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A Postmortem Ocular Finding of Tache Noire in a Living Patient

Michael K. Lin, ScB1; Dov Sebrow, MD2; Michele Slone, MD3; Jason Horowitz, MD2
[+] Author Affiliations
1College of Physicians and Surgeons, Columbia University, New York, New York
2Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University, New York, New York
3Office of Chief Medical Examiner, New York, New York
JAMA Ophthalmol. 2016;134(5):603-604. doi:10.1001/jamaophthalmol.2015.5951.
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A woman in her late 50s presented with abnormal discoloration of the right eye and after she later died of systemic illness, pathology corroborated the scleral darkening in her eye was tache noire.

Patients in the intensive care unit develop exposure keratopathy in the setting of sedation and severe illness. This chronic drying of the ocular surface can cause corneal ulceration and even perforation.1 In a patient who was being treated in the intensive care unit, desiccation in the exposed part of the eye produced a pattern of scleral discoloration known to forensic pathologists as tache noire de la sclerotique, which is an early postmortem darkening of the sclera where the eye is not covered by the lids.2 To our knowledge, this is the first report of a postmortem eye finding in a living patient.

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Figure 1.
Postmortem Eye Finding in a Patient With Ocular Exposure

Initially, the sclera appeared darkened in the exposed area but was normal where covered.

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Figure 2.
Resolution of Tache Noire

After lubrication and taping the lids overnight, the sclera appeared almost completely recovered.

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