Disrupted Balance: How Stroke And Cataract Surgery Precipitated Unilateral Dry Eye Disease
Published 2023 - 41st Congress of the ESCRS
Reference: PO0784 | Type: Free paper | DOI: 10.82333/0whc-be89
Authors: Nuno Miguel Sousa Gouveia* 1 , João Gil 2 , Esmeralda Costa 2 , Andreia Rosa 2 , Cristina Tavares 2 , Maria João Quadrado 2 , Joaquim Murta 2
1Ophthalmology,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal, 2Ophthalmology,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal;Clinical Academic Center of Coimbra (CACC),Coimbra,Portugal;Faculty of Medicine,University of Coimbra,Coimbra,Portugal
Purpose
Dry eye disease (DED) is considered a multifactorial disease of the ocular surface in which tear film instability, inflammation, hyperosmolarity and neurosensory abnormalities play an important role. Corneal hypoesthesia following an ischemic stroke has been associated with decreased levels of growth factors. Furthermore, cataract surgery can exacerbate DED with implications in postoperative visual outcomes. Plasma rich in growth factors (PRGF) has been proposed for the treatment of severe DED given its composition, regenerative effect and safety. We report a case of unilateral severe DED precipitated by cataract surgery in a patient with left-sided facial hypoesthesia, which was successfully treated with PRGF eye drops.
Setting
Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
Methods
Case description based on retrospectively reviewed clinical record, ocular examination and anterior segment photography.
Results
A 68-year-old woman reported recurrent episodes of blurry vision and burning sensation OS after undergoing cataract surgery OU a year before. She had developed long-term left-sided facial hypoesthesia and left limb ataxia after suffering an ischaemic stroke. Best corrected visual acuity (BCVA) was 20/20 OD and 20/30 OS. Slit lamp examination revealed a generalised superficial punctate keratitis OS (grade 4). Schirmer I test reached 12mm OD and 5mm OS. Using a hand-held esthesiometer, contact was felt at 5.5cm OD and not felt OS. After six months under treatment with PRGF, she noted a significant improvement in symptoms. BCVA OS was 20/20, no signs of keratitis were observed, tear breakup time was 8 seconds and Schirmer I test reached 7mm.
Conclusions
Stroke survivors seem to have an increased risk for developing DED and neurotrophic keratopathy as the loss of corneal innervation deprives the epithelium of essential neurotrophic factors and removes the drive to lacrimal secretion. PRGF is a hemoderivative product that has been proposed for the management of severe ocular surface diseases because of its numerous growth factors and proteins, which effectively promote tissue repair and epithelial healing. Active questioning of ocular symptoms, evaluation of predisposing factors for DED and comprehensive eye examination should be routinely performed prior to routine cataract surgery and during follow-up to prevent disease exacerbation after surgery and avoid compromising visual outcomes.