Scleral melting in a patient with carotid artery obstruction
Jan H Schotveld1, Jeroen J G Beerthuizen, Michel J W Zaal
1Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands. j.h.schotveld@olvg.nl
Purpose:
To report a case of severe scleral melting in a patient with carotid artery obstruction.
Methods:
This is an observational case report. We reviewed the patient's chart and the available literature on ocular melting and ocular ischemia.
Results:
A 71-year-old man with a history of carotid vascular disease and a blind left eye due to a previous vascular accident developed scleral melting of the right eye. Despite frequent lubricants, systemic immunosuppressives, and repeated conjunctiva transplants, the thinning progressed and his visual acuity deteriorated. Intensive screening for possible underlying diseases revealed no infectious or collagen vascular disease. Magnetic resonance angiography, however, showed a subtotal obstruction of the right internal carotid artery. Further investigations revealed coronary artery obstruction. Carotid surgery combined with coronary artery bypass grafting was performed, and a stable ocular situation was achieved.
Conclusions:
Although a causal factor cannot always be determined, corneoscleral melting should be regarded as a manifestation of underlying systemic or ocular disorders. In the absence of more common causes of corneoscleral melting, a thorough workup is warranted and might reveal life-threatening disorders.
