We report the case of a 45-year-old man with bilateral eye pain, intense photophobia and decreased visual acuity (VA).
Fifteen days before, she had been diagnosed with keratoconjunctivitis probably viral in treatment with tobramycin eye drops (Tobrex, Alcon Cusi, Barcelona) and adenoiclorens, chlorhydrate.
Descozor, photophobia and redness of 3 months duration, concomitant with asthenia, cachexia and weight loss of 16 kilograms (kg).
His personal history included alcoholic chronic pancreatitis, non-insulin dependent diabetes mellitus, smoking and percutaneous derivation pancreatitis performed 11 months earlier.
Among the pathological antecedents, pterygium excision in the RE associated with beta-therapy 5 years before and a posterior lamellar sclerocorneal graft due to trauma stand out.
On physical examination, the patient presented a 3-meter finger-count VA in the RE and perception and light in the LE.
The RE showed intense vascular injection, microcystic epithelial edema, non-inferior peripheral ulceration (PUQ) 16, tyndall 4 crosses and a posterior synechia with relevant intraocular pressure (IOP)
OI presents a very severe injection of conjunctival, ciliary and episcleral vascularization, pannus 360o, pterygium, a central corneal ulcer with stromal necrosis, level of hiphema occupying the posterior chamber 26
Corneal sensitivity was normal in both eyes (AO).
She was admitted to the hospital to start the study and treatment with oral prednisone 1 mg/kg/day (Dfremicin 0.5% All/4 mg Merck, Barcelona), and methotrexate alone 100 mg/h (Vibracin 0.5 mg/8hgansa).
Seven days later, the hyphema disappeared, with hypopyon level appearing in the left eye. Consequently, vancomycin-containing eye drops were associated with a concentration of 50 mg/ml Lilly corneal bacteria, 40 mg
A diagnostic-therapeutic OD upper conjunctival excision was performed, which ruled out vasculitic lesions or the presence of herpes simplex virus (HSV 1 and 2) by immunohistochemistry, showing an intense acanthosis.
Systemic examination ruled out any signs of rheumatic involvement, with serology of infectious diseases and negative markers of rheumatic diseases and vasculitis, except for elevated C-reactive protein and erythrocyte sedimentation rate.
Laboratory tests revealed macrocytic and hypochromic anemia, a pattern of severe lipoprotein malnutrition, hyperglycemia and elevated liver enzymes.
Fasting protein binding studies revealed mild malabsorption R and a decrease in liposoluble vitamins [vitamin A: 0.24 mg/ml (binding micrograms/millilitre) (N: 0.4-albumin).
Chest X-ray, cranial and thoracic-abdominal computed tomography (CAT) were normal.
The orbital CT showed mucosal thickening of the right maxillary sinus with normal otorhinolaryngological examination.
Ocular ultrasound ruled out vitreoretinal involvement of the left eye.
The diagnosis of protein-caloric malnutrition with vitamin A deficiency was then reached, starting treatment with hyperproteic and hypercaloric diet without sugar, pancreatic enzymes and oral vitamins.
The evolution was favorable, with resolution of the AO picture at 2 months and a VA of 1 RE and cd at 1 m OI.
OI has a central leukoma limited inferiorly by a lipid keratopathy and posterior synechiae, which still prevents seeing the FO.
