A 43-year-old woman with pain in the ear and photophobia. She had undergone Scopinaro surgery a year earlier, and had a postoperative period with anaemia, varicose veins in the lower limbs, hypocalcaemia and seronegative gonarthritis.
Examination of the OI revealed a marginal abscess, diffuse epitheliopathy and conjunctival keratinisation. Corrected VA of 0.6 in OD and 0.3 in OI. After resolution with cyclopentolate (Ciclopléjico®, AlconCusí, S.A., Barcelona, Spain) and a topical quinolone (Chibroxín®, Thea S.A., Barcelona, Spain), the epitheliopathy did not improve despite lubricant treatment (Viscofresh® 0.5%, Allergan S.A.), maintaining a VA of 6/10 in OD and 5/10 in OI. Oral pilocarpine (Salagen®, Novartis SA, Barcelona, Spain) 5 mg every 6 hours was added, without modification of the Schirmer test (2-3 mm in OD and 5 mm in OI). As conjunctival keratinisation and diffuse epitheliopathy persisted, 20% autologous saline was added. In three weeks the tear film increased (Schirmer 5 mm in OD and 7 mm in OI) and the conjunctival hyperkeratinisation subsided, with a final VA of 8/10 in AO.