Active Infection or Quiet Scar?

This is a patient sent for evaluation of a neurotrohic ulcer. The patient had been on Vancomycin, Ciprofloxacin, Loteprednol, Restasis and autologous serum tears in the past and the referring physician was considering re-culturing. Prior cultures were negative per report.

On clinical exam there was no active infection. On AS-OCT, the epithelium is fully intact. The active process likely resolved a while ago, indicated by the significant epithelial hypertrophy. Almost all of the stromal thinning has been filled in. The bright white in the AS-OCT represents the haze of the residual stroma.

Prior history notes perforation of the left eye. It is unclear how this was repaired. In the left eye, there is severe central stromal thinning, with some mild epithelial hypertrophy. 

In the posterior cornea, there appears to be some fibrotic material, possibly iris tissue, which likely had plugged the prior perforation.

Images courtesy of Brett Levinson, MD of Specialized Eye Care.