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Correspondence to Professor Conor Murphy; [email protected]
Background
A common dermatological problem with estimated prevalence of 1%,1 2 hidradenitis suppurativa (HS) has been observed to be associated with inflammatory eye disease, in particular peripheral ulcerative keratitis,3–7 but also interstitial keratitis,8 9 scleritis and uveitis.6 7 In one severe HS case, a middle-aged African American man developed Mooren’s type ulceration, which led to corneal perforation in one eye.5 An association of HS with interstitial keratitis and secondary ectasia leading to perforation, without concomitant corneal ulceration, has not been described previously to our knowledge. We describe a severe case of interstitial keratitis associated with HS.
Case presentation
A woman in her mid-20s, with a history of HS and Graves’ disease with multinodular goitre diagnosed 3 years previously, was referred to the corneal service with worsening vision and pain in both eyes. Recurring episodes of redness and discomfort were an issue since she was 6 years old. Initially her general practitioner managed her with topical chloramphenicol drops or Fucithalmic ointment, and she was seen in her local ophthalmology service initially 6 years prior to presentation to the corneal service. Her local ophthalmologist had diagnosed mild anterior uveitis and conjunctivitis and had been treating with her with topical prednisolone minims (0.5%) and cyclopencolate (1%) drops, typically four times a day and three times a day, respectively, in a tapering regime. She was a non-smoker, and medications at presentation included doxycycline 100 mg once daily. Her thyrotoxicosis had settled after 2 years of treatment with carbimazole. Initially, her corrected distance visual acuity (CDVA) with her glasses was 6/7.5 with −8.50/+4.50 × 102 in the right eye, and 6/30 with −8.50/+7.75 × 33 in the left eye. On examination, she had ciliary injection bilaterally, and interstitial keratitis with significant corneal thinning and steepening in the mid-periphery, with local thinnest area of 209 and 217 µm, and corresponding Kmax of 74.4D and 71.9D in the right and left eyes, respectively (figure 1), though the central corneal thickness was relatively spared at 561 and 543 µm in the right and left eyes. The thinned mid-peripheral cornea showed vascularisation and opacification, with sparing of the central cornea. There was a poor tear film meniscus height bilaterally, with corneal punctate epithelial...