When The Ocular Surface Mirrors A Harmful Systemic Condition

To emphasize the role of ocular surface in revealing immune disorders

 

Ocular surface is an important item to consider while prescribing anti glaucoma therapy. Topical drugs may considerably harm the cornea and the clinician is somehow redirected to other therapeutic alternatives. Nevertheless the pressure lowering medications are not always the primary source of corneal suffer. 

we report the example of a patient with refractory open angle glaucoma and damaged ocular surface who was diagnosted with ocular cicatricial pemphigoid after deeper investigations. 

A 50 year-old-man presented in our consultation for open angle glaucoma (OAP) refractory to pressure-lowering medications. He reported the notion of increased photophobia and permanent red eyes since 6 months.  Best corrected visual acuity (BCVA) was 20/80 in both eyes. Slit lamp examination  revealed hyperemic conjunctiva, a marginal corneal ulcer with positive fluorescein reaction and diffuse punctuate keratitis in both eyes. Examination of the left eye showed a symblepharon. The decision was to stop all the topical medication. Conjunctival biopsy of the left eye  concluded to ocular cicatricial pemphigoid. The patient benefited from oral corticosteroid and immunosuppressant therapy  with favorable evolution and relieved ocular symptoms. 

OAG refractory to well conducted medical treatment shouldn’t lead systematically to practice filtering surgery. This case shows that ocular intolerance to pressure-lowering medications may be the first manifestation of a silent systemic condition.