Vol 4 (2019): Continuous Publishing
Case report
Published online: 2019-11-13

open access

Page views 810
Article views/downloads 969
Get Citation

Connect on Social Media

Connect on Social Media

Scleromalacia perforans as the presenting sign for rheumatoid arthritis — a case report

Ibrahim Al Nawaiseh1, Rashed Mustafa Nazzal2, Katarzyna Nowomiejska2, Mario Toro2, Robert Rejdak2
Ophthalmol J 2019;4:56-59.

Abstract

Scleromalacia perforans is a rare but well-recognised extra-articular complication of rheumatoid arthritis. It is diagnosed
usually late in the course of the disease. In this paper we present a case of scleromalacia perforans in which the patient was not diagnosed with rheumatoid arthritis previously; the elderly female presented with bilateral foreign body sensation and was found to have scleromalacia perforans, which was treated medically with a bolus dose of steroids followed by combined oral steroids and methotrexate, from which she developed the devastating side effect of thrombocytopaenia. The patient was planned for surgical therapy for the scleromalacia, but unfortunately she passed away during the follow-up.

Article available in PDF format

View PDF Download PDF file

References

  1. Jack J, Kanski BB. Clinical Ophthalmology: A Systematic Approach. Elsevier 2016: 253–267.
  2. American Academy of Ophthalmology. Basic and Clinical Science Course. Section 8. American Academy of Ophthalmology, San Fransisco 2014: 202–210.
  3. van der Hoeve J, J va. Scleromalacia perforans. Ned T Geneesk. 1931; 75: 4733.
  4. Ashton N, Hobbs HE. Effect of cortisone on rheumatoid nodules of the sclera (scleromalacia perforans). Br J Ophthalmol. 1952; 36(7): 373–384.
  5. Kopacz D, Kopacz D. Scleromalacia Perforans — What We Know and What We Can Do. J Clin Exp Ophthal. 2013: 9–11.
  6. Fong LP, Sainz de la Maza M, Rice BA, et al. Immunopathology of scleritis. Ophthalmology. 1991; 98(4): 472–479.
  7. Ghauri MI, Riaz SU, Husain A, et al. Scleromalacia perforans: a case report. J Med Case Rep. 2018; 12(1): 155.
  8. Herrera-Esparza R, Avalos-Díaz E, Herrera-Esparza R, et al. Infliximab treatment in a case of rheumatoid scleromalacia perforans. Reumatismo. 2009; 61(3): 212–215.
  9. Foster CS, Forstot SL, Wilson LA. Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis. Effects of systemic immunosuppression. Ophthalmology. 1984; 91(10): 1253–1263.