Corneomalacia perforans in a patient with rheumatoid arthritis

Bilateral corneomalacia perforans occurred in a young woman who had had rheumatoid arthritis for 7 years. The perforations appeared to be precipitated by systemic corticosteroid therapy. The only symptom was a sudden loss of vision. Conservative treatment - withdrawal of the steroid therapy and application of soft contact lenses for 3 weeks - resulted in complete healing of the perforations and a marked increase in visual acuity.