Terrien marginal degeneration presenting with spontaneous corneal perforation.
OBJECTIVE
To report spontaneous corneal perforation as a presenting sign of unilateral Terrien marginal degeneration in a young adult.


METHODS
A 19-year-old woman presented with sudden loss of vision in her left eye of 1-day duration. Examination revealed superior corneal thinning with superficial vascularization and secondary lipid keratopathy. There was an area of corneal perforation at the 11 o'clock position, leading to a shallow anterior chamber, ocular hypotony, and a hypotonic maculopathy. The right eye was normal on biomicroscopy.


RESULTS
The area of perforation was confirmed by a positive Seidel test. A 22-mm-diameter bandage contact lens was fitted, which led to closure of the perforation and reformation of the anterior chamber. Orbscan corneal topography confirmed superior corneal thinning, 2.3 D of against-the-rule astigmatism, and 3.4 D of irregular astigmatism in the central 3-mm zone. Topography of the right showed no apparent abnormality.


CONCLUSIONS
Terrien marginal degeneration is an unusual cause for a spontaneous corneal perforation. Patients with this disorder should be warned about this possibility.
Srinivasan
Sathish
S
St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom. sathish@tiscali.co.uk
Murphy
Conor C
CC
Fisher
Anthony C
AC
Freeman
Laurence B
LB
Kaye
Stephen B
SB
D000328:Adult; D000867:Anterior Chamber / Q000473:pathology; D003316:Corneal Diseases / Q000175:diagnosis*; D003317:Corneal Dystrophies, Hereditary / Q000175:diagnosis*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D015814:Ocular Hypotension / Q000209:etiology; D012422:Rupture, Spontaneous