A 35-year-old lady, who worked in the royal stable, presented with redness and decreased vision in her right eye of 15 days duration. She was initially treated at a local health center for a corneal abrasion in her right eye, after being hit by the tail of a horse while cleaning the stable. She applied honey three times everyday to her painful right eye as advised by a local traditional healer. A week later, the pain in her eye decreased, but the vision in the right eye deteriorated and redness increased.\nAt the time of presentation, she had no pain or photophobia. The best corrected vision in the right eye was counting fingers at 2 m, and left eye was 0.5 with +2.0 D sph. The right eye showed ciliary congestion. A central corneal ulcer measuring (2 × 3 mm) in size with a hypopyon was noted. Culture of the scrapings from the ulcer grew dermatophytes on Sabouraud agar, which was identified as T. mentagrophytes. There was no evidence of superficial mycoses affecting skin, nails or any other area of her body.\nThe ulcer was treated with topical antifungal drops (Fluconazole 0.3%; Zocon® FDA Ltd) every hour, and cycloplegic (Cyclopentolate hydrochloride 1%; Mydrilate® Intrapharm) three times daily. Ten days following treatment, the patient underwent therapeutic keratoplasty for a non-healing corneal ulcer with impending perforation. The graft was clear and the eye quiet with a visual acuity of 0.2 on the first postoperative day. The topical medications were continued post-keratoplasty. However, the primary infection recurred involving the graft by the fourth postoperative day, progressing relentlessly to involve the entire graft by the 15th day resulting in a vascularized central scar by 2 months (). Posterior segment of the eye and the vitreous cavity appeared normal on B scan ultrasonography. Intra ocular pressure was 10 mmHg. The final visual acuity at the end of 2 months was appreciation of hand movements in the right eye.
A 56-year-old female was referred to King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, with central corneal thinning in her left eye and a scar. She reported a painless decrease in vision following the self-application of alum substances to her left eye for eye redness and discomfort. There was no history of previous trauma, surgery, or any ophthalmic disorder. There was no history of any systemic illness or use of any systemic or topical medications. Ophthalmic examination indicated the best-corrected visual acuity of 20/20 in the right eye (OD) and counting fingers at 1 m in the left eye (OS). Intraocular pressure measured with applanation tonometry was within the normal range bilaterally. Examination of the right eye was unremarkable except for a mild cataract. Slit-lamp examination of the left eye indicated a quiet conjunctiva and central corneal scar with no corneal epithelial defect; there was corneal thinning without descemetocele, nuclear sclerosis, and a hazy view of the fundus []. B-scan ultrasonography OS indicated no pathology at the posterior pole. The alum substance was analyzed using scanning electron microscope (SEM) and revealed the elements shown in .