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Editor,—Patients with rheumatoid arthritis commonly have two types of corneal ulceration. One is a peripheral corneal ulceration thought to be caused by complex mediated hypersensitivity.1 The other is a paracentral corneal ulceration that tends to perforate the cornea rapidly. Its pathogenesis remains unknown, though a key feature is the lack of inflammation, leading to the suggestion that it is the result of surface disease (drying).
CASE REPORTS
We examined two individuals, a 38 year old woman and a 76 year old woman, with unilateral corneal epithelial defects and aqueous tear deficiencies. Both patients had been treated for rheumatoid arthritis for several years; however, neither had been on systemic corticosteroids. The 76 year old had had successful cataract surgery 1 week previously and was using 0.1% betamethasone eye drops. At the time of presentation both women had severe dry eye (possibly secondary Sjögren’s syndrome, though no biopsies were taken to confirm this) …