Exposure keratopathy, perforation risk
First Author: C.Porcar Plana SPAIN
Co Author(s): J. Moya Roca M. Puzo Bayod
To present a high grade exposure keratopathy and perforation case report because of a facial nerve palsy after an acoustic neurinoma.
Miguel Servet Universitary Hospital (HUMS).
A 74-year-old man attended de emergency service refering ocular pain and tearing. As a relevant antecedent he had a gold weight on his left upper lid because of a facial nerve palsy. On the examination an small (2mm) but deep ulcer, positive seidel and a medium anterior chamber were noted. The anterior pole OCT showed a complete ínfero-temporal deffect. Anterior pole photography were taken for posterior follow- up.
A cyanocrylate tissue adhesive patch and a therapeutic contact lens (TCL) were placed and anterior pole OCT sowed was practice to prove they correctly oriented. Next day as the anterior chamber wasn´t reformed, surgical managment with a 3mm corneal plastia, amniotic membrane and permanent lateral tarsorrafia was decided. Posterior follow up the amniotic membrana was removed showing good aspect of the graft.
'- Facial nerve palsy is the main postoperative complication after acoustic neurinoma surgery. - Facial nerve palsy is a therapeutic challenge for ophthalmogist because each patient managment must be individualized to minimize perforation risk. - Over time and because of eyelid laxity a gold weight may become insufficient to reach a good eyelid closure, so an extensive follow-up is essential. - In exposure keratopathy perforations, the treatment may be focused on correcting corneal deffect as well as correcting eyelid deffects.