Open AccessNecrotizing Anterior Scleritis in a Woman with Terrien’s Marginal Degeneration: A Case Report
Author(s) -
María Alejandra Fonseca-Mora,
Paula Tatiana Muñoz-Vargas,
Juliana Reyes-Guanes,
William Rojas-Carabali,
Miguel Cuevas,
Alejandra de-la-Torre
Publication year - 2021
Publication title -
the open ophtalmology journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.67
H-Index - 19
ISSN - 1874-3641
DOI - 10.2174/1874364102115010318
Subject(s) - medicine , scleritis , dermatology , photophobia , episcleritis , prednisolone , surgery , visual acuity , cyclophosphamide , ophthalmology , uveitis , chemotherapy
Purpose: The aim of the study was to report the first case of a patient with Terrien’s Marginal Degeneration (TMD) who developed necrotizing anterior scleritis without systemic disease association, requiring systemic immunosuppressive treatment. Case Report: A 32-year-old female consulted for bilateral ocular burning and hyperemia. Initially, she was diagnosed with conjunctivitis and treated with topical antibiotics and corticosteroids, with mild transitory improvement but the progression of the disease. Years later, she attended the ocular immunology consultation for a second opinion where TMD with ocular inflammatory component OU was diagnosed. Seven months later, she presented with severe pain, decreased visual acuity, and photophobia in OS. At the slit-lamp examination, necrotizing anterior scleritis with a high risk of perforation in OS was observed. The patient was referred to the rheumatologist and started treatment with systemic corticosteroids and cyclophosphamide, exhibiting a clinical improvement. The patient did not meet the criteria for any systemic illness associated with scleritis, such as autoimmune diseases or vasculitis. Thus, scleritis was related to the adjacent inflammatory process associated with TMD, as an atypical presentation of this disease. Conclusion: Although an inflammatory type of TMD has been proposed, it is essential to follow up closely these patients and consider necrotizing anterior scleritis, a severe ocular disease that requires prompt immunosuppressive management, as a possible atypical associated presentation of this disease.