Main Article Content

Abstract

Corneal ulcer is an infectious condition of the cornea that involves the epithelial layer to the stroma. Steroid use to treat corneal ulcer without indication is still a massive issue especially in primary-level healthcare facility (PLHF) and may potentially cause various complications. Steroids can delay epithelial healing and induce perforation, and also neutrophil inhibition that will lead to infection exacerbation. A holistic understanding of corneal ulcers, especially the approach to diagnosis, both clinically and diagnostics work up, and effective management for patients are very important to understand, especially in PLHF. This case report aims to provide knowledge regarding the  steroid management of corneal ulcers and periosteal graft use in perforated corneal ulcers. .


Male, 39 year old, comes to RSUD Dr. Saiful Anwar Malang (RSSA) with chief complaints of redness, pain, and white lesion that progressively widened in left eye. Patient had a history of trauma caused by inflorescence one month ago. White lesion was first only a pinpoint lesion but progressively widened. Patient have sought medical advice to PLHF  and secondary-level healthcare facility (SLHF), then referred to  RSSA with potential complication occurring. 


Approach to diagnosis holistically and management with correct indication is important to prevent corneal ulcer perforation especially due to steroid use. 

Article Details

How to Cite
Vilado, I., Herwindo, D., David, N., Chandra, B., & Sagita, Z. (2022). Perforated Corneal Ulcer Due to Steroid Use Without Indication: A Case Report . Jurnal Klinik Dan Riset Kesehatan, 2(1), 247-252. https://doi.org/10.11594/jk-risk.02.1.7

References

1. Farias R, Pinho L, Santos R. Epidemiological profile of infectious keratitis. Rev Bras Oftalmol. 2017;76(3):116–20.
2. Kenia VP, Kenia R V, Pirdankar OH. Diagnosis and Management Protocol of Acute Corneal Ulcer. Int J Heal Sci Res [Internet]. 2020;10(March):69. Available from: www.ijhsr.org
3. Suwal S, Bhandari D, Thapa P, Shrestha MK, Amatya J. Microbiological profile of corneal ulcer cases diagnosed in a tertiary care ophthalmological institute in Nepal. BMC Ophthalmol [Internet]. 2016;16(1):1–6. Available from: http://dx.doi.org/10.1186/s12886-016-0388-9
4. Sitoula RP, Singh SK, Mahaseth V, Sharma A, Labh RK. Epidemiology and etiological diagnosis of infective keratitis in eastern region of Nepal. Nepal J Ophthalmol. 2015;7(1):10–5.
5. Maung N, Thant CC, Srinivasan M, Upadhyay MP, Priyadarsini B, Mahalakshmi R, et al. Corneal ulceration in South East Asia. II: A strategy for the prevention of fungal keratitis at the village level in Burma. Br J Ophthalmol. 2006;90(8):968–70.
6. Anugrah DP. Diabetik Di Rsup Dr Mohammad. 2020;
7. Ilyas S, Yuliani SR. Ilmu Penyakit Mata. 5th Editio. Jakarta: Badan Penerbit Fakultas Kedokteran Universitas Indonesia; 2014.
8. Baruah M, Das RK, Agarwalla V, Basyach P. Corneal ulcer: an epidemiological, microbiological and clinical study of cases attending Assam medical college and hospital, Dibrugarh, India. Int J Res Med Sci. 2020;8(3):1076.
9. Asroruddin M, Nora RLD, Edwar L, Sjamsoe S, Susiyanti M. Various factors affecting the bacterial corneal ulcer healing: A 4-years study in referral tertiary eye hospital in Indonesia. Med J Indones. 2015;24(3):150–5.
10. Almahmoud T, Elhanan M, Elshamsy MH, Alshamsi HN, Abu-Zidan FM. Management of infective corneal ulcers in a high-income developing country. Med (United States). 2019;98(51):1–5.
11. Jhanji V, Young AL, Mehta JS, Sharma N, Agarwal T, Vajpayee RB. Management of Corneal Perforation. Surv Ophthalmol [Internet]. 2011;56(6):522–38. Available from: http://dx.doi.org/10.1016/j.survophthal.2011.06.003
12. Khor WB, Prajna VN, Garg P, Mehta JS, Xie L, Liu Z, et al. The Asia Cornea Society Infectious Keratitis Study: A Prospective Multicenter Study of Infectious Keratitis in Asia. Am J Ophthalmol. 2018;195:161–70.
13. Hongyok T, Leelaprute W. Corneal ulcer leading to evisceration or enucleation in a tertiary eye care center in Thailand: Clinical and microbiological characteristics. J Med Assoc Thail. 2016;99(3):S116–22.
14. Sitorus RS, Sitompul R, Widyawati S, Bani AP. Buku Ajar Oftamologi. Jakarta: Badan Penerbit Fakultas Kedokteran Universitas Indonesia; 2017.
15. Kanski J, Bowling B. Clinical ophthalmology: a systematic approach. Elsevier Health Sciences; 2011.
16. Palioura S, Henry CR, Amescua G, Alfonso EC. Role of steroids in the treatment of bacterial keratitis. Clin Ophthalmol. 2016;10:179–86.
17. Samira N, Bani AP, Susiyanti M. Rare case of bilateral perforated corneal ulcer due to gonococcal infection, managed with temporary periosteal graft. BMJ Case Rep. 2016;2016:1–4.