral  inferior hypertrophic white glistening corneal scars with iron lines. Eyelid assessment revealed lagophthalmos with incomplete lid closure. The remainder of the anterior and posterior segment examination was within normal limits. The patient denied any history of ocular trauma, infection, prior eye surgery. The hypertrophic scar is most likely corneal keloid which resulted from chronic corneal exposure secondary to lagophthalmos. which is unusual as exposure to keratopathy tends to result in a thinned scarred cornea, and the corneal keloid present usually with patients who had previous trauma or infection or surgery. This patient was managed with intensive ocular lubrication and protective measures, and the surgical option was deferred as the scar was stable and located inferiorly which does not obscure his vision. 

This case highlights an unusual presentation of bilateral corneal keloid secondary to chronic exposure keratopathy in the absence of trauma, infection, or prior surgery. This case emphasizes the importance of early diagnosis and intervention of exposure keratopathy to prevent corneal scarring and to preserve vision.