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JAMA Ophthalmology Clinical Challenge
March 14, 2019

A Middle-aged Man With Alcoholism and a Nonhealing Corneal Ulcer

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
JAMA Ophthalmol. 2019;137(5):575-576. doi:10.1001/jamaophthalmol.2019.0115

A 53-year-old male was referred for evaluation of a nonhealing corneal ulcer. He had not received medical care in 20 years and had no known medical diagnoses, but his social history was notable for consumption of approximately 12 alcoholic beverages per day. His ocular history was notable for left-eye enucleation from recent trauma. He initially presented to his local ophthalmologist with right eye redness, pain, and photophobia for 1 week. He was diagnosed with a corneal ulcer. Bacterial (aerobic and anaerobic) and fungal cultures were obtained, and the patient started receiving topical moxifloxacin. The cultures were negative after 1 week, but the patient did not demonstrate signs of clinical improvement. A complete blood cell count, metabolic panel, and serum test results (for antinuclear antibodies, peripheral antineutrophil cytoplasmic antibodies, cytoplasmic antineutrophil cytoplasmic antibodies, rheumatoid factor, and anti–cyclic citrullinated peptide) were unremarkable. On referral, his visual acuity was 20/100 OD, and his intraocular pressure was 16 mm Hg. Anterior examination revealed a diffusely hazy cornea with a blunted light reflex. A large, well-demarcated epithelial defect with substantial underlying stromal loss was seen in the inferonasal periphery (Figure). The stroma was 40% thinned without infiltrate. The epithelium was heaped up along the lesion borders. Corneal sensation was diminished. The conjunctiva demonstrated hyperemia, which was more prominent around the corneal lesion, although there was no discharge. A dilated ophthalmoscopic examination was unremarkable. Repeated bacterial and fungal cultures were obtained.

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