Bilateral Shield Corneal Ulcer

Abstract

A 5 year old boy presented with complaints of pain and photophobia and gross diminution in vision in both eyes. Slit lamp examination revealed cobble stone papillae in the tarsal conjunctivae, diffuse punctate epitheliopathy of cornea and two almost similar round epithelial defects in both corneas. He was diagnosed to be suffering from bilateral vernal keratoconjunctivitis, with grade 2 Shield ulcer in both eyes. Shield ulcer of grade 2 and above is refractory to the combined regime of topical corticosteroids, dual acting antihistamine and lubricating eye drops. After removal of plaque and scrapping of base, the ulcer re-epithelialized completely in two weeks, leaving behind a nebular opacity eccentric to pupil which stained negatively with fluorescein dye. The patient was followed up for two months and no recurrence of ulcer was noted. The unique finding in this case is the presence of bilateral, almost similar lesions in both eyes that were refractory to medical treatment