Queratopatía neurotrófica severa en paciente con compromiso bilateral del reflejo palpebral con diferente sustrato neurológico pos-TEC: reporte de un caso / Severe Neurotrophic keratopathy in patients with bilateral involvement of blink reflex with different neurological lesion post TBI: a case report

Se presenta el caso de un paciente que experimentó un TEC severo, asociado a fracturas de huesos craneales y lesión de pares craneales: II par izquierdo, ramas sensitivas corneales y oculares de la primera rama del trigémino derecho, y VII par izquierdo. Secundario a lo anterior, en el paciente se alteró el reflejo palpebral de manera bilateral, pero con un sustrato neurológico diferente. Con el paso del tiempo, ya en fase crónica pos-TEC, el paciente desarrolló una queratopatía neurotrófica severa. Es un caso llamativo por la correlación neuroanatómica que exige y el papel trófico epitelial que representa el nervio trigémino a nivel corneal y porque otorga información al personal médico en neurociencias clínicas para predecir la aparición de una complicación compleja de tratar como lo es la queratopatía neurotrófica. Son escasos los reportes en la literatura de esta temática, asociada a TEC y lesión de diferentes pares craneanos.

A case report of a patient with severe TBI associated with fractures of the skull base and cranial nerve involvement: II left cranial nerve, sensitive fibers from de V right cranial nerve and VII left cranial nerve. Because of complex lesions in cranial nerves, the patient had bilateral altered blink reflex. During the follow-up the patient developed severe neurotrophic keratopathy because. This is a rare cause of corneal lesion secondary to the damage to the trigeminal fibers which has a protective effect in the corneal epithelium. It is also important because could be a complications that could be avoidable en patients with severe TBI with an early diagnosis and treatment. There are few cases reported in the literature.

Neurotrophic Corneal Ulcer Development Following Cataract Surgery with a Limbal Relaxing Incision

A 60-year-old man with bilateral corneal opacity underwent cataract extraction surgery involving the use of a limbal relaxing incision in his left eye. He had lower lid ectropion and lagophthalmos in both eyes. Eleven days after the surgery, a slit-lamp examination revealed a neurotrophic corneal ulcer with a punch-out epithelial defect and rolled edges at the center of the pre-existing corneal opacity. The patient was treated with sodium hyaluronate, autologous serum, and oral doxycycline. Six weeks after the surgery an improvement in corneal sensation was observed and the neurotrophic corneal ulcer subsequently healed over the course of one year. In this report, we present a case of neurotrophic keratitis that occurred after performing cataract surgery concurrent with a limbal relaxing incision. As such, we suggest that limbal relaxing incisions should be performed cautiously in patients with causative risk factors for corneal hypesthesia.