Traumatic Corneal Perforation as a Complication of Neurotrophic Keratitis in the setting of Atopic Keratoconjunctivitis and Rheumatoid Arthritis

Purpose: To report a case of traumatic corneal perforation secondary to neurotrophic keratitis associated with atopic keratoconjunctivitis and rheumatoid arthritis.Methods: Case report.Results: We present the case of a 34-year-old woman with untreated rheumatoid arthritis (RA), atopic keratoconjunctivitis (AKC) and neurotrophic keratitis (NK) who developed severe bilateral cor-neal ulceration and unilateral perforation as a result of traumatic eye drop application.The patient responded favorably to a multifaceted treatment approach including the application of corneal fibrin glue and bandage contact lens bilaterally, oral steroids, doxycycline and vitamin C. Addi-tional conservative measures to improve the ocular surface were employed, including frequent application of preservative free artificial tears and warm saltwater soaks.Proper technique for eye drop application was discussed and demonstrated to the patient.Lastly, identifying and treating the patient's underlying RA significantly improved the conjunctival inflammation.Conclusion: Corneal esthesiometry should be performed routinely in patients with AKC or RA to identify patients with an increased risk factor for severe NKrelated complications.A multifaceted ap-proach to treatment including topical and systemic medication is recommended for patients who present with complications of NK associated with AKC or RA.Identifying and treating underly-ing autoimmune disease such as RA can aid tremendously in the treatment of ocular inflamma-tion and prevention of further complications.Despite corneal perforation, no surgical intervention was required and the patient's visual acuity was preserved.