# Sclerokeratitis and Secondary Glaucoma in Relapsing Polychondritis in a 30-Year-Old Asian Male Patient: A Case Report

## TL;DR

A 30-year-old Asian male with relapsing polychondritis developed severe eye complications, including scleromalacia and glaucoma, highlighting the need for early diagnosis and multidisciplinary care.

## Contribution

This case report highlights the rare ocular manifestation of scleromalacia perforans in a young RPC patient with secondary glaucoma.

## Key findings

- The patient presented with scleromalacia perforans, corneal scarring, and elevated intraocular pressure.
- Despite treatment, glaucoma remained uncontrolled, indicating therapeutic challenges in RPC-related ocular complications.
- RPC can present with ocular symptoms before cartilage inflammation, risking delayed diagnosis.

## Abstract

Relapsing polychondritis (RPC) is an immune-mediated systemic disease characterized by recurring inflammatory episodes in cartilage structures, mainly in the ears, nose, and respiratory tract. It is associated with various systemic and ocular manifestations, such as scleritis, the most common ocular feature of RPC. Scleromalacia perforans (SP) is a rare and severe form of anterior scleritis that appears as a dark bluish discoloration and bulging of a thinned-out sclera in the absence of pain or redness. This case report describes a 30-year-old Asian male who presented a seven-year history of blurred vision and recurrent eye redness. Visual acuity (VA) was 15/200 and 20/63+2 on OD and OS, respectively. An eye exam showed diffusely hazy cornea, thinned-out sclera, and elevated intraocular pressure (IOP) in both eyes. A systems review revealed bilateral auriculitis and mixed hearing loss. He was clinically diagnosed with RP and started on systemic corticosteroids at 1 mg/kg/day. On follow-up, the patient showed resolution of conjunctival hyperemia; however, IOP remains elevated despite maximal therapy. Ocular manifestations in RPC are protean and may be the presenting symptoms of RPC, resulting in the possibility of delayed or missed diagnosis in the absence of chondritis. SP, corneal scarring, and secondary glaucoma are late sequelae and vision-threatening conditions that may pose significant therapeutic challenges to ophthalmologists. Multispecialty collaboration is warranted in the management of systemic complications of RPC.