[Using systemic corticotherapy for adult gonococcal keratoconjunctivitis: three case reports]. / Intérêt de la corticothérapie générale dans la kératoconjonctivite gonococcique de l'adulte: à propos de trois cas.

INTRODUCTION: adult gonococcal keratoconjunctivitis is a rare disease possibly leading to blindness, whose severity is related to the risk of corneal perforation and whose progression is conditioned by the rapidity of diagnosis and therapeutic management. PURPOSE: discuss the value of general corticotherapy in the treatment of scleritis associated with this disease. PATIENTS AND METHODS: retrospective analysis of patients with adult gonococcal keratoconjunctivitis managed in an emergency setting in 2007. OBSERVATION: three patients aged 22-55 years contracted the disease during unprotected sexual activity. Involvement was bilateral in two cases out of three; the intensity of the signs was always asymmetrical. Each patient underwent stromal melting of the superior limbic structures, with severity proportional to the delay in treatment. For each case, systemic and local antibiotics did not control corneal thinning, which seemed correlated with the intensity of the systematically associated signs of scleral inflammation. Treatment of scleritis with general corticotherapy under antibiotic cover stabilized the corneal thickness. DISCUSSION: whether the physiopathology of perilimbic corneal thinning can lead to ocular perforation in this condition is unknown. In our experience, the stabilization of corneal thickness seems correlated with regression of the scleritis observed after introducing general corticotherapy, potentially indicating aseptic inflammatory involvement. CONCLUSION: stromal melting of the limbus observed in adult gonococcal keratoconjunctivitis seems to be related to the associated scleritis. Systemic corticotherapy controls progression and reduces the risk of corneal perforation.

[Bilateral oedipism: a case report]. / Oedipisme bilatéral non concomitant: à propos d'un cas.

INTRODUCTION: Oedipism (or self-enucleation) is a rare form of self-mutilation and most often described in acutely psychotic patients, less frequently among drug addicts or the mentally deficient. CASE REPORT: We report a case of a 46-year-old man, who, 3 years after having enucleated his left eye during an acute bout of delirium symptomatic of schizophrenia, mutilated his right eye in the same way. We detail the emergency medical and surgical management indicated in these circumstances. CONCLUSIONS: In most cases described, self-mutilation involves one eye and rarely both. This case of bilateral oedipism is therefore exceptional. In these circumstances, it is necessary to prevent any intracerebral complications induced by the traction exerted on the optic nerve, such as subarachnoid hemorrhage, whose signs can be masked by the patient's psychic state, and to take the neuropsychiatric precautions necessary.