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  • Corneal perforation in undiagnosed Sjögren’s syndrome following topical NSAID and steroid drops post routine cataract extraction

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Unexpected outcome (positive or negative) including adverse drug reactions
CASE REPORT
Corneal perforation in undiagnosed Sjögren’s syndrome following topical NSAID and steroid drops post routine cataract extraction
  1. Patrick Murtagh1,
  2. Richard Comer2,
  3. Gerry Fahy1
  1. 1Department of Ophthalmology, Galway University Hospitals, Galway, Ireland
  2. 2Department of Ophthalmology, Bon Secours Hospital Galway, Galway, Ireland
  1. Correspondence to Dr Patrick Murtagh, murtagp{at}tcd.ie

Summary

A 74-year-old man presented with a progressive decrease in visual acuity and foreign body sensation in his right eye 8 days post uncomplicated phacoemulsification cataract surgery and intraocular lens insertion. The patient had been placed on a perioperative cataract regimen which consisted of G. Maxitrol (dexamethasone, polymyxin B sulfate, neomycin sulfate) four times a day and G. Yellox twice daily (bromfenac, a non-steroidal anti-inflammatory) for 2 weeks. On examination, he had a corneal ulcer and stromal thinning in his right eye which progressed to a full thickness perforation 12 hours later. The patient required a full thickness tectonic corneal transplant. Direct questioning revealed that this patient had both dry mouth and eyes. Serology revealed that the patient was positive for rheumatoid factor and for anti-Ro and anti-La antibodies. A parotid gland biopsy revealed significant lymphocytic infiltrate consistent with Sjögren’s syndrome.

  • eye
  • ophthalmology
  • anterior chamber
  • sjogren’s syndrome

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bcr-2018-225428

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    Footnotes

    • Contributors RC initially saw the patient and underwent emergency treatment. He was referred to GF for further intervention. RC suggested to PM that the case should be written up and PM wrote the case report under the guidance of both GF and RC. GF and RC reviewed numerous drafts until they deemed it fit for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.