Dr. AMIRTHA VAITHIANATHAN

Dr. MATHU KRISHNAN VALLINAYAGAM, Dr. KOUSHIK SHIVAKUMAR

Abstract

Neurotrophic keratitis is caused by damage to Trigeminal innervation, which leads to spontaneous epithelial breakdown and non-healing ulcer. A superimposed neuroparalytic component poses daunting prospects of recovery. 64 year-old female was referred with complaints of redness and watering in right eye, following surgical excision of acoustic neuroma one week prior. Examination revealed an oval ulcer located in inferior paracentral cornea with smooth rolled margins. Lagophthalmos and reduced corneal sensation were noteworthy features, with restriction of abduction in right eye. A pre-operative review showed normal corneal sensation and normal eyelid closure. Therapy was initiated with lid taping, lubricants, antibiotics and bandage contact lens. An iatrogenic cataclysm of neurotrophic and neuroparalytic ulcer is an unusual presentation, post- vestibular Schwannoma surgery. Newer modalities like cenegermin and corneal neurotization are future directions for this therapeutic challenge.