Delhi Journal of Ophthalmology

Bilateral Disciform Keratitis with Immune Corneal Ring in a Patient with HLA-B27 Positive Reactive Arthritis

Niveditha Narayanan, Pavani Murthy
Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.

Corresponding Author:

Niveditha Narayanan FRCS
Medical Research Foundation
Sankara Nethralaya
18, College Road, Chennai 600 006,
Tamil Nadu, India
Email id:

Received: 22-MAR-2019 Accepted: 06-APR-2019 Published Online: 05-MAY-2019

AbstractPurpose: To report a presentation of bilateral disciform keratitis with immune corneal ring in a young male with HLA B 27 positive reactive arthritis.
Case Report: A 21 year old man suffered an attack of bacterial UTI a month back with concurrent self-limited bilateral scleritis for 3 days. A week later, he developed multiple joint aches and a rheumatologist diagnosed HLAB27 associated reactive arthritis for the first time, though he had occasional mild joint aches for 8 years and was on irregular aurvedic medication. Specific treatment led to remission of arthritis. About 2 weeks later, he had second episode of bilateral red eye with blurry vision along with self-limited genital ulcer. With no improvement using topical and systemic antivirals for 3 days, he reported to us with bilateral disciform keratitis with incomplete immune rings. Preliminary smear reports of corneal scraping and conjunctival swab were negative and the patient was started on topical antibiotics and later tapering dose of topical steroids were added that led to complete resolution in 45 days.
Conclusion: This is the first report of immune corneal ring in bilateral disciform keratitis in a patient with HLAB27 positive reactive arthritis to the best of our knowledge.

Keywords :Disciform keratitis, Immune corneal rings, Reactive arthritis, Scleritis