Spontaneous corneal perforation associated with atopic keratoconjunctivitis: a case series and literature review.

Purpose: To describe spontaneous corneal perforations in patients with atopic keratoconjunctivitis.

Methods: Records of patients with atopic keratoconjunctivitis and spontaneous corneal perforation seen by the authors were reviewed. A literature search of corneal complications in atopic keratoconjunctivitis and predisposing factors for spontaneous corneal perforations in corneal ectasias was undertaken.

Results: Three patients with seven incidents of corneal perforation were identified and presented. Corneal thinning and keratoconus are observed at a higher rate in patients with atopic keratoconjunctivitis, and severe ocular allergy has been reported as a risk factor for corneal hydrops.

Conclusions: Atopic keratoconjunctivitis appears to be a risk factor for spontaneous sterile corneal perforation. Corneal thinning and keratoconus in addition to inflammatory changes of the cornea in these patients probably predispose to the corneal melt in these perforations. A close observation of the fellow eye of affected patients is important and systemic immunosuppressive therapy should be considered.