Rheumatoid corneal melt: autoimmunity or infection?

Awomanwith type 2 diabetes, rheumatoid arthritis and secondary Sjögren’s syndrome developed severe corneal ulceration (keratitis) on two separate occasions three years apart while taking systemic immunosuppression for her rheumatoid arthritis. Her ocular history included Sjögren’s syndromerelated dry eyes for which she used non-preserved ocular lubricants, together with recurrent episodes of marginal keratitis treated successfully with topical steroids and prophylactic antibiotics on an outpatient basis. The early management strategies for each of the severe clinical episodes are presented and the clinical outcomes for both eyes, discussed.