Challenges In Managing Moderate Keratitis In A Patient With Lagophthalmos After Blepharoplasty And Moderate Dry Eye Disease With Meibomian Gland Dysfunction

The purpose of this study is to highlight the importance of the ocular surface in visual health and function and to emphasize the significant impact of ocular surface diseases (OSD) on individuals' quality of life. It aims to draw attention to the prevalence of OSD, particularly dry eye syndrome (EOS), and the associated complexities in managing these conditions. Additionally, the study aims to underscore the need for a multidisciplinary approach involving various specialists to ensure timely and efficient diagnosis, treatment, and monitoring of OSD and its complications.

This case illustrates multiple eyelid and ocular surface pathologies in a patient experiencing significant ocular discomfort, along with both functional and anatomical implications.

A 68-year-old patient with a history of moderate dry eye disease, experiencing ocular discomfort and symptoms such as pain, burning, and blurry vision, sought medical attention. Past medical history includes hyperthyroidism, upper and lower blepharoplasty, chalazion removal, and phacoemulsification. Initial assessment revealed lagophthalmos, posterior blepharitis, and keratitis. Management included discontinuation of vasoconstrictors and initiation of lubrication therapy, Loteprednol, and IPL therapy. Follow-up after six months showed partial improvement, prompting additional IPL therapy and reinforcement of lubrication therapy. Visual acuity remained stable, with lagophthalmos managed through continuous lubrication and nighttime eye taping

Ocular surface diseases encompass many conditions affecting the cornea and conjunctiva. Environmental factors expose this region to disorders, notably dry eye syndrome (DES), affecting 8-30% globally. DES often coexists with blepharitis, conjunctivitis, and meibomian gland dysfunction, as seen in our patient. Lagophthalmos post-blepharoplasty contributed to her dry eye, meibomian gland dysfunction, and chronic keratitis. These conditions disrupt tear film stability, leading to hyperosmolarity, inflammation, and neurosensory reflex activation. Managing such complex cases requires a multidimensional approach, including lubrication, anti-inflammatory drugs, immunomodulators, and intense pulsed light therapy

It is evident that structural abnormalities of the ocular surface can accompany or exacerbate preexisting ocular surface diseases. Just as in the case of postoperative lagophthalmos in our patient, it acted as a trigger for the development of different conditions that ultimately worsened the ocular surface of both eyes, even with multimodal and appropriate management. These conditions should not be overlooked, as they are not only a concern for ophthalmologists but also impact people's daily lives. Understanding them adequately is crucial for providing effective ophthalmic care and improving patients' quality of life.