On June 1, 1996, she returned with a complaint of moderately severe pain and poor vision in the left eye. On examination, the visual acuity was counting fingers at 6 ft OD and 20/25 OS. There were progressive peripheral thinning and vascularization involving the entire periphery of the right cornea, with marked centripetal extension in the superior cornea from the 10- to 2-o'clock position (Figure 1). The leading edge of centripetal extension was undermined with corneal stromal involvement 1 to 2 mm beyond the apparent clinical edge of involvement. There was an epithelial defect involving the entire cornea. Results from examination of the left eye were normal with the exception of the unchanged appearance of her pre-existing keratoconus. She was hospitalized and treated for 7 weeks with a bandage contact lens, topical corticosteroids, progestational steroids, tetracycline ointment, lubricants, systemic prednisone, and doxycycline. Findings from her systemic evaluation (which included erythrocyte sedimentation rate, rheumatoid factor, antinuclear antibodies, immunoglobulin levels, and electrophoresis) were normal with the exception of a markedly elevated IgE level (687 U; normal <100 U [to convert to the SI units of milligram per liter, IgE first needs to be reported as milligram per deciliter; then multiply this value by 10 to get the SI value]). There was no clinical evidence of systemic helminth infection, although specific serum and gastrointestinal evaluation was not performed. Therapy resulted in reduction in inflammation, vascular regression, cessation of centripetal spread of the ulcer, and preservation of the clarity of the central visual axis. Conjunctival resection was not performed because of her favorable response to therapy with the medications prescribed. Systemic immunosuppression was not used because of her age. She was discharged with an uncorrected visual acuity of 20/80 OD. At no time during her hospitalization was there any inflammation or other evidence of any involvement of the left eye.