Case presentation
A 15-year-old lady presented with symptoms of allergic conjunctivitis such as epiphora, pain, and redness of the lid margin of the right eye. On her eye examination, she had visual acuity of counting finger from 1 m, diffuse vascularized corneal opacity, ectropion and injected conjunctiva with papillary reaction. Additionally, she had physical signs of allergy such as periorbital edema, erythema and scaling of adjacent skin (Fig. 1a, b). However, there were not any signs of cicatricial component such as lamellar shortening or lid retraction. She had a history of admission in our ward for the same eye fungal keratitis 9 months ago (Fig. 1c). She had been treated with topical Natamycin (Natacyn, Alcon, Fort Worth, TX). After partial improvement of the corneal ulcer, she had been discharged with topical 5% Natamycin four times a day. She hadn’t come for follow up visits and continued using Natamycin for a total of 9 months until her recent visit. She did not use any other topical or systemic medication during that time. We stopped Natamycin and administered lubrication and a topical steroid (0.1% Fluorometholone (FML, Allergan, Inc., Irvine, CA) every 6 h. One month later, the ectropion resolved completely (Fig. 1d, e).