Síndrome de ojo seco, perforación corneal y artritis reumatoidea: a propósito de un caso

Abstract

The subject is a male patient with a history of rheumatoid arthritis, dry eye syndrome and corneal transplant 3 years ago. Patient reports decreased visual acuity in his right eye. On physical examination, a rejection line is detected in meridian 6 of the cornea and temporal conjunctival hyperemia. A month later, he reports increased pain, conjunctival hyperemia, excessive secretion and visual acuity decreased to finger count at 3 meters in his right eye. The examination reveals a 360º corneal vascularization and aseptic perforation of the central cornea. The first therapeutic measure was cyanoacrylate and soft contact lenses, moxifloxacin 0.5% eye drops every 4 hours and sodium hyaluronate 0.1% eye drops. Fifteen days later, he did not report improvement and his visual acuity was reduced to finger count at 2 meters. On examination, neovascularization in four quadrant and seidel test was positive. The next day a conjunctival graft was performed improving the clinical condition; finally, a second tectonic corneal transplant was executed. The therapeutic and surgical approach to a corneal perforation depends on the size, shape, location and cause of the lesion, with cyanoacrylate tissue adhesives being useful in small lesions.