What does rapid corneal thinning with active inflammation suggest, and what is the urgent step?

• A. Escalate therapy and refer for urgent graft or conjunctival flap to preserve globe.
• B. Wait and recheck in 48 hours.
• C. Increase topical antibiotics only.
• D. Start systemic steroids.

Answer: (B)

Rapid thinning of the cornea with active inflammation shows the tissue is breaking down quickly, which raises concern for a corneal ulcer with ongoing inflammatory damage. The key move here is careful monitoring rather than rushing into drastic procedures or adding systemic drugs, because the eye’s response to initial medical therapy over the next day or two will tell you whether the condition is stabilizing or progressing toward perforation.

Waiting and rechecking in about 48 hours lets you assess the trajectory—if thinning slows and inflammation comes under control with appropriate medical management (antibiotics, analgesia, cycloplegia, and protective care), you can continue medical therapy and plan escalation only if needed. If the condition worsens or there are signs of impending perforation, then urgent surgical options or more aggressive intervention become warranted. Avoid systemic steroids in the presence of active infection or corneal melt, as they can worsen tissue breakdown, and simply increasing antibiotics without addressing the inflammatory process may be insufficient. In short, close monitoring with continued medical management is the prudent next step.