PMC8077634_01
The condition of the right and left eyes at admission: subconjunctival hemorrhage, chemosis, dense, in the form of a "roller" infiltration of the conjunctiva, partially covering the limb zone (a, b); zone of corneal ulceration (white arrow) (c, d).
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F1
The central and paracentral corneal zones were transparent, and the epithelium was rough and dull (shown in Fig. 1).
Right eye. Keratotopography (OCULUS Pentacam ) showed a deep defect of the corneal stroma in the paralimbal zone, on the contrary, in the adjacent corneal paraoptic zone, there was a sharp elevation of the lunate shape due to perifocal edema and cicatricial process.
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F2
Keratotopography (OCULUS Pentacam ) of the patient's both eyes showed gross changes in the axial, tangential, and profile maps, which was associated with a deep defect of the corneal stroma in the paralimbal zone, on the contrary, in the adjacent corneal paraoptic zone, there was a sharp elevation of the lunate shape due to perifocal edema and cicatricial process (shown in Fig. 2).
Right eye. Optical coherence tomography (Heidelberg Spectralis ) a zone of sharp thinning of the stroma in the paralimbal zone, the structure of the stroma was loose, adjacent to the zone of the ulcer defect was accompanied by a zone of perifocal edema. Similar changes were observed at all levels of scanning along the limbal zone.
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F3
Optical coherent tomography (Heidelberg Spectralis ) of the anterior segment showed a zone of sharp thinning of the stroma in the paralimbal zone, the structure of the stroma was loose, adjacent to the zone of the ulcer defect was accompanied by a zone of perifocal edema (shown in Fig. 3, 4).
Left eye. In the paralimbal zone with the established zone of destruction of the deep layers of the stroma, covered with a tear film. Peripheral damage was noted as "stepped," which was biomicroscopically corresponding to the active edge of an ulcerative defect. In contrast to the heterogeneous structure of the endothelium, corresponding to single precipitates.
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F4
Optical coherent tomography (Heidelberg Spectralis ) of the anterior segment showed a zone of sharp thinning of the stroma in the paralimbal zone, the structure of the stroma was loose, adjacent to the zone of the ulcer defect was accompanied by a zone of perifocal edema (shown in Fig. 3, 4).
MRI demonstrated right-sided sinusitis, frontal sinusitis, and residual signs of sphenoiditis and edema of eye muscles on the left eye.
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F5
MRI demonstrated right-sided sinusitis, frontal sinusitis, and residual effects of postponed sphenoiditis and edema of eye muscles on the left eye (shown in Fig. 5).
Abscessing and spontaneous opening of the abscess with the presence of mucopurulent discharge.
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F6
In addition to rapid deterioration of the general condition, an abscess formed in the zones of tense conjunctiva; a day later, it began to spontaneously open, exposing the sclera, covered with abundant purulent discharge (shown in Fig. 6).
Hematoxylin and eosin stain. 20x of biopsy showing a patchy infiltrative pattern. Chronic granulomatous inflammatory infiltrate and focal areas of necrosis (white arrows).
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F7
Biopsy demonstrated granulomatous inflammation with infiltrates and necrosis (shown in Fig. 7).