|Year : 1973 | Volume
| Issue : 1 | Page : 30-31
Neuroparalytic keratitis after cataract extraction
Prem Chandra, BS Chohan
Department of Ophthalmology, Medical College and Hospital, Rohtak, Haryana, India
Department of Ophthalmology, Medical College and Hospital, Rohtak, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chandra P, Chohan B S. Neuroparalytic keratitis after cataract extraction. Indian J Ophthalmol 1973;21:30-1
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,  and later by his son A. FucHs,  . NAUHEIM  observed marginal keratitis and corneal ulceration after surgery of extraocular muscles. THEODORE  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. 
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|| |
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|| |
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  using Marx description says that corneal sensations return fully to normal in a little more than an year.
LEOZ ORTIN  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  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|| |
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|| |
Duke elder: System of ophthalmology, Kimpton, London, Vol. IV, p. 412, 1968.
Fuchs, E.: Ueber Dellen in der Hornhaut-Archiv. fur. Ophthal. 78: 82-92, 1911.
Fuchs, A.: Pathological Dimples (Dellen) of the Cornea, Amer. J. Ophth., 12: 877-883, 1929.
Gupta, J. S., Kumar, K. and Chatterjee, A.: Complete Iridoplegia, Amer. J. Ophth., 59: 711, 1965.
Leoz Ortin: Histopathological study of regenerating nerve fibres. Arch. Ofthal. hisp-Amer. 15: 225, 1915.
Nauheim, J. S.: Marginal keratitis and corneal ulceration after surgery on the extra ocular muscles. Arch. Ophthal. (Chicago), 67: 708 711. 1962.
Theodore, F. H.: Complications after cataract surgery, 1st Ed., p. 163-165. Churchill Ltd., London, 1965.