Eyelids & the Anterior Segment:
                       Case thirty

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Figure 1

Figure 2

This 52 year-old woman had had a right acoustic neuroma removed two years ago. Since then she had suffered from a left recurrent painless red eyes. She underwent several lid operation to protect her left eyes (Figure 1) but without success. Figure 2 shows the most recent operation.

a. What ocular complications can follow removal of acoustic neuroma?

Acoustic neuroma is found in the cerebellopontine angle and frequently involves the seventh and the fifth cranial nerves. Tumour removal often results in injury to these nerves and can result in:
• lower facial nerve palsy
• corneal hypoaesthesia
This combination can result in severe corneal damage. This patient suffered from recurrent corneal erosion and abscess due to neurotrophic keratopathy.

b. What lid operations had she undergone?

The patient had had two lid operations to correct her facial nerve palsy:
• lateral tarsorrhaphy
• medial canthoplasty

c. What is the procedure in figure 2?

Conjunctival flap.

This patient had had recurrent sterile corneal abscess resulting in dense corneal scar and was at risk of corneal perforation. Conjunctival flap was performed to protect the eye from further insult. Conjunctival flap should be avoided if the patient had had any useful vision.
 

d. What other options are available for this patient?

In neurotrophic keratopathy. The following options may be tried:
• frequent use of lubricants to protect the corneal surface.
• bandage contact lens
• induced ptosis with gold weight or botulinum toxin injection into the upper lid.