Posters

Neurotrofic ulcer and dry eye secundary to radiotherapy: a medico-surgical challenge

Poster Details

First Author: A.Mata Madrid SPAIN

Co Author(s):    B. Garcia-Valcarcel Gonzalez   L. Ibares Frías   B. Moreno García              

Abstract Details

Purpose:

To remember the possible ocular complications of periorbitary radiotherapy as well as the therapeutics possibilities.

Setting:

University Hospital Gregorio Marañon, Madrid

Methods:

Case presentation of a 54 years old man treated with chemotherapy and radiotherapy for a malignant sinunasal epidermoid tumor. After the radiotherapy the patient presented corneal anesthesia, limbar insufficiency, severe hyposecretory dry eye and a marked reduction of blinking leading, appearing a neurotrophic ulcer that required of an intensive medical in conjunction with a surgical treatment.

Results:

The patient presented a Schirmer of 0, decreased blinking and visual acuity that descended from 20/40 to moving fingers. Slit lamp showed an epitelial defect of 4x3,5mm with a thinning of 1mm, inferior limbar insufficiency with deep and superficial neovascularization and absence corneal sensation measured with a handheld esthesiometer. Topical treatment showed ineffective. An amniotic membrane transplant (AMT) was performed but the patient developed a neurotrofic ulcer with a horshoe-shaped thinning that required a multilayer AMT with a tarsorraphy to avoid perforation. The tarsorraphy and another AMT were needed again after 6 months and nowadays there’s no risk of perforation.

Conclusions:

Radiotherapy constitutes nowadays one of the basis of tumor treatment, but it is not without consequences, both short and long term, some of them causing sometimes irreversible alterations such as the ocular ones. Although some of the most frequent consequences of radiotherapy are cataracts, retinopathy, optic neuropathy and dry-eye syndrome it can also present with limbar insufficiency, reduced blinking, diminished corneal sensitivity and corneal ulceration, among others complications. Severe clinical scenarios sometimes present secundary to radiotherapy that are required of a strict follow-up. Surgical treatments (amniotic membrane transplant or tarsorraphy) should be considered when dealing with severe ocular surface pathology.

Financial Disclosure:

None