SUDDEN ONSET OF CORNEAL CICATRISATION HAS SPONTANEOUS RECOVERY

 A PATIENT who developed a sudden onset of uniocular cicatrisation accompanied by a skin rash had an equally mysterious disappearance of his condition, said Andrena McElvanney, UK, in a case report she presented at a Cornea Day session at the 20th ESCRS Winter Meeting in Athens yesterday.
 The patient, a 79-year-old man with a long history of stable cicatricial pemphigoid, presented with acute visual loss in his left eye, with vision reduced to light perception, aggressive cicatrisation with central corneal ulceration and thinning. His right eye was unaffected. He also had a rash occurring on his arms, legs and trunk.
 The patient was receiving maintenance immunosuppressive therapy with dapsone for cicatricial pemphigoid diagnosed when he was 59 years old. He refused an increased dosage of immunosuppressive therapy for his current condition, because of previous systemic reactions. However, his ocular cicatrisation resolved almost completely, with a subjective improvement in vision when receiving monotherapy with topical chloramphenicol.
 A skin biopsy revealed that the patient had spongiotic dermatitis, with abundant eosinophiles. Histology was inconsistent with cutaneous lupus but was consistent with hypersensitivity reaction to systemic lupus. He also had raised levels of immunoglobulins M and G, suggesting monoclonal gammopathy.
“Conjunctival cicatrisation is a spectrum of diseases. Treatment should be based on the activity of disease progression and the patient’s general health.
 Systemic evaluation is necessary to exclude other underlying disease processes,” Dr McElvanney concluded.