This patient is an 88-year-old female with a history of rheumatoid arthritis who presented with bilateral eye pain. An external photo of the right eye shows dilated episcleral vessels traversing 360 degrees around the limbus. There is significant scleromalacia around the senile calcific plaque temporally with a deep furrow extending roughly 90% through the sclera. Underlying uvea can be seen on the close-up photo of the right eye. Less advanced scleromalacia is seen nasally. The left eye also exhibits dilated episcleral vessels surrounding the limbus as well as scleromalacia nasally and temporally. Both eyes have an irregular cornea reflex due to significant dryness which also likely contributed to the melt. Rheumatoid arthritis (RA) should be high on the differential diagnosis of patients who present with scleromalacia. Autoimmune damage to the lacrimal gland can result in severe dry eye in patients with RA.
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
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