Circumcorneal Thinning Post Rheumatoid Disease
- 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
