Corneal ulceration following cataract surgery in patients with rheumatoid arthritis

A sterile corneal ulcer was observed in four cataract patients (two with intraocular lenses) during the early postoperative period. All patients had a history of rheumatoid arthritis and were on systemic antiinflammatory agents. The two patients treated medically exhibited a short recovery phase with complete healing over several days and no recurrence. Aggressive treatment of the dry eye syndrome with artificial tears, bandage lenses, punctal occlusion, tarsorrhaphy, and antibiotics resulted in immediate improvement. In this report, variabilities in corneal ulceration are stressed while emphasis is given to the role of dry eyes and exposure as the principal common factor. A discussion of risk factors, presentation, treatment, pathogenesis, and prevention is provided.