Bilateral neurotrophic keratopathy complicating Vidian neurectomy.
OBJECTIVE
To present a case of bilateral neurotrophic keratopathy with miosis after bilateral Vidian neurectomy for vasomotor rhinitis.


METHODS
Observational case report.


RESULTS
A 68 year-old man presented with irritation and blurred vision in both eyes 2 weeks after bilateral Vidian neurectomy. Slit-lamp examination revealed a large epithelial defect, typical of neurotrophic keratopathy, in the inferior two-thirds of cornea in both eyes. Corneal sensitivity test with a Cochet-Bonnet anesthesiometer and electrical study of the blink reflex indicated bilateral trigeminal dysfunction. Both pupils were miotic, and tests with hydroxyamphetamine 1% and epinephrine 0.1% showed postganglionic sympathetic nerve damage. The corneal epithelial defects healed after 2 months of treatment with systemic prednisolone, vitamin B(12) and tarsorrhaphy.


CONCLUSIONS
Neurotrophic keratopathy associated with dry eye syndrome may be a serious complication of Vidian neurectomy.
Lin
P Y
PY
Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan. pylin@vghtpe.gov.tw
Cheng
C Y
CY
Wu
C C
CC
Yen
M Y
MY
Wang
S J
SJ
Liao
K K
KK
Lee
S M
SM
D000368:Aged; D003315:Cornea / Q000294:innervation*; D003316:Corneal Diseases / Q000209:etiology*; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D015877:Miosis / Q000209:etiology; D009297:Nasal Mucosa / Q000294:innervation*; D017764:Parasympathectomy / Q000009:adverse effects*; D010275:Parasympathetic Nervous System / Q000601:surgery*; D012223:Rhinitis, Vasomotor / Q000601:surgery; D020433:Trigeminal Nerve Diseases / Q000209:etiology*