Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.
Eur J Ophthalmol. 2021 Nov;31(6):NP9-NP12. doi: 10.1177/1120672120932089. Epub 2020 Jun 3.
To report a case of unilateral corneal perforation due to isolated ocular lichen planus.
Interventional case report. Informed consent by the patient was obtained to publish clinical images. A 64-year-old male presented with severe vision loss and a 2-week history of corneal perforation treated with penetrating keratoplasty in the left eye. He had a longstanding diagnosis of severe chronic dry eye disease. On the initial assessment a visual acuity of 20/50 in the RE and HM perception in the left eye were documented. Biomicroscopy revealed subepithelial fibrosis on the tarsal conjunctiva and clinical signs of severe dry eye disease in both eyes. A clear corneal button and a white cataract were observed in the left eye. No other skin or mucosal lesions were observed.
An excisional biopsy of the bulbar conjunctiva was performed under topical anesthesia. Direct immunofluorescence analysis revealed a linear deposit of fibrinogen in the basement membrane consistent with ocular lichen planus. Clinical improvement was achieved using aggressive topical lubrication, corneal epithelial regenerators, topical tacrolimus, and immunosuppressive therapy with systemic corticosteroids and cyclophosphamide.
Isolated ocular lichen planus is an extremely infrequent presentation of lichen planus often indistinguishable from other cicatricial conjunctivitis. Corneal perforation is a severe complication associated with severe dry eye, not previously reported with ocular lichen planus. An adequate clinical assessment and histopathologic diagnosis are crucial to lead prompt treatment and prevent sight-threatening complications.
报告一例因孤立性眼扁平苔藓导致的单侧角膜穿孔。
介入性病例报告。获得患者知情同意后，发表了临床图像。一名 64 岁男性因左眼严重视力丧失和 2 周的角膜穿孔病史就诊，曾接受穿透性角膜移植术治疗。他患有长期严重的慢性干燥性眼病。初次评估记录右眼视力为 20/50，左眼 HM 知觉。生物显微镜检查显示在睑结膜上皮下纤维化，双眼有严重干燥性眼病的临床征象。左眼观察到透明角膜纽扣和白色白内障。未观察到其他皮肤或黏膜病变。
在局部麻醉下对球结膜进行了切除活检。直接免疫荧光分析显示基底膜有纤维蛋白原的线性沉积，符合眼扁平苔藓。通过积极的局部润滑、角膜上皮再生剂、局部他克莫司以及全身皮质类固醇和环磷酰胺的免疫抑制治疗，实现了临床改善。
孤立性眼扁平苔藓是扁平苔藓的一种非常罕见的表现，通常与其他瘢痕性结膜炎难以区分。角膜穿孔是一种严重的并发症，与严重的干眼症有关，以前与眼扁平苔藓无关。充分的临床评估和组织病理学诊断对于及时治疗和预防威胁视力的并发症至关重要。
