History
A 79-year-old black female presents to the corneal specialty service with a non-healing corneal ulcer. Her medical history includes type 2 diabetes mellitus and a previous carotid endarterectomy that led to a right cerebral vascular accident.

The surgical wound from the endarterectomy became infected and involved the left mastoid bone, necessitating a mastoidectomy. The procedure compromised the left facial nerve, resulting in left facial muscle weakness. At the time of our examination, four months after the mastoidectomy, the patient was on Ocuflox (ofloxacin, Allergan) q2h and bacitracin ung q2h. 

At initial consultation, we observed dense central opacification and neovascularization of the cornea.

Diagnostic Data
Best-corrected acuity was 20/30 O.D. and light perception O.S. at distance. Examination of the left cornea revealed a corneal ulcer involving half the corneal thickness. There was very poor lid/globe congruity, along with incomplete lid closure. The patient complained of significant pain as well as constant discharge from the left eye. IOP measured by Tonopen was 13mm Hg O.D. and 19mm Hg O.S.

Your Diagnosis
How would you approach this case? Does this patient require any additional tests? How would you manage this patient? What is her likely prognosis? To check your diagnosis click here.