This document presents a case study of a 65-year-old female experiencing diminishing vision, pain, redness, and photophobia in her left eye for 15 days. Her history includes a corneal graft in the left eye 2 months prior and treatment for herpes simplex keratitis. On examination, the left eye shows signs of graft rejection including edema, microcysts, and vascularization. The provisional diagnosis is acute corneal graft rejection in the left eye. The recommended treatment includes IV and oral steroids, topical medications, and antivirals.

1. CASE PRESENTATION

2. Demographic data
• Name: xyz
• Age : 65 years
• Sex : Female
• Address : Sitapur
• Occupation : Housewife
• Socio-economic status: Low socio economic
class
9-Jan-23 Sitapur Eye Hospital, RIO Sitapur 2
 Diminution of vision in left eye -15 days
 Pain in left eye – 15 days
 Redness in left eye – 15 days
 Photophobia in left eye – 15 days

3. History of presenting illness
• Patient was apparently asymptomatic 15 days back when she started
developing diminution of vision which was sudden in onset, progressive
in nature .
• There is also a history of pain ,photophobia in LE which was acute in
onset, continuous, dull aching , non radiating, localised and relieved on
taking medication
• There is also history of redness in LE since 15 days.
9-Jan-23 Sitapur Eye Hospital, RIO Sitapur 3

4. Past history
• No h/o trauma
• No h/o diabetes, hypertension and thyroid disorders.
• No h/o any systemic illness
• No history of use of any contact lenses.
• She underwent uneventful cataract surgery in both eyes 4 years
ago.

5. Past history
• Patient had past history of recurrent redness and diminution of
vision in the left eye since 2 year. She was diagnosed with left
eye herpes simplex keratitis and was treated for the same .
• She had undergone left eye optical penetrating keratoplasty on
3 June 2022 and was on topical antibiotic steroid medications .
• She was using on E/d Moxifloxacin 0.5% 4 times in LE
,Dexamethasone 0.1% used 4 times in left eye , E/d
carboxymethyl cellulose 0.5% used 6 t/day

6. Family history
• Not significant

7. Personal History
• Diet – Vegetarian
• Appetite- Normal
• Sleep – Undisturbed
• Bowel habits – Unaltered
• Bladder habits – Unaltered
 No h/o alcohol consumption
9-Jan-23 Sitapur Eye Hospital, RIO Sitapur 7

8. General & Systemic examination
• Average built, well nourished, conscious, well oriented to time ,
place and person
• Afebrile, temprature -98.6 degree F.
• Vitals-: Pulse- 88/min, regular, normal in volume and rhythm
• Respiratory rate-17/min
• BP-124/80 mm Hg left arm sitting position
• No pallor, icterus, clubbing, cyanosis, regional lymphadenopathy
• CVS, R/S , Abdomen – WNL

9. Ocular Examination (Both Eyes)
• Head Posture – Straight looking forward, Normal facial symmetry.
• Orbit- margins palpable, continuous, well defined, non tender, no crepitus or fracture.
• Eyeballs- normal in size and position
• Eyebrows are at normal level and position.
• Eyelids- upper eyelids and lower eyelid are normal in position, movements, No trichiasis
or distichiasis. No lid lag.
• Lacrimal apparatus -no fistula, no swelling, ROPLAS negative
9-Jan-23 Sitapur Eye Hospital, RIO Sitapur 9

10. OD OS

11. Ocular Examination
OD OS
UCVA 6/12 FCF
With Pin hole 6/9 FCF
Near Vision N-6 <N-36
BCVA 6/9 @ - 1.0D cyl at 90 No Acceptance
Retinoscopy (wet) at 2/3rd
mtr with E/d tropicamide
phenylephrine
No fundal glow seen
IOP (Applanation
tonometer)
@10 : 30 am
18 mmHg 16mmHg
+0.5DS
+1.5DS
11

12. OD OS
CONJUNCTIVA Normal, No congestion or chemosis Circumcillary congestion
CORNEA Normal size, shape , transparency,
lusture, curvature and sensation
intact.
Diffuse epithelial and stromal edema
with microcysts more localized from
2-6 clock hours with superficial
vascularization present extending
superiorly , 9 intact corneal sutures
ANTERIOR CHAMBER Normal in depth and content Vh2 , AC reaction was present
IRIS Brown in color and normal in texture Hazily seen
PUPIL Single, central, circular Hazily seen
LENS PCIOL PCIOL

14. OS

15. Provisional Diagnosis
• My provisional diagnosis on the basis of history and clinical
examination LE Acute corneal graft rejection .
• RE Pseudophakia

16. Management
• IV methyl prednisolone pulse therapy 500mg in saline BD X3
days following which oral steroids in tapering dose for 6 weeks
• Topical prednisolone eye drops hourly for 3 days and 2nd hourly
after for left eye
• Left eye Subconjunctival inj. Dexamethasone
• Cyclosporine eye drops 1 % 4 times a day for left eye
• Homatropine 2% eye drops 3 times for left eye
• Oral acyclovir 400mg 5 times a day for 1month