Use of topical steroids in the setting of corneal subepithelial deposits due to multiple myeloma

Introduction: The aim of this case report was to describe the use of topical steroids in a patient with subepithelial corneal deposits most likely due to multiple myeloma. Case Report: A 58-year-old white female with multiple myeloma was referred to a cornea sub-specialty clinic at Massachusetts Eye and Ear for intermittent blurred vision and development of peripheral corneal deposits in both eyes. On examination, bilateral, superior peripheral corneal deposits were identified with an otherwise clear cornea. There was no corneal neovascularization, epithelial defect, or stromal gelatinous changes. The anterior chamber was quiet without any cell or flare. Dilated fundus examination was unremarkable. The corneal deposits did not resemble nodules found in Salzmann nodular degeneration or pannus from ocular rosacea/contact lens wear/trauma. Given that the patient had no prior history of eye problems or trauma, it was believed that the corneal subepithelial deposits were inflammatory changes due to her relatively recent (within one year) diagnosis of multiple myeloma. The patient was started on loteprednol etabonate 0.5% ophthalmic suspension one drop two times daily in both eyes and one month follow-up was arranged. At her one-month visit, the corneal deposits were much improved and, subsequently, her loteprednol drops were reduced to one drop nightly in both eyes for two months followed by 1 drop Monday/Wednesday/Friday in both eyes for two months. Conclusion: We describe an interesting case in which low dose topical steroid was utilized and may have contributed toward the stabilization and regression of peripheral subepithelial corneal deposits most likely due to multiple myeloma. It is possible that some of the observed improvement in the patient’s corneal deposits were in part due to her systemic treatment of multiple myeloma. Further studies are needed to establish the impact of topical steroids in this patient population, especially in more severely affected eyes.