Severe acute lacrimal gland insufficiency in the initial stage of reactive arthritis (Reiter’s syndrome)

A male in early adolescence presented with a sudden drop in vision in the emergency clinic. At the presentation, visual acuity was counting fingers in both eyes. Clinical evaluation revealed severe conjunctival congestion, sterile corneal melt and acute severe aqueous deficiency (Schirmer values 0 mm at 5 min) in both eyes. He had a history of fever, body ache, large joint swelling and oral and urogenital ulcers of 20 days duration. Laboratory investigations revealed positive Human Leucocyte Antigen (HLA) B27, strongly positive Dense Fine Speckled (DFS)70, elevated C-reactive protein (CRP), raised erythrocyte sedimentation rate (ESR), increased serum ferritin levels and pus cells on urine examination, corroborative with the clinical diagnosis of reactive arthritis. He was managed with emergency tarsorrhaphy, frequent artificial tear supplements, systemic antibiotics and immune modulators. The corneal epithelial defect healed rapidly with restoration of visual acuity to 20/20 in both eyes. Acute lacrimal gland insufficiency leading to corneal melts should be promptly diagnosed and managed to prevent vision-threatening complications.