Superficial Anterior Lamellar Keratoplasty For Corneal Scarring Following Bilateral Chlamydial Ophthalmia Neonatorum Complicated By Familial Early-Onset Meibomian Gland Dysfunction

To report a complex case of bilateral Chlamydial ophthalmia neonatorum complicated by early-onset familial meibomian gland dysfunction with protracted healing and subsequently managed with superficial anterior lamellar keratoplasty (SALK)

Tertiary care centre in South India

A 10-day-old full-term female neonate presented with excessive watering, inability to open both her eyes, and inconsolable crying. She was delivered vaginally without perinatal complications. The mother suffered chronic ocular irritation and severe meibomian gland dysfunction (MGD), characterised by inspissated gland orifices and thickened meibum secretions. Ocular examination of the neonate revealed eyelid oedema, conjunctival hyperemia, mucopurulent discharge, and bilateral total corneal epithelial defects. Conjunctival swabs tested positive for Chlamydia trachomatis on polymerase chain reaction (PCR), confirming vertical transmission as the maternal vaginal swab was also positive. The neonate received a single dose of oral azithromycin (10 mg/kg), topical azithromycin 1% eye ointment thrice daily, and frequent preservative-free lubricants. Despite appropriate antimicrobial therapy, the epithelial defects persisted. Examination revealed inflamed lid margins and thick meibomian gland secretions, similar to her mother. The cornea healed over two months with superficial corneal vascularisation and anterior stromal haze. Topical fluorometholone 0.1% three times a day was added to manage haze. After two months, the cornea healed with central leucomatous opacity, persistent vascularisation, and a compromised ocular surface. However, severe haze persisted, and a superficial anterior lamellar keratoplasty was done in the left eye for the infant at 7 months to mitigate amblyopia.

This is the first report of vertically transmitted chlamydial conjunctivitis with bilateral total corneal epithelial defects, potentially compounded by familial early-onset MGD. This case underscores the importance of considering meibomian gland involvement in neonates with unusually severe or persistent epithelial disease, particularly when accompanied by a maternal ocular history. Early recognition and comprehensive management, including lid therapy and ocular surface support, may improve outcomes and reduce long-term visual morbidity. Further studies are needed to explore potential genetic or familial contributions to neonatal MGD. Superficial anterior lamellar keratoplasty may be considered for early visual rehabilitation.