Keratoconus with spontaneous perforation of the cornea

A 24-year-old woman with a 5-year history of bilateral keratoconus who was in her eighth month of pregnancy presented with central corneal edema and mild acute iritis in her right eye. The iritis responded rapidly to therapy with topical corticosteroids, which was stopped after 1 week. The patient returned 1 week later with a markedly edematous central cornea, which had perforated. Management included a therapeutic soft contact lens, patching and, eventually, penetrating keratoplasty. The authors discuss the possible role of the pregnancy and of the topical corticosteroids in the development of the corneal perforation, a rare complication of keratoconus.