J Korean Ophthalmol Soc.  2014 Jun;55(6):913-917.

A Case of Peripheral Ulcerative Keratitis and Scleritis in a Patient with Pustular Psoriasis

• Lee TH
• Ji YS
• Kim SJ
• Yoon KC

Abstract

PURPOSE
To report a case of peripheral ulcerative keratitis and scleritis in a patient with pustular psoriasis.
CASE SUMMARY
A 62-year-old male presented with skin lesions on the hands and feet and pain in the right eye, which started a few days prior. Corrected visual acuity was 0.5 in the right eye and 0.7 in the left eye at initial visit. Corneal edema, erosion, ulcer and peripheral corneal infiltration of the right eye were observed. However, anterior chamber reaction was not observed. Histological analysis of hand skin lesions indicated pustular psoriasis. The patient was initially treated with topical antibiotics and a combined therapy of oral and topical steroids for ocular symptoms. As a result, the right eye showed slight improvement and the oral steroid was discontinued. One month after the initial visit, scleritis appeared on the left eye and topical and oral steroids were restarted for both eyes. Two months after the initial visit, ocular symptoms were improved significantly and corrected visual acuity was 1.0 in both eyes. The mild peripheral corneal opacity remained in the right eye, but the previous inflammations in both eyes were improved.
CONCLUSIONS
As shown in this case, possibility of peripheral corneal infiltration, corneal ulcer and scleritis should be considered in patients with pustular psoriasis and topical and systemic steroids should be administered if accompanying ocular manifestations occur.

Keyword

Peripheral ulcerative keratitis; Pustular psoriasis; Scleritis

MeSH Terms

Anterior Chamber
Anti-Bacterial Agents
Corneal Edema
Corneal Opacity
Corneal Ulcer*
Foot
Hand
Humans
Inflammation
Male
Middle Aged
Psoriasis*
Scleritis*
Skin
Steroids
Ulcer
Visual Acuity
Anti-Bacterial Agents
Steroids

Figure

• 

  Figure 1. Slit lamp photographs of the right eye. (A, B) The whitish infiltration with ulceration (white arrow), epithelial defects (yellow arrow) and superficial vascularization (white arrow head) at the upper peripheral cornea and perilimbal inflammation in the sclera were noted at initial visit. (C) Two weeks after treatment, the peripheral corneal lesions were improved. (D) Two months after treatment, the lesions were healed with mild peripheral corneal haze.

• 

  Figure 2. Photographs of the patient and histology. (A) Asymptomatic erythematous variable sized pustules and papules were visible in the palm of the hand. (B) Variable sized erythematous pustules were noted in the plantar of the foot. (C, D) The histologic exami-nation of the biopsy tissue revealed an epidermal hyperplasia, hyperkeratosis, parakeratosis, dilated vessels at the tip of the dermal papillae, and perivascular infiltrate of lymphocytes and neutrophils (C) and a large collection of neutrophils with spongiosis in the upper spinous layer and granular layer (D) (Hematoxylin & Eosin stain, x 100).

• 

  Figure 3. Slit lamp photographs of the left eye. (A) One month after initial treatment, newly developed episcleral and scleral vascular injections were noted. (B) One months after treatment of scleritis, the previous injections were improved.

Reference

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