We report a patient with bilaterally symmetrical perforated corneal
ulcers with formation of anterior staphyloma associated with
scrofuloderma. A 22-year-old female in her third month postpartum presented with multiple perforated corneal
ulcers bilaterally. There was a presence of a skin lesion that was consistent with
scrofuloderma. Fine needle aspiration cytology of preauricular lymph nodes showed evidence of granulomatous
inflammation consistent with
tuberculosis. Corneal scraping revealed the presence of
coagulase-negative Staphylococcus. She was treated with topical fortified combination
antibiotics (
cefazolin and
tobramycin). The
corneal ulcer resolved with formation of anterior staphyloma in both eyes. The patient underwent anterior staphylectomy and tectonic
keratoplasty in both eyes. Eight weeks postoperatively, her visual acuity improved to 20/200 in both eyes with clear grafts.
Scrofuloderma may be associated with recurrent phlyctenulosis. Multiple corneal ulcerations coupled with use of topical
steroids may result in
corneal perforation and formation of anterior staphyloma.