NEUROTROPHIC ULCER POST-SURGERY FOR TRIGEMINAL NEURALGIA: A CASE REPORT

Neurotrophic keratopathy is partial or complete denervation of the cornea from various origins. It causes corneal sensitivity disorders and chronic degenerative damage to the corneal epithelium. It can be complicated by chronic ulcers which can go as far as perforation. It is a relatively rare pathology and which presents a problem of management. The aim of this work is to illustrate the clinical, therapeutic and prognostic aspect of neurotrophic ulcers through a case report

ophthalmology department, hospital August 20, casablanca university hospital

this is a 57-year-old female patient, followed for trigeminal neuralgia, operated 6 months ago by thermo-coagulation of Gasser's gg in neurosurgery. she presented to the emergency room with a painless red eye and reduced visual acuity in her left eye that had progressed for 20 days the patient was placed under eye wash, autologous serum, wetting agents, a therapeutic soft lens with a daily monitoring the evolution was marked on D5 of the treatment by a start of re-epithelialization on D32 of treatment with total re-epithelialization, the patient retained para-axial corneal opacity as sequelae with visual acuity corrected to 1/10.

Neurotophic corneal ulcers is a serious entity. They can endanger the anatomical integrity of the ocular surface and the transparency of the cornea be at the origin of a deep and lasting decline in VA. Trigeminal neuralgia surgery is a classic etiology of neurotrophic ulcers but other etiologies are described as V palsy (aneurysm, post-traumatic, post-surgical, tumor, hereditary ...), Infectious (Herpes simplex, Herpes ZONA), Burns, diabetes, System Diseases… They are manifested by reduced visual acuity, conjunctival hyperemia, lacrimation, and abolished corneal sensitivity. Neurotrophic corneal ulcers are staged according to the MACKIE Staging (stage 1: superficial punctate keratitis, stage 2: Epithelial ulceration, stromal edema, tyndall in anterior chamber, stage 3: stromal damage, perforation). Treatment of neurotrophic ulcers is nonspecific and should be prompt and aggressive. Wetting agents are indicated whatever the stage. As well as the avoidance of eye drops with preservatives and local corticosteroid therapy. Autologous serum, Therapeutic soft lens, scleral glass, Amniotic membrane are also prescribed according to the indication.

The management of corneal ulcers is difficult. The clinical approach should include an accurate history and a complete clinical examination, during which the assessment of sensitivity is paramount. The priority is to exclude an infectious pathology. The treatment must be rapid and effective because the integrity of the globe is threatened.