Central Corneal Melting Associated with Reformulated Generic Diclofenac in a Patient with Inferior Fornix Foreshortening

Purpose: To report a case of corneal melting in a patient with fornix foreshortening being treated with reformulated generic diclofenac. Methods: Case report. Results: An asymptomatic 76-year old man presented with central corneal melting while being treated with reformulated generic diclofenac. This formulation did not contain the vitamin E derivative, tocophersolan, which has been felt to contribute to corneal melting associated with generic diclofenac in the past. Other factors for corneal melting included multiple medication use and altered forniceal architecture, but did not include previous corneal or cataract surgery. Following discontinuation of the topical medications and temporary tarsorrhapy, the defect reepithelialized. Conclusion: In patients with a compromised ocular surface, reformulated generic diclofenac has the potential to cause corneal melting without prior cataract or refractive surgery. Use should not be indiscriminate or without close supervision.