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Disseminated keratoconjunctival epitheliopathy in a patient with systemic lupus erythematosus
  1. S Den1,
  2. M Dogru1,2,
  3. N Kato2,
  4. Y Tanaka3,
  5. S Shimmura4,
  6. J Shimazaki5
  1. 1Department of Ophthalmology, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
  2. 2Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
  3. 3Clinical Laboratory, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
  4. 4Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku and Department of Ophthalmology, Tokyo Dental College, Tokyo, 160-8582, Japan
  5. 5Department of Ophthalmology, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, and Department of Ophthalmology, Keio University School of Medicine, Japan
  1. Correspondence to: Seika Den MD, Department of Ophthalmology, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan;seikatdc{at}u01.gate01.com

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Conjunctivocorneal involvement in systemic lupus erythematosus (SLE) is quite infrequent.1–3 We report the impression cytological (IC), immunohistochemical (IHC), and transmission electron microscopic (TEM) features of a case with unusual keratoconjunctival epitheliopathy refractory to medical treatment.

Case report

A 76 year old woman was referred with a long history of bilateral foreign body sensation. She had been on topical antibiotics, artificial tears, corticosteroids, hyaluronate, and aciclovir without improvement. At initial examination, biomicroscopy revealed diffuse, translucent, disseminated peripheral corneal intraepithelial coin lesions with a cystic appearance (fig 1A, B), also in the bulbar conjunctiva over the limbus (fig 1C). Fluorescein staining revealed increased permeability with negative staining. Schirmer’s test was normal in both eyes. The patient had systemic and dermatological features diagnosed as SLE and had been taking prednisolone 7.5 mg/day for 1 year. Conjunctival cultures were negative for infectious processes. A thorough systemic evaluation for other systemic diseases and serum antibodies for herpes simplex virus (HSV-1, HSV-2), varicella zoster …

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