title: Keratitis associated with multiple endocrine deficiency.
abstract: OBJECTIVE
  To report an 8-year-old girl with bilateral progressive visual loss and photophobia secondary to stem cell deficiency as a result of multiple endocrine deficiency.
  
  
  METHODS
  A case report and review of medical literature.
  
  
  RESULTS
  The patient suffered from severe photophobia and decreased visual acuity since May 2000. Despite multiple outpatient visits, no definite cause was found, and conservative treatments failed. On slit-lamp examination severe meibomian gland dysfunction, loss of eyelashes, decreased tear meniscus, diffuse corneal vascularization, and delayed punctate fluorescein staining of corneal epithelium were detected. She had also episodes of hypotension, oral candidiasis, and seizures. Her systemic work up revealed multiple endocrine deficiency (Addison disease and hypoparathyroidism). Hormone replacement therapy with fludrocortisone and oral calcium accompanied by punctual occlusion led to significant clinical recovery.
  
  
  CONCLUSIONS
  In a pediatric patient with diffuse corneal vascularization and no definite cause, systemic workup should be done to rule out multiple endocrine deficiencies. Treatment consists of hormone replacement therapy and management of the dry eye.
authors.affiliation: Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Mohammadpour
authors.forename: Mohammad-Ali
authors.initials: MA
authors.lastname: Javadi
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D002648:Child; D003315:Cornea / Q000473:pathology; D004359:Drug Therapy, Combination; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D020795:Photophobia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016884:Polyendocrinopathies, Autoimmune / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014792:Visual Acuity
chemical_list: D000893:Anti-Inflammatory Agents; D002118:Calcium; D005438:Fludrocortisone