Posters

Severe neurotrophic keratitis as the first sign of trigeminal trophic syndrome

Poster Details

First Author: S.Martin Nalda SPAIN

Co Author(s):    J. Puig   L. Bisbe   C. Garcia-Arumi   D. Aragon   J. Oliveres   S. Banderas     

Abstract Details

Purpose:

To describe the case of a patient with a neurotrophic ulcer in her left eye resistant to multiple treatments (blood products, amniotic membrane and conjunctival flap) until a tarsorraphy was performed. During the follow-up a neurological examination and nuclear magnetic resonance were performed due to the facial loss of sensitivity and nasal ala ulceration, that was getting larger, and trigeminal trophic syndrome was diagnosed.

Setting:

Cornea and Ocular Surface Unit. Vall d'Hebron Hospitals. Barcelona. Spain.

Methods:

We present the case of a 29-year-old woman that was referred to our hospital because of a 3 month neurotrophic keratitis in her left eye resistant to topical treatment with preservative-free tear substitutes and therapeutic contact lenses. Amniotic membrane transplantation and umbilical cord eye drops were applied but ulcer did not heal. Also autologous serum, topical cryopreserved amniotic membrane, and a conjunctival flap were used but the ulcer worsened. During follow-up the patient complained of left facial parestesias and a left nasal ala ulceration. A neurological examination was requested and a nuclear magnetic resonance was performed.

Results:

Nuclear magnetic resonance showed a focal lesion of cystic aspect, non- aggressive in the left trigeminal nerve root. Infectious, stroke or tumoral etiology were excluded. Neurologists recommended radiological follow-up every six months. The corneal ulcer healed thanks to a tarsorraphy, but with a corneal scar, total anaesthesia and low visual acuity. She was treated by the plastic surgery service to repair the large ulceration of the left nasal ala.

Conclusions:

Trigeminal trophic syndrome is a rare complication of trigeminal nerve injury. Includes a classical triad: facial ulceration with anesthesia and parestesia in the same affected trigeminal dermatome. The nasal ala is involved in more than half of the cases and neurotrophic keratitis appeared in some of them. The etiologies are mainly cerebrovascular accidents and neurosurgery of the trigeminal ganglion. Time of onset of this syndrome may vary from weeks to decades. We present this case of neurotrophic keratitis resistant to multiple treatments as first sign of trigeminal trophic syndrome.

Financial Disclosure:

None