4. PATIENT
INFORMATION
• NAME : JANE DOE
• AGE: 66
• GENDER: FEMALE
• RACE:WHITE
• ADDRESS: NY
• OCCUPATION: RETIREDTEACHER
5. CHIEF
COMPLAIN
• Decreased vision in the right eye for the past 6 months
• Overall blurry vision worse upon waking up
• Difficulty seeing in low light
6. HISTORY • Diagnosed with right eye pseudo phakic bullous
keratopathy due to microcystic epithelial edema
• Positive history of cataract in both eyes
• She underwent IOL implantation in both eyes
• No relevant family history
• No known allergy
8. OCULAR
EXAMINATION
• Slit lamp examination of the left eye ,revealed
presence of cornea guttata
• There was also beaten metal appearance on the cornea
• Corneal stroma had normal transparency
• Lids, adnexa and conjunctiva were normal
• AC normal in depth
13. • FED is a bilateral, slowly progressive degeneration of
the cornea
• Women > Men
• Formation of guttate lesions between endothelium
and Descemet membrane
• Guttata- dew drop/ small excrescences noted in the
Descemet’s Membrane
• As the lesions enlarge , they covering endothelial cells
stretch and eventually fall off
• Cornea begins to swell causing glare, halo and reduced
visual acuity
DISCUSSION
18. HISTORY • Wears soft contact lenses on a monthly basis
• Felt some dryness in the past week and kept removing
the lenses
• No history of trauma
• No known allergies
• Hobbies include reading
20. OCULAR
EXAMINATION
• SL examination revealed a paracentral raised ulcer on
the cornea
• Approx. 0.8mm in size and surrounding ring of sub
epithelial infiltrates
• Ulcer was considered elevated
• There was 1n to 2+ injection OD
24. MANAGEMENT
&
FOLLOW-UP
• DiscontinueCL use
• Antibiotics ( Zymar ophthalmic solution) : initial dose
instilled every 15 min for the first hour and q2h
thereafter
• NSAID ( NSAIDAcular LS) q.i.d to ease the discomfort
• Patient instructed to return the next day
Follow –up
• Ulcer remained approx. the same size
• Patient reported less discomfort
• Continue therapy and instructed to call clinic if
discomfort increases
25. REFERENCES • SHERERJW.TRAUMATIC CORNEALULCER; REPORTOF
A CASE.JAMA. 1898;XXX(21):1215–1216.
doi:10.1001/jama.1898.72440730021002d
• Nicula,C., & Szabo, I. (2016). Complicated corneal ulcer.
Case report. Romanian journal of ophthalmology, 60 4,
260-263 .
• Fuchs E. Dystrophia epithelialis corneae. Grafes Arch
Clin Exp Ophthalmol. 1910; 76: 478–508.
• Elhalis H, Azizi B,Jurkunas UV. Fuchs endothelial corneal
dystrophy. Ocular Surf. 2010;8: 173–184.