Sebaceous Carcinoma Presenting with Corneal Ulcer and Descemetocele

An 87-year-old male was referred for second opinion due to nonhealing corneal ulcer of his right eye. He had a past medical history significant for basal cell carcinoma, arthritis, hypertension, hypothyroid, CABG, and carotid stent. Initial examination disclosed hand motion vision in the right eye and 20/40 vision in the left eye. He had two corneal infiltrates in the right eye and noted severe meibomian gland disease. Cultures were taken which were ultimately positive for pan-susceptible S. pneumo, fortified antibiotics were begun, and the patient followed up with his outside provider.

The patient re-presented 1 month later with a large central descemetocele, pinpoint seidel positivity, and resolved infiltrate. Lab work for inflammatory etiologies was negative. Amniotic membrane and bandage contact lens were applied twice, and anterior-segment OCT showed severe, non-improved thinning. Penetrating keratoplasty was performed and in the post-operative period that patient was noted to have nonresolving rosacea-like lid disease. Oculoplastics performed a biopsy that was positive for stage T2b sebaceous cell carcinoma with pagetoid spread. Slow MOHs resection was performed along with extensive upper lid reconstruction. A PET scan showed a questionable left upper lung lesion, but cardiothoracic surgery deferred intervention after endobronchial culture revealed MAC infection and the lesion resolved on subsequent CT scan. Through this, the patient was maintained on topical medications for his graft and final visual acuity is estimated to be 20/80-20/100 with a scleral contact lens. Adjuvant chemotherapeutic agents (i.e., MMC) were deferred unless signs of recurrence or pagetoid spread. Repeat PET scan will be performed in a few months, and patient will continue to follow with the multidisciplinary.  

Presentation Date: 08/06/2020

Issue Date: 01/22/2021