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Illustration 1. The patient, a 68-year-old man with a 20-year history of seropositive, erosive rheumatoid arthritis (RA), presented to our ophthalmology office experiencing the sensation of a foreign body and ocular pain in the left eye. At the time of presentation, he was being treated with prednisolone (10 mg/day) and nonsteroidal antiinflammatory drugs, and his RA was quiescent. The ophthalmologic examination showed an inferior circumferential peripheral ulcerative keratitis (arrows in A). The patient was initially treated with high-dose prednisolone (60 mg/day for 2 months and then tapered back to baseline levels), topical medroxyprogesterone, artificial tears, and bandage soft contact lenses, with good response. Within 8 months, a total epithelization of the ulcer and peripheral corneal neovascularization were achieved (arrows in B). Keratitis in RA most frequently occurs in conjunction with adjacent scleritis, but may also occur as an isolated finding. Peripheral ulcerative keratitis usually occurs inferiorly in the corneas of patients with longstanding RA. Although patients with RA generally have minimal corneal infiltrate, this patient had a marginal infiltrate (>180°). The marginal furrow differs from the other forms of vasculitic peripheral ulcerative keratitis because there is little associated corneal infiltration, and the lesion progresses by local ulceration rather than by circumferential or central extension, as in the patient shown here.

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