ESCRS - P176 - COMBINED NEUROTROPHIC AND EXPOSURE KERATOPATHIES: “SECOND WAVE” OF NASOPHARYNGEAL CARCINOMA OPHTHALMIC FEATURES

COMBINED NEUROTROPHIC AND EXPOSURE KERATOPATHIES: “SECOND WAVE” OF NASOPHARYNGEAL CARCINOMA OPHTHALMIC FEATURES

Published 2022 - 26th ESCRS Winter Meeting

Reference: P176 | Type: Abstracts | DOI: 10.82333/bzhn-z936

Authors: Imad Messafi* 1 , Siham CHARIBA 1 , Asmae MAADANE 1 , Rachid SEKHSOUKH 1

1Ophthalmology,Mohammed VI University Hospital,Oujda,Morocco

Purpose

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood. The two most common. histologic variants are embryonal and alveolar subtypes. Head and neck localisations include the nasopharynx, which can be responsible of multiple ophthalmic symptoms following the concerned structures. Ocular surface features are usually due to exposure. We report a rare case combining a neurotrophic and exposure keratopathies following treatement of nasopharyngeal RMS.

Setting

Ophthalmology departement, Mohammed VI univeristy hospital, Oujda, Morocco 

Methods

 A 9 years old girl, treated by chemotherapy for nasopharyngeal RMS. She presented neurotrophic and exposure keratitis secondary to combined compression of trigeminal and facial nerves.

Results

Patient admitted for left ptosis and decreased vision. She had dental extraction, abscess and otalgia, treated as otitis without improvement. Ophthalmological exam was normal in right eye , OS: VA at 0.5, proptosis, ophthalmoplegia with semi-mydriasis and normal fundus: Gradenigo and orbital apex syndromes with facial paralysis. Imaging: nasopharyngeal tumor extended to infratemporal fossa, mastoid cells , carotid artery, temporal lobe, optical channel, cavernous sinus and trigiminal nerve. Biopsy: embryonnal RMS. After chemotherapy, she presented lagophthalmos, corneal ulcertaion, abolition of corneal sensitivity and infectious keratitis. Evolution was favourable under preservative free lubricant agents, fortified eye drops and eye occlusion.

Conclusion

In this report, we describe a case of neurotrophic keratopathy associated with nasopharyngeal RMS. Extension to cavernous sinus and trigeminal nerve seems to be causative of epithelial defect , meanwhile facial paralysis aggravated the clinical presentation by exposing cornea. As most cases of ocular impact of nasopharngeal carcinoma, our patient presented initially neuro-ophthalmic manifestations . Due to chemotherapy and regression of third cranial nerve compression , the “ protective “ effect of ptosis disappeared , enabling combination of the previous cited corneal complications.