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Background: There have been relatively many reports of cases of acute hydrops followed by infectious keratitis, there has not been a report of cases of infectious keratitis complicated by acute hydrops. Case presentation: A 35-year-old man had undergone cataract surgery 7 years earlier and was being treated for atopic dermatitis by a neighborhood dermatologist. However, the dermatitis was poorly controlled. He came to our hospital with a complaint of pain and blurred vision in his left eye. The decimal best-correctly visual acuity (BCVA) of the left eye was 0.01. Slit-lamp microscopy showed conjunctival injection and a corneal opacity. The patient was diagnosed with infectious keratitis and treated with topical and systemic antibiotics. During his hospitalization, we noted that he frequently rubbed his eyes vigorously. Five days after the first visit, the cornea was noted to protrude markedly and the stroma surrounding an ulcerated area was edematous. These findings led to the diagnosis of acute hydrops and he underwent keratoplasty for the impending corneal perforation. Histopathological study of the excised cornea showed stromal edema, leucocyte infiltration, and a tear of Descemet membrane. Unfortunately, he developed endophthalmitis on the day after the surgery. We irrigated the anterior chamber with antibiotics and injected antibiotics into the vitreous. The endophthalmitis gradually subsided, and at two years after the surgery, his decimal BCVA had improved to 0.6. Conclusions: Eye rubbing in cases of infectious keratitis can induce acute hydrops and timely surgical intervention is recommended.

Kumiko Kato,1 Maki Takeuchi,1 Yuka Yonekawa,1 Yuzen Kashima,1 Koji Hirano,2 Mineo Kondo1 1Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan; 2Department of Ophthalmology, Fujita Health University Bantane Hospital, Nagoya, JapanCorrespondence: Kumiko KatoDepartment of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, JapanTel +81-59-231-5027Fax +81-59-231-3036Email k-kato@clin.medic.mie-u.ac.jpPurpose: To report our findings in three cases of an inflamed conjunctival nevus whose size and degree of pigmentation were reduced by topical antiallergic and immunosuppressive ophthalmic solutions.Methods: Observational case series. Three patients with inflamed conjunctival nevus were examined by slit-lamp biomicroscopy, and the findings before and after the treatments were compared.Results: All three patients had a slightly pigmented and edematous conjunctival tumor at the corneal limbal area. The tumors were hyperemic, and papillae and follicles were present on the superior conjunctiva in all patients. All of the patients had an allergic predisposition. The antiallergic treatment not only resolved the hyperemia and edema of the palpebral conjunctiva, but also reduced the tumor size. In one case, the topical antiallergic agent alone led to a reduction of the tumor size. A combination of topical antiallergic agent and topical immunosuppressant was effective in reducing the tumor size and degree of pigmentation in the other two patients.Conclusion: The hyperemia and pigmentation in eyes with inflamed conjunctival nevus can be resolved by topical antiallergic agent and topical immunosuppressant without resection of the tumor.Keywords: inflamed juvenile conjunctival nevus, epinastine, tacrolimus