Dry Eye Syndrome: Severe Ocular Surface Inflammatory Syndrome Post LASIK Caused by Blepharitis
Blepharitis and chronic meibomitis can affect the tear film composition, produce epithelial corneal defects, and lead to dangerous bacterial infections after LASIK surgery. Infection symptoms include pain, decreased vision, photophobia, irritation, or red
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Jorge L. Alió, Dominika Wróbel, and Alessandro Abbouda
Contents
Why Is This Case Relevant for the Refractive Surgeon?
Why Is This Case Relevant for the Refractive Surgeon? ..................................
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Case Background ...................................................
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Main Problem to Solve ..........................................
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Ancillary Tests ........................................................
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Surgical/Medical Intervention ..............................
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Outcome ..................................................................
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What to Learn from This Case .............................
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References ...............................................................
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J.L. Alió, MD, PhD (*) Department of Refractive Surgery, Vissum Corporación Oftalmológica, Alicante, Spain e-mail: [email protected] D. Wróbel, MD Glaucoma Diagnostic and Microsurgery Department, Medical University of Lublin, Lublin, Poland R&D Department, Vissum Corporacion, Alicante, Spain e-mail: [email protected] A. Abbouda, MD Department of Refractive Surgery, Vissum Corporación Oftalmológica, Alicante, Spain Department of Ophthalmology-Policlinico Umberto I of Rome, University of Rome “Sapienza”, Viale del Policlinico, 155, 00186 Roma, Italy R&D Department, Vissum Corporación Oftalmológica, 03016, Alicante, Spain e-mail: [email protected]
Blepharitis and chronic meibomitis can affect the tear film composition, produce epithelial corneal defects, and lead to dangerous bacterial infections after LASIK surgery. Infection symptoms include pain, decreased vision, photophobia, irritation, or redness. As many as 10 % of cases may be asymptomatic. The refractive surgeon should identify preoperative blepharitis to avoid serious complications [1].
Case Background A 49-year-old woman was referred to our department complaining of photophobia and blurred vision for 1 week. She underwent refractive surgery 2 years prior, and her manifest refraction before the treatment was −6.5 diopters (D). Prior to surgery, she wore contact lenses regularly and had recurrent blepharitis. The current manifest refraction was +3.0 −3.0 × 50° in the right eye (RE) and +0.75 −0.50 × 130° in the left eye (LE). Her best corrected visual acuity (BCVA) was 20/25 in the RE and 20/63 in the LE. The slit lamp examination showed blepharitis in both eyes and ciliary injection and central corneal infiltrate in the LE (Fig. 46.1). The fundus examination was normal.
J.L. Alió et al. (eds.), Difficult and Complicated Cases in Refractive Surgery, DOI 10.1007/978-3-642-55238-0_46, © Springer-Verlag Berlin Heidelberg 2015
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Fig. 46.1 Slit lamp examination showed blepharitis and central corneal infiltrate
Fig. 46.2 Slit lamp examination showed a resolution of central infiltrate, but an inferior epithelial ingrowth nest was observed
Main Problem to Solve
a night. The case did not show the progressive evolution of an infection, and the treatment had no apparent anti-infectious effect. We decided to s
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