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Corneal melt and perforation secondary to floppy eyelid syndrome in the presence of rheumatoid arthritis
  1. J D Rossiter1,
  2. R Ellingham2,
  3. K N Hakin3,
  4. J M Twomey3
  1. 1Southampton Eye Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
  2. 2Bristol Eye Hospital, Lower Maudlin Street, Bristol BS1 2LX, UK
  3. 3Department of Ophthalmology, Taunton and Somerset Hospital, Taunton TA1 5DA, UK
  1. Correspondence to: Mr Rossiter

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Floppy eyelid syndrome (FES) is an uncommon condition that it is often underdiagnosed or misdiagnosed owing to the somewhat trivial and non-specific symptoms with which it often presents.1, 2 In association with the dry eye of rheumatoid arthritis it can, however, have devastating effects.

Case report

A 60 year old moderately obese man with well controlled rheumatoid arthritis (RA) presented to the eye clinic with recurrent red and gritty eyes. A diagnosis of dry eye syndrome with blepharitis was made. He was also found to have a mucocoele of the left lacrimal sac. Lid hygiene and ocular lubricants yielded an initial encouraging response and he was discharged.

He re-presented 5 years later with similar symptoms and reduced visual acuity (VA) of 6/36 in the left eye. A diagnosis of dry eye syndrome with secondary corneal epithelial changes was made. Topical lubricants failed to relieve the condition satisfactorily and he was therefore scheduled for punctal occlusion. However, upon admission for this 8 weeks later, he was …

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