Blebitis In A Child Under Chemotherapy

Trabeculectomy is a standard procedure for glaucoma treatment but can lead to complications like blebitis, especially in immunocompromised patients. This case report aims to discuss the occurrence of blebitis in a child undergoing chemotherapy, highlighting the risk factors involved and the management strategies for this complication, as well as the importance of early diagnosis and intervention in preventing further ocular damage.

This case was managed in a pediatric ophthalmology clinic, where a 4-year-old girl with neurofibromatosis type 1 (NF1) was referred for glaucoma management. The patient had previously undergone trabeculectomy in the left eye and was being treated with chemotherapy for a right optic nerve glioma. Follow-up in the clinic focused on her ocular health amidst the immunosuppressive effects of chemotherapy.

A 4-year-old girl with neurofibromatosis type 1 (NF1) was referred for glaucoma management that required a trabeculectomy in her left eye. During follow-up for her NF1, a glioma of the right optic nerve was diagnosed, and chemotherapy was initiated. After the third chemotherapy session, the patient presented with symptoms of redness and discomfort in her right eye. On clinical examination, Lisch nodules were observed on the right iris, and the optic disc appeared pale. On the left eye, a clear cornea, buphthalmia, ectropion of the uvea, an avascular filtration bubble, and localized blebitis were noted at the trabeculectomy site. No anterior chamber reaction or hypopyon was seen, and the red reflex was preserved. Blood tests confirmed the immunocompromised state due to ongoing chemotherapy. The treatment plan included temporarily halting chemotherapy and starting both topical and oral antibiotics. Daily follow-up was arranged to monitor progress.

Following antibiotic treatment, the patient showed significant improvement. Redness and discomfort decreased, and the blebitis was successfully managed without signs of endophthalmitis. The clinical course remained stable, and the patient continued to be monitored closely for any further complications.

This case highlights the critical need for vigilant management of complications following trabeculectomy in immunocompromised patients. Conditions such as meibomian gland dysfunction, seborrheic dermatitis, and chemotherapy-induced immunosuppression can heighten the risk of blebitis. Early identification and treatment are key to preventing more severe outcomes, such as endophthalmitis. Ongoing, meticulous follow-up is essential to ensure that patients recover without serious long-term ocular complications.