LAUSR

A 25-year-old man with a history of rheumatoid arthritis currently taking oral methotrexate, 25 mg per week, presented with a lesion of the left bulbar conjunctiva of about 1 month’s duration. He had no other symptoms other than occasionally noticing a sensation of a foreign body in that eye and denied any changes in his vision. He had no history of contact lens use, ocular trauma, or ocular surgery. His only other medications were oral vitamin D and folic acid. He was initially treated with topical antibiotics followed by a course of oral sulindac, 200 mg twice daily, without any improvement. On examination, his visual acuity was 20/20 OD and 20/25 OS. Intraocular pressure was 16 mm Hg OD and 23 mm Hg OS. The lesion measured 6.5 × 2.5 mm and was firm, nonvascular, slightly mobile, and located on the superotemporal portion of the bulbar conjunctiva (Figure 1). It was purulent in appearance, but no material was expressed with attempted incision and drainage at the slitlamp. A culture was positive only for Propionibacterium acnes. Tests for herpes simplex, cytomegalovirus, and Epstein-Barr virus polymerase chain reactions were negative.