A rare case of peripheral ulcerative keratitis in temporal arteritis

Area of Science:

• Ophthalmology
• Rheumatology
• Vascular Inflammation

Background:

• Temporal arteritis is a systemic vasculitis primarily affecting medium and large arteries.
• Ocular involvement in temporal arteritis can lead to severe visual impairment, including blindness.
• Peripheral ulcerative keratitis (PUK) is a serious ocular condition characterized by inflammation and melting of the peripheral cornea.

Observation:

• A 76-year-old male with newly diagnosed temporal arteritis presented with acute vision loss and severe peripheral corneal melting in his right eye.
• The clinical presentation rapidly progressed to corneal perforation despite initial treatment.
• The patient had no prior history of ocular involvement with his temporal arteritis.

Findings:

• The corneal perforation was successfully sealed using cyanoacrylate glue.
• Medical management included topical corticosteroids (dexamethasone), oral corticosteroids (prednisolone), and azathioprine.
• The patient achieved resolution of inflammation, with a quiescent eye post-treatment.

Implications:

• This is the first reported case of PUK progressing to corneal perforation in a patient with newly diagnosed temporal arteritis.
• The case underscores the potential for severe and rapid ocular complications in temporal arteritis, even without prior eye symptoms.
• Aggressive management combining surgical sealing of perforation, corticosteroids, and immunosuppressants may be crucial for preserving vision in such cases.