Corneal Melting Secondary To Malnutrition And Systemic Steroid Abuse: A Case Report

To report rare case of corneal melting and perforation secondary to malnutrition following bariatric surgery and systemic steroid abuse and to highlight the potentially fatal complications corticosteroids might have if used without medical supervision.

Emergency department at Kasr Al Ainy,Cairo University Hospitals.

A 27-year-old female presented with painful diminution of vision along with eye redness starting 1 month ago.
She has a history of gastric bypass surgery done 10 years ago following which she lost significant amount of weight from 145 kg to 52 kg. 3 months ago, she decided to start oral prednisolone 90 mg/day for weight gain following excessive weight loss. 2 weeks prior to her presentation, she tapered the dose to 7.5 mg/day.
On examination, she was pale, ill-appearing with cushingoid facies. Orthostatic hypotension was present and bruises were observed over extremities. Mucous membranes were dry. Ocular examination showed left corneal perforation with infected, irregular margins. Anterior chamber was lost along with severe ciliary injection. Unaided visual acuity was hand motion. Right eye had severe dryness, but examination was otherwise irremarkable. Laboratory investigations showed anemia (Hemoglobin10.1 g/dL), bleeding tendency (INR 1.6)and hypoglycemia.
Patient was diagnosed with adrenal insufficiency, along with marked nutritional deficiency. She was stabilized in the ED and given stress dose steroids 100 mg IV following which emergency tectonic graft surgery was performed with AC reformation. She was later treated for steroid-withdrawal induced adrenal insufficiency along with nutritional rehabilitation.
Ultrasound done after wound stabilization revealed clear vitreous and attached retina. Shemis awaiting perforating keratoplasty after stabilization of medical condition.

Unsupervised use of corticosteroids can lead to sight- and life-threatening complications. Patient education is crucial post-bariatric surgery to prevent severe complications due to nutritional deficiency and/or self-medication.