The development of inflammatory eye diseases in patients with endocrine ophthalmopathy after the removal of restrictive strabismus

Abstract

AbstractResearch objectiveIs to show the ways of prevention of corneal complications that patients with endocrine ophthalmopathy (EOP) may have after restrictive strabismus removal.MethodsA patient with an acute keratouveuitis, a purulent helcoma of the left eye against the background of EOP of both eyes after left eye restrictive strabismus removal was examined. The patient underwent biomicroscopic examination with staining solution of fluorescein, beta scanning, anterior segment optical coherence tomography and anti‐inflammatory, antibacterial, keratoprotective treatment was prescribed. There was done bacteriological conjunctival test. Design of the research – case series.ResultsAn important point of intraoperative case management in patients with EOP was to prevent corneal complications. It was related to the duration of surgical intervention, risk of damage to the corneal epithelium during its contact with expander as a result of significant vertical eye rotations during the surgery. We use more frequent irrigation of cornea with normal saline solution or instillation of viskoelastics as keratoprotectors. After surgery, the patient does not have the ability to close the eyelids. It also increases the risk of corneal damage. The cause may be the contact of the cornea with a sterile gauze bandage applied and its non‐moisturizing due to the lack of blinking. In addition, the preoperative hypotropia created protection of the cornea by its contact with the conjunctiva of the lower eyelid. The eye level achieved after the surgery deprives the patient of this “protection”. Therefore there wasn’t applied a gauze bandage but a perforated convex plastic occluder. The cornea is irrigated with keratoprotectors till the ability to close eyelids is reached.ConclusionsSuggested intraoperative and postoperative strategies to manage cases in patients with EOP are the most effective. As long as they allow to reduce all possible corneal complications.