Parry–Romberg syndrome is a rare disorder, with an estimated worldwide occurrence of approximately 1 per 700,000 individuals, although this figure is likely underestimated due to underdiagnosis and variability in clinical expression [5]. The disease typically affects children and young adults and follows a slowly progressive course over a highly variable period ranging from 2 to 20 years, before entering a phase of spontaneous stabilization, the mechanisms of which remain poorly understood [6].

Clinically, PRS is characterized by unilateral progressive hemifacial atrophy involving the skin, subcutaneous fat, muscles, and, in advanced cases, the underlying osseous structures [5,6]. This facial involvement frequently coexists with extracutaneous manifestations, reflecting the potentially multisystemic nature of the disease. Neurological involvement represents the most common associated manifestation and includes partial seizures, migraine, hemiplegia, cerebral atrophy, and intracranial vascular abnormalities [7]. In the present case, migraine was the sole neurological symptom reported, without focal neurological deficits, in keeping with previous reports describing isolated or mild neurological involvement in some patients [8].

Ophthalmological manifestations are reported in approximately 10–30% of patients with PRS and may occasionally constitute the initial presentation of the disease [9]. These manifestations most commonly include enophthalmos secondary to orbital fat atrophy, eyelid atrophy, uveitis, and, more rarely, retinal vasculitis [9,10]. In our patient, enophthalmos was associated with recurrent keratitis related to both ocular surface dryness and corneal hypoesthesia. Corneal sensory impairment is an uncommon but clinically significant finding in PRS and represents a major risk factor for the development of chronic epithelial defects and neurotrophic keratopathy, conditions that are often difficult to manage and associated with delayed corneal healing [10,11].

The originality of this case lies in the ophthalmological mode of presentation, with a chronic corneal ulcer revealing previously unrecognized PRS in a patient with established hemifacial atrophy. This atypical presentation highlights the importance of a thorough general and facial examination in cases of unexplained chronic keratitis, particularly when associated with facial asymmetry. Early recognition of PRS allows appropriate multidisciplinary management and may help prevent sight-threatening and functional complications.