A CASE OF NEUROTROPHIC ULCER IN A TYPE TWO DIABETIC

Title A CASE OF NEUROTROPHIC ULCER IN A TYPE TWO DIABETIC
Author, Co-Author Kimberly Kohne, Jane Ann Grogg
Topic
Year
2005
Day
Program Number
055042
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Affiliation
Abstract BACKGROUND: Neurotrophic keratopathy is a rare, persistent epithelial defect that results from a decrease in corneal sensation in the epithelium from fifth cranial nerve damage. The ulcers are oval in shape with rolled or heaped edges usually found in the inferior portion of the corea. There are several etiologies that need to be ruled out when a neurotrophic ulcer is discovered. Included in the differentials are the following: herpes simplex, herpes zoster, leprosy, corneal dystrophies, neurosurgery, contct lens wear, retinal surgeries, stroke, diabetes and chronic use of topical drugs, such as Beta-blockers. This case looks at the management and treatment of a patient with a neurotrophic ulcer as a result of diabetes.

CASE REPORT(S): A 57 year old male came into the primary care clinic with the chief complaint of decreased vision in his left eye for a few months accompanied with photphobia. His BVA was 20/20 OD and 20/30 OS. External examination and pupils were normal. Slit lamp examination revealed a large epithelial defect on the inferior nasal aspet of the corea. The ulcer had the characteristic rolled edges and surrounding edema. The ulcer measured 4 X 2 mm. There was no cell and flare in the anterior chamber. The patient was placed on Vigamox q2h. After several visits the patient was eventually put into a bandage contact lens, Vigamox TID OS and Homatropine 5% BID OS. With the bandage lens and close follow-up the lesion slowly healed leaving the patient with 20/20 vision OU.

CONCLUSIONS: Neurotrophic ulcer is a rare corneal problem that is often difficult to manage and treat. The decreased sensitivity makes it more difficult to treat the ulcer and can lead to significant loss of vision as a result of scarring and possible perforation. Treatment options include partial or complete tarsorrhaphy. This case demonstrates the benefits of a bandage contact lens and the avoidance of a surgical procedure to mange a neurotrophic ulcer.
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