PURPOSE To report a case of bilateral central corneal ulcers with scleroderma-associated sjogren’s syndrome. METHODS A 52-year-old female presented with complaint of ocular pain and decreased visual acuity of both eyes for almost two months. The meibomian orifices were plugged with inspissated secretions(Figure 1). Meanwhile the patient was characterized by bilateral eyelid tightness and mild hypophasis. Bilateral corneal lesions were situated centrally with local epithelial loss and deep stromal infiltration. The right corneal lesion has already developed scar and calcified(Figure 1), the left lesion was in the aggressive-phase with corneal edema and opacity(Figure 2). The tear film break-up time of both eyes were less than 5”, bilateral Schirmer tests were less than 5mm without anesthesia. Both lesions were treated with artificial tears, lubricant ointment and antibiotic medications. Her past medical history included systemic scleroderma and sjogren’s syndrome .
RESULTS After treatment, bilateral corneal ulcers subsided (Figure 4). But visual acuity of both eyes didn’t improve.
CONCLUSIONS Systemic scleroderma is a progressive multi-system connective tissue disease. Ocular involvement includes keratoconjunctivitis sicca, progressive shallowing of conjunctical fornices, peripheral ulcerative keratitis and eyelid tightness. No association has been reported between scleroderma and central corneal ulcers, we concluded the ulcers may be caused by both dry eye and infections. |