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NSAID-induced corneal melt as the first presentation of Sjögren’s syndrome
  1. Mustafa Hammad1,2,
  2. Lubna Ahmed3 and
  3. Mohamed Seifelnasr4,5
  1. 1General Surgery, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK
  2. 2Royal College of Surgeons in Ireland Medical University of Bahrain, Muharraq, Bahrain
  3. 3Ophthalmology, Northampton General Hospital NHS Trust, Northampton, UK
  4. 4Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK
  5. 5Ophthalmology, Alexandria University, Alexandria, Egypt
  1. Correspondence to Mohamed Seifelnasr; mohamadseifelnasr{at}gmail.com

Abstract

A non-diabetic woman in her 80s presented 1 week following uncomplicated left eye cataract surgery complaining of decreased vision, gritty sensation and photophobia in the same eye. Postoperative treatment included G. Acular (Ketorolac Tromethamine 0.5%, NSAID: non-steroidal anti-inflammatory drug) and G. Tobradex (Tobramycin 0.3% and Dexamethasone 0.1%, antibiotic and steroid, respectively) each prescribed four times a day for 2 weeks. On examination, the patient had a corneal epithelial defect which progressed to a full-thickness perforation despite ceasing the NSAID drops. Cyanoacrylate glue application with a plastic drape patch failed to seal the perforation, and a full-thickness tectonic corneal transplant was performed. On investigation, the patient had positive anti-RO and anti-LA antibodies, suggesting a diagnosis of Sjögren’s syndrome. We advocate for careful preoperative assessment prior to cataract surgery, patient education, close follow-up and cautious medication use postoperatively including avoiding NSAID drops in patients with risk factors for postoperative dry eye disease.

  • Ophthalmology
  • Anterior chamber
  • Rheumatology
  • Sjogren's syndrome
  • Pharmacology and therapeutics

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: MH and MS. The following authors performed the corneal glue and corneal transplant: MS. The following authors followed up the patient care and obtained informed consent: LA. The following authors gave final approval of the manuscript: MH, LA and MS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.