Corneal perforation as a primary manifestation of keratoconus in a patient with underlying rheumatoid arthritis

PURPOSE The purpose of this study is to report a case of corneal perforation in a patient with undiagnosed keratoconus and underlying rheumatoid arthritis. METHODS This is a retrospective case study based on the patient's medical records and followed by a brief review of the literature. RESULTS A 53-year-old patient was referred to our department for acute pain and sudden decrease of visual acuity in his left eye. Corneal perforation was detected and attributed to a previously undiagnosed and untreated keratoconus. Additional laboratory work-up and clinical examination revealed a coexisting rheumatoid arthritis. Amniotic membrane was originally transplanted in order to maintain the structural integrity and promote healing of the perforated eye. Subsequently, the patient underwent a penetrating keratoplasty, though with unfavorable results due to postoperative endophthalmitis. CONCLUSIONS Rheumatoid arthritis may be associated with higher risk of corneal perforation in patients with ectatic degenerative diseases such as keratoconus.