A Case of Neurotrophic Keratopathy Associated with Trigeminal Neuralgia Post-neurosurgical Procedures

Title A Case of Neurotrophic Keratopathy Associated with Trigeminal Neuralgia Post-neurosurgical Procedures
Author, Co-Author Linda Kit, Julie Sheen, Richard Sui
Topic
Year
2015
Day
Friday
Program Number
155225
Room
Great Hall Foyer
Affiliation
Abstract Background: Neurotrophic keratopathy (NK) is a degenerative disease of the cornea induced by desensitization of the cornea. The ocular complications include decreased tear production, compromised corneal healing, epithelial breakdown, corneal ulcers, and in extreme cases, perforation. Although few ocular and systemic diseases may result in NK, we will focus on iatrogenic causes or lesion(s) of the trigeminal nerve or its branches during neurosurgical procedures. Thus, an accurate surgical and medical history, including assessment of corneal sensitivity and tear film layer during the clinical examination, is crucial for prompt diagnosis and management.

Case Summary: A 39 year old white female presented a chief complaint of constant red eyes OU without any discomfort or pain but with associated constant blurred vision at all distances with correction OS>OD for 1 week. The patient’s medical history was remarkable for brain surgery 5 years ago that unfortunately resulted with trigeminal neuralgia. Ocular history included dry eye syndrome OU. The BCVA was 20/25 OD and 20/200+ PHNI OS. Slit lamp examination revealed an unstable tear film, instant tear break-up time, and moderately scattered superficial punctate keratitis OS>OD with a small superior epithelial abrasion OS. Loss of corneal clarity with 2+ epithelial edema was also noted as well as significantly reduced corneal sensitivity OS. IOPs were measured at 13 mmHG OD and 14 mmHG OS. Given the ocular findings, it was determined that the patient’s neurosurgery likely caused damage to the sensory innervation to the cornea in addition to the trigeminal neuralgia. The diagnosis of stage 1 NK was made for OS, and the patient was treated with prophylactic topical steroid and antibiotics along with preservative-free tears and lubricating gel at bedtime. After several close follow-up visits, the patient's corneal findings had significantly improved with BCVA OS at 20/60. The patient is currently to continue use of preservative-free artificial tears and is being monitor every 6 months.

Conclusion: Clinical diagnosis of NK can be difficult without a proper case history and appropriate tests. Treatment and management can be even more challenging given the irreversible underlying cause of sensory nerve damage. Most treatment options are relegated to managing the patient’s ocular sequelae long term. This poster will review and outline the pathogenesis, diagnosis, and treatment and management of neurotrophic keratopathy associated with trigeminal neuralgia.
Affiliation of Co-Authors Newington VA Medical Center, Newington VA Medical Center
Outline