Spontaneous perforation of the cornea in mild keratoconus

Spontaneous corneal perforation during acute hydrops in keratoconus is a very rare complication and has only been described in patients with advanced keratoconus. We describe a case of spontaneous corneal perforation in mild keratoconus in a patient with no identifiable risk factors.

We report retrospectively on a 34-year-old woman with mild keratoconus (Krumeich stage II) who presented with the spontaneous perforation of the cornea. A literature review was undertaken.

The handful of previously reported cases included patients with advanced keratoconus. Our patient had none of the risk factors identified in previously reported cases (eye rubbing, topical steroid use, and raised intraocular pressures). Corneal gluing was performed to restore globe integrity. She retained a visual acuity of 6/9 even through the acute episode. With the resolution of the acute episode, her corneal astigmatism improved and she achieved a final best-corrected visual acuity of 6/6 with spectacles.

To our knowledge, this is the first reported case of spontaneous perforation of the cornea in mild keratoconus. We demonstrate that in this event, a good visual prognosis is possible from gluing alone.