CORNEAL ABSCESS IN LAGOPHTHALMOS IN CHILDREN: CASE REPORT

The quality and frequency of blinking allow the tear film to properly cover the ocular surface and are essential to the good health of the latter. The resulting corneo-conjunctival abnormalities are all the more marked as the malocclusion is frequent and significant.

12-year-old child, with a history of motor and cerebral infirmity, polymarformative syndrome and hydrocephalus, admitted to the ophthalmological emergency department for a red eye, evolving for 20 days.

The visual acuity couldn’t be measured. The examination revealed lagophthalmos, abortive blinking with a frequency of 9 blinks per minute, presence of purulent secretions and moderate conjunctival hyperemia. A unilateral axial corneal abscess in the right eye, measuring 6 mm x 5.8 mm with fluorescein intake was found. Fundus examination was not possible. Ultrasound revealed a flat retina with absence of vitreous organization. The treatment consisted of hospitalization, with corneal samples which turned out to be negative. Treatment was topical with eye wash; fortified ceftazidime eye drops and vancomycin associated with nocturnal ocular occlusion. The evolution was marked by a regression in the size of the abscess and the symptoms.   

Modern tools for analyzing the ocular surface have made it possible to confirm a concept already known to clinicians for a long time, but difficult to measure: the quality of eyelid occlusion. In addition to the obvious situations of nocturnal malocclusion following peripheral facial paralysis or an eyelid wound, or even poor surgery for a cancerous disease of the face, in certain patients there are more or less abortive blinks which can generate or aggravate ocular surface abnormalities. This partial malocclusion can affect all the blinks or only part of them. In the most severe cases, it can be examined directly by observing the patient during the questioning period. Confirmation is provided after instillation of fluorescein. The more marked the malocclusion, the greater the risk of corneo-conjunctival complications.

Eyelid malocclusions can accompany multiple pathologies including those of the nervous system. It is important to take care of this type of patient as a whole and prevent possible ocular complications.