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ARTICLES
Year : 1973  |  Volume : 21  |  Issue : 1  |  Page : 30-31

Neuroparalytic keratitis after cataract extraction


Department of Ophthalmology, Medical College and Hospital, Rohtak, Haryana, India

Correspondence Address:
Prem Chandra
Department of Ophthalmology, Medical College and Hospital, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


PMID: 4793004

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How to cite this article:
Chandra P, Chohan B S. Neuroparalytic keratitis after cataract extraction. Indian J Ophthalmol 1973;21:30-1

How to cite this URL:
Chandra P, Chohan B S. Neuroparalytic keratitis after cataract extraction. Indian J Ophthalmol [serial online] 1973 [cited 2020 Dec 3];21:30-1. Available from: https://www.ijo.in/text.asp?1973/21/1/30/31422

Occurrence of neuroparalytic kera­titis after cataract extraction has not been reported in the literature. Mar­ginal ulceration associated with anaes­thesia of the cornea was first observed by E. Fucxs, [2] and later by his son A. FucHs, [3] . NAUHEIM [6] observed mar­ginal keratitis and corneal ulceration after surgery of extraocular muscles. THEODORE [7] observed similar patholo­gical marginal dimple like ulcerations with temporary sensory impairment after the operations of cataract, glau­coma, retinal detachment, and resec­tion of medial rectus muscle. Super­ficial punctate keratitis and superior limbic keratoconjunctivitis of filamen­tary type involving the area of cataract incision associated with transient hyperasthesia of the cornea were also reported by THEODORE. [7]

Among the latest literature on cor­neal complications after cataract sur­gery have been mentioned neurogenic complications like marginal ulceration of Dallen, superficial punctate kerati­tis and superior limbic keratoconjunc­tivitis but fully established clinical picture of neuroparalytic keratitis has not been observed.


  Case Report Top


J. L. 55 male was admitted with the complaints of defective vision left eye. Extraction of mature cataract (ab-externo section) was done with­out any complications. Immediate post-operative period was also event­less and he was discharged from the ward 9 days after the operation. A week later the patient reported with the complaint of lacrimation. Fluore­seine staining of the left cornea show­ed desquarnation of epithelium at the central area, the peripheral 2-3 mm. area remaining healthy. He was ad­mitted for the treatment of corneal ulcer. It was found to be a painless pathology with complete anaesthesia of all quadrants of the cornea. In spite of treatment, desquamation of the epithelium involved whole of the cor­nea and left a narrow rim of the healthy cornea at the periphery. Slit lamp examination showed the haziness of the underlying stroma. Median tar­sorrhaphy was done. Examination after 3 months showed significant im­provement of the condition. Lids were separated after 6 months but the cornea again showed desquamation and opacification. Median tarsor­rhaphy was again advised to the pati­ent, to which he did not agree. The cornea appeared totally opaque and flat on re-examination after 8 months.


  Comments Top


Following corneal section of cata­ract operation, there is loss of sensa­tions principally over the upper half of the cornea and over the lower half as well because of free communica­tions and intermingling of fibres be­tween the corneal nerves. For this reason it is quite difficult to study ac­curately the area of anaesthesia after cutting the corneal nerves. DUKE­ELDER [1] using Marx description says that corneal sensations return fully to normal in a little more than an year.

LEOZ ORTIN [5] found considerable vari­ations in the return of corneal sensiti­vity during their post-operative stu­dies in man and experimentally in animals following variable corneal in­cisions.

Wide discrepancies exist as regards the time necessary for a complete re­turn of corneal sensations. In general it may be said that some sensation be­gins to return to the cornea in about 2-4 weeks. Definite and precise sen­sation cannot be elicited until after 4-8 weeks and complete recovery of sensation may occur from about 150 days to over an year.

It is generally accepted that the corneal sensory nerves exert a pro­found influence on the structural acti­vity of the cornea particularly on the epithelium. It is probable that the disease is due to irritative and meta­bolic changes in and about the dege­nerating nerves. Mere section or para­lysis of the ophthalmic division of the V nerve is unable to produce neuro­paralytic keratitis in the absence of irritative conditions. Antidromic im­pulses and axon reflexes play a large part in the local control of the meta­bolism of the tissue supplied by this nerve and it is possible that excessive output of histamine like substances may account for neuroparalytic kera­tltis. GUPTA, KUMAR AND CHATTER­JEE [4] reported a case of complete iri­doplegia as a result of retrobulbar anaesthesia, probably due to injury to the ciliary ganglion or its motor root. There was no anaesthesia and neuro­paralytic keratitis did not occur. No other report of the injury to the gan­glion during retrobulbar anaesthesia is available in the literature.

Neuroparalytic keratitis in the case reported herein is presumed to be due to injury to the ciliary ganglion during retrobulbar block and injury to the corneal nerves during cataract inci­sion. Denudation of the epithelium did not occur during the immediate postoperative period because the eye remained bandaged and so evaporation of lacrimal secretion did not occur. Impairment of corneal sensations re­sulting from the injury to the ciliary ganglion and the semilunar cataract incision at the limbus resulted in diminution of the controlling influ­ence of antidromic action of the tri­genimal responsible for trophic chan­ges of neuroparalytic keratitis.


  Summary Top


A case of neuroparalytic keratitis after cataract operation as a result of injury to the ciliary ganglion and ab­externo cataract incision is reported. The possible underlying pathology is discussed.

 
  References Top

1.
Duke elder: System of ophthalmo­logy, Kimpton, London, Vol. IV, p. 412, 1968.  Back to cited text no. 1
    
2.
Fuchs, E.: Ueber Dellen in der Hornhaut-Archiv. fur. Ophthal. 78: 82-92, 1911.  Back to cited text no. 2
    
3.
Fuchs, A.: Pathological Dimples (Dellen) of the Cornea, Amer. J. Ophth., 12: 877-883, 1929.  Back to cited text no. 3
    
4.
Gupta, J. S., Kumar, K. and Chat­terjee, A.: Complete Iridoplegia, Amer. J. Ophth., 59: 711, 1965.  Back to cited text no. 4
    
5.
Leoz Ortin: Histopathological study of regenerating nerve fibres. Arch. Ofthal. hisp-Amer. 15: 225, 1915.  Back to cited text no. 5
    
6.
Nauheim, J. S.: Marginal keratitis and corneal ulceration after sur­gery on the extra ocular muscles. Arch. Ophthal. (Chicago), 67: 708­ 711. 1962.  Back to cited text no. 6
    
7.
Theodore, F. H.: Complications after cataract surgery, 1st Ed., p. 163-165. Churchill Ltd., London, 1965.  Back to cited text no. 7
    




 

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