The patient’s uncorrected visual acuity was 20/400 OD and hand motion OS. Her vision improved with a pinhole to 20/200 OD, but not in the left eye.
Slit lamp examination revealed diffuse, grade 4 superficial punctuate keratitis in both eyes and a 1.5 x 2.5-mm central epithelial defect with Descemet’s folds and corneal edema in the left eye. There were no significant signs of ocular inflammation or stromal involvement. Both eyes had trace conjunctival injection and grade 2 meibomian gland dysfunction (MGD). Her tear meniscus height measured 0.2 microns. Tear osmolarity was 326 mOsm/L OD and 339 mOsm/L OS.