Resolution Of A Pterygium-Associated Dellen Combined With Ciprofloxacin Deposits In The Cornea

Dellen, also known as 'delle' or 'Fuchs dimples,' are localized areas of corneal or scleral thinning, typically presenting as oval-shaped lesions near the limbus. Dellen can be associated with conjunctival surface elevations such as pterygium, recess-resect procedures, or filtration blebs. Due to the presence of these surface elevations, normal blinking fails to adequately wet the affected region.

Left untreated, dellen may progress to corneal perforation. Treatment modalities include artificial tears, ointments, patching, and bandage contact lenses to facilitate repair and prevent complications. Understanding the etiology and management of dellen is crucial in preserving ocular integrity and preventing vision-threatening sequelae.

We report a case of a male patient who presented with a corneal dellen that occurred 1 day after vitrectomy. The patient presented to the Shengavit Medical Centers ophthalmological department, Yerevan, Armenia for postoperative evaluation.

A 55-year-old patient presented to the ophthalmological department for post-operative evaluation. The patient had undergone a vitrectomy on the right eye one day before due to a vitreous hemorrhage. The surgery was uneventful. The past ocular history was remarkable for bilateral nasal and temporal pterygiums.

On the postop second-day visit slit-lamp biomicroscopy revealed an ellipse-shaped epithelial defect, 50% thinning of the stroma with overlying ciprofloxacin deposits, and adjacent edema of the nasal pterygium's head. The patient was diagnosed with dellen combined with ciprofloxacin deposits. 

The patient was advised to change the Ciprofloxacin eye drops to Tobramycin (4 times/per day) and Dexamethasone (2 times/per day) for postoperative treatment.  Fluorometholone 0.1% (3 times/per day) and preservative-free artificial tears were added. The bandage contact lens was placed to avoid corneal perforation and restore the focal thinning of the cornea.

2 days later the ciprofloxacin deposits were resolved. 1 week later there was a significant thickening of the cornea with a resolved epithelial defect, but the contact lens was kept for 1 more week with the prescribed regimen of treatment. One month later dellen was completely resolved and the patient was advised to undergo a pterygium removal surgery to avoid further complications.

Management and follow-up of corneal dellen can be challenging due to a high risk of corneal perforation.

As presented in our case report, topical lubricants, and bandage contact lenses were proved to be an appropriate therapy. 

This case is unique because according to our knowledge, there is not any previously documented report of corneal dellen associated with ciprofloxacin deposits in literature so far.