A 54 year-old presented
with a 2-week history of a very painful right eye. He was treated by his GP
and a private general ophthalmologist with topical antibiotics without
improvement. His vision was 6/12. Slit-lamp examination showed an area of
scleral necrosis in the temporal region with exposure of the uvea tissue.
The tissue was covered by a layer of thin membrane. The medial area showed
an area of thinning medially. There was a mild anterior chamber reaction but
the vitreous showed no inflammatory cells.
Ocular history revealed
that he had had a medial pterygium excision 9 years ago but it was not known
if he received any adjunctive mitomycin C treatment. Systemic enquiries were
negative for any systemic diseases. He was started on 2hourly topical
betamethasone and chloramphenicol, oral doxycycline and vitamin C. Blood
tests were requested for connective vascular diseases and also as a base
line in preparation for systemic immunosuppressant therapy (ie. steroid and
cyclosporine). A chest X-ray was requested to look for any signs of systemic
diseases (for example Wegener's disease and sarcoidosis) and also to exclude
tuberculosis as the patient is likely to require systemic steroid.
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Temporal necrotizing scleritis and a
nasal area of thinning.
Temporal necrotizing scleritis with
uveal tissue exposure.
A closer view of the necrotizing
scleritis. |
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