A case with corneal perforation due to bacterial concretion derived from lacrimal canaliculitis

Abstract

Purpose: To report a case with corneal perforation, presumably due to ocular cicatricial pemphigoid (OCP) and bacterial concretion derived from lacrimal canaliculitis.

Observations: A patient with OCP demonstrated adherence of concretion to the cornea of her right eye. She also demonstrated canaliculitis in this eye. We removed a whitish precipitate from the bottom of the corneal ulcer. When we flushed her lacrimal pathway, a marked amount of bacterial concretion and dense mucosa were refluxed from both puncta on the right side. On the next day, corneal perforation was visible from the area where concretion was removed. We performed punctoplasty and removed the bacterial concretion from the lacrimal canaliculus and sac. After the operation, her symptoms improved and corneal perforation recovered.

Conclusions and importance: Both lacrimal canaliculitis and OCP can cause corneal perforation, and adherence of bacterial concretion onto the cornea is very rare. However, once it occurs, corneal perforation can rapidly follow. OCP sometimes causes corneal epithelial damage, which may influence adherence to concretion. Canaliculitis in patients with OCP should be managed carefully.

Keywords: Bacterial concretion; Corneal perforation; Lacrimal canaliculitis; Ocular cicatricial pemphigoid.

Fig. 1

Slit lamp photographs of the right cornea and conjunctiva on the first day. (A) Several whitish precipitates (arrows) are observed at 7 and 9 o'clock in the midperipheral zone of the cornea. (B) The lower conjunctiva shows fornix shortening and mild symblepharon. (C), (D) Both superior and inferior puncta of the right eye are swollen and dilated with discharge (arrows).

Fig. 2

Slit lamp photographs of the right cornea on the second day. (A), (B) Corneal perforation is observed at 7 o'clock (arrows), where the white precipitate was removed.

Fig. 3

Photograph of extraction of concretion and histopathological photograph of the extracted concretion. (A) A marked amount of concretion was extracted during punctoplasty. (B) The deposits adhering to the cornea and the concretion contained the same components. Infiltrations of neutrophils were found (arrows) around sulfur granules (※). (Hematoxylin−eosin stain).