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Editor,—A 60 year old woman presented with intense, bilateral ocular irritation and photophobia. She had a history of rheumatoid arthritis and was under treatment with prednisone, azathioprine, sulindac, plaquenil, and intramuscular injections of gold sodium thiomaleate (50 mg once weekly). She had received a total of 7.4 g of gold over the past 3 years. Examination revealed an extremely photophobic patient with a visual acuity of 20/20 in both eyes. The conjunctivas were mildly injected, with bilateral perilimbal chemosis. The peripheral cornea showed 360° stromal oedema. Mid-stromal vessels were seen entering the oedematous stroma from the limbus (Fig 1(left)). The rest of the examination was unremarkable. The patient was diagnosed with rheumatoid marginal keratitis, and therapy was started with hourly application of topical prednisolone acetate. Over …