Abstract
Abstract: :
Purpose: To document for the first time development of a peripheral corneal stromal melt secondary to the combination of staph marginal keratitis and neurotrophic keratitis. Methods: Observational case report. Results: A 66–year–old Caucasian female with a 15–year history of IDDM and 3+ anterior blepharitis presented with a 1.5 mm x 2.75 mm superficial perilimbal corneal infiltrate OD, with oval configuration and long axis running parallel to the limbus. A similarly configured nonstaining vascularized dellen was noted at the 6 o'clock perilimbal position. In addition, 2+ diffuse PEK was noted across the inferocentral cornea. Following one week of treatment with Vigamox and FML q.i.d., the patient returned demonstrating slough of the infiltrate with resultant clear stroma but frank epithelial defect. Corneal sensation (Cocket–Bonnet) and Schirmer testing (with topical anesthesia) revealed values of 5 mm OD, 30 mm OS, and 10 mm OD, 11 mm OS respectively. A silicone plug was inserted into the RLL, the FML discontinued, and the Vigamox maintained at q.i.d. One week later, the patient again returned, this time demonstrating a 50% stromal melt of the affected area. A silicone plug was inserted into the RUL, resulting in rapid epithelialization and stabilization of the lesion. Conclusions: Staph marginal keratitis coupled with neurotrophic keratitis can result in peripheral corneal stromal melt, with potential for corneal perforation. This previously undescribed entity, termed here "Combined Marginal Corneal Melt," should be added to the differential diagnosis for peripheral corneal melts including Terrien's marginal degeneration, Mooren's ulcer, and collagen vascular diseases. Proper diagnostic recognition can result in relatively simple but highly effective (punctal occlusive) therapeutic intervention.
Keywords: keratitis • Staphylococcus • cornea: clinical science