Bilateral corneal perforation caused by neurotrophic keratopathy associated with leprosy: a case report

Abstract

Background Neurotrophic keratopathy (NK) is a rare degenerative corneal disease caused by damage to the trigeminal nerve. We hereby describe a severe case with bilateral corneal perforation due to leprosy (Hansen’s disease)-associated NK. Case presentation An 89-year-old man with a history of leprosy treated 40 years previously in our sanatorium developed bilateral corneal perforation due to NK. He had a history of bilateral persistent epithelial defects and bacterial keratitis. Although epithelialization was obtained with the use of autologous serum eye drops, progressive corneal thinning concomitant with stromalysis led to bilateral perforation. Over one month treatment with topical antibiotics, anti-inflammatory and lubricants resulted in healing of the epithelial defects and corneal perforations. A Cochet-Bonnet esthesiometer demonstrated a total absence of corneal sensation in both eyes. Conclusions The present case indicated the irreversible nerve damage due to leprosy that had been cured 23 years ago, which can progress over the years and cause bilateral corneal perforations.

Corneal Neurotization: Essentials for The Facial Paralysis Surgeon

“…Acquired NK may be caused by herpes simplex or zoster infections, tumors, intraoperative injury, and trauma such as thermal and chemical burns 11,12 . More rarely, acquired causes of NK can be due to systemic neuropathies, such as diabetes mellitus or leprosy, or metabolic etiologies such as vitamin B12 deficiency [13][14][15][16] . Iatrogenic causes range from contact lens misuse to the chronic use of some topical medications, such as those used to treat glaucoma, in addition to damage during ocular or CND surgery 17 .…”

Corneal Nerve Assessment by Aesthesiometry: History, Advancements, and Future Directions

“…Systemic disease states that have been reported to impact the ophthalmic nerve and corneal innervation are numerous and include acquired neuropathies—such as diabetic and chemotherapy-induced—as well as inherited neuropathies such as Charcot-Marie-Tooth disease [ 2 , 23 ]. NK has rarely even been reported in association with uncommon disease states such as leprosy, as well as metabolic etiologies such as vitamin B-12 deficiency [ 24 , 25 ].…”

Challenges of sustaining leprosy elimination in India and prospects of eradication: Current status & way forwards

“…Later on, ulcers on the sole of the feet and even blindness may ensue. 4,5 The good news is that Leprosy is curable and aggressive treatment in the early stage prevents disability. Early diagnosis carries some inherent advantages including the complete cure of the disease before further nerve damage occurs and preventing disabilities, avoiding infecting close contacts, and it also motivates people to seek treatment early.…”