Circumcorneal Thinning Post Rheumatoid Disease

Circumcorneal thinning and mild neovascularization post rheumatoid-associated peripheral ulcerative keratitis. 

  • Rheumatoid arthritis is the most common systemic, immune-mediated disease affecting the ocular surface.
  • Primarily affects middle age females.

Clinical features:

  • Episcleritis or scleritis
  • Mild superficial punctate keratitis or severe sclerosing keratitis
  • Peripheral corneal infiltrates which may progress to marginal furrowing, thinning or melting
  • Keratoconjunctivitis sicca (secondary Sjorgen syndrome)

Management:

  • Treatment is addressed primarily to the systemic condition.
  • Systemic and topical corticosteroids are useful for ocular inflammation.
  • Aggressive ocular surface lubrication and/or punctal plug for keratoconjunctivitis sicca.
  • Cyanoacrylate adhesive for severe corneal melting.
  • Lamellar or penetrating keratoplasty for perforation.