Corneal Perforation In Peripheral Ulcerative Keratitis Associated With Rheumatoid Arthritis In A Monocular Patient: Management Challenges

Peripheral ulcerative keratitis is a severe ocular manifestation of Rheumatoid Arthritis, characterized by progressive peripheral corneal thinning that may lead to Corneal Perforation. This condition represents a major threat to ocular integrity and visual function. We report a challenging case of corneal perforation occurring in a monocular patient with long-standing rheumatoid arthritis.

Department of Ophthalmology, University Hospital.

We report the clinical presentation, management, and outcome of a 51-year-old woman with a 20-year history of seropositive Rheumatoid Arthritis, treated with methotrexate and low-dose oral corticosteroids. The patient presented with a painful red eye and decreased vision in her only functional eye. Ophthalmological examination revealed conjunctival hyperemia and a 2-mm nasal Corneal Perforation with iris prolapse. Emergency surgical management was performed using Amniotic Membrane Transplantation, combined with intravenous corticosteroid pulse therapy.

Postoperative evolution was favorable, with closure of the perforation, restoration of corneal integrity, and complete epithelialisation of the graft. Visual rehabilitation with a scleral contact lens allowed improvement of best-corrected visual acuity to 1/10. Systemic management of rheumatoid arthritis was optimised to control the underlying inflammatory process.

Peripheral ulcerative keratitis associated with rheumatoid arthritis is a sight-threatening condition that may lead to corneal perforation. Prompt surgical management combined with adequate systemic control of the underlying disease is essential to preserve ocular integrity and optimize visual outcomes.