Bilateral Corneal Perforations Due to Elder Neglect

Volume 5 | Issue 2 | Article 3 - Clinical Case Report

Jaclyn Jordan, MD, Katherine Selman, MD, Richard Byrne, MD
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Atraumatic corneal melting and perforation is a rare etiology of eye pain and visual loss in the Emergency Department (ED), and xerophthalmia from vitamin A deficiency is primarily described as a cause of blindness in pediatric patients.


A 68-year-old female presented to the ED with worsening eye pain and months of clouding and vision loss. History was limited by cognitive impairment and was provided by spouse. On exam, she was found to have a body mass index of 13.7 kg/m2, dry mucous membranes, purulent discharge from both eyes, and opacification and erosion of both corneas. She was diagnosed with bilateral corneal perforations due to xerophthalmia with superimposed bacterial keratitis. Her vitamin A levels were found to be undetectable.


This presentation was highly concerning for elder neglect due to delay in presentation, poor outpatient follow-up, and presence of severe malnutrition. This case exemplifies the intersection of an acute medical presentation with a syndrome of neglect and demonstrates the importance of ED clinician evaluation for elder abuse and neglect.

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