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Ophthalmic Images
March 8, 2018

Corneal Perforation With Iris Plugging

Author Affiliations
  • 1Royal Victorian Eye and Ear Hospital, Melbourne, Australia
JAMA Ophthalmol. 2018;136(3):e180081. doi:10.1001/jamaophthalmol.2018.0081

A man in his early 50s with chronic left dacryocystitis presented with decreased vision in the left eye. On examination, his visual acuity was 20/200 OS. The patient had a corneal infiltrate with a central perforation that was leaking despite an iris plug (Figure). The perforation was managed with cyanoacrylate glue and intensive topical ofloxacin, 0.3%. Microbiology results confirmed Streptococcus constellatus as the causative organism. When the glue dislodged 4 months later, his visual acuity had improved to 20/25 and the perforation had healed. Optical coherence tomography (Visante; Zeiss) was useful in characterizing the degree of corneal thinning and the iris plug.