J Korean Ophthalmol Soc.  2015 Feb;56(2):275-279. 10.3341/jkos.2015.56.2.275.

A Case of Sympathetic Ophthalmia due to Corneal Perforation in a Patient with Meningioma

• Sung YM
• Jung SK
• Kim KS
• Yang SW

• KMID: 2216013
• DOI: http://doi.org/10.3341/jkos.2015.56.2.275

Abstract

PURPOSE
To describe a case of sympathetic ophthalmia due to corneal perforation caused by exposure keratitis in a patient with recurrent sphenoid wing meningioma.
CASE SUMMARY
A 34-year-old female patient presented with proptosis in her left eye caused by left sphenoid greater wing meningioma despite tumor debulking surgery and radiation treatment. The cornea was perforated with prolapsed iris due to exposure keratitis, thus enucleation of the left eye was performed. After 2 weeks, an inflammatory reaction occurred in both eyes, keratic precipitates on corneal endothelium, exudative retinal detachment, and multiple granulomatous nodules on the right eye retina. The patient was diagnosed with sympathetic ophthalmia, thus enucleation of the left eye and debulking of the tumor were performed followed by a high-dose intravenous steroid therapy. At 5 months postoperatively, slit lamp biomicroscope showed no chamber reaction; improved disc swelling and exudative retinal detachment in the right eye were observed.
CONCLUSIONS
Despite conservative treatment for exposure keratitis due to proptosis caused by malignant sphenoid meningioma, corneal perforation can develop. Because sympathetic ophthalmia can occur, the other eye should be monitored.

Keyword

Meningioma; Sympathetic ophthalmia

MeSH Terms

Adult
Cornea
Corneal Perforation*
Endothelium, Corneal
Exophthalmos
Female
Humans
Iris
Keratitis
Meningioma*
Ophthalmia, Sympathetic*
Retina
Retinal Detachment

Figure

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  Figure 1. (A) Corneal opacity and mid-dilated pupil in the left eye, (B) brain MRI showed progressed mass extent to orbit, ethmoid sinus, nasal cavity, sphenoid sinus, intracranium, (C) conjunctival injection in the right eye after 2 weeks, (D) KP’s on endothelium and fibrinous membrane on anterior lens capsule in the right eye, (E) exudative retinal detachment and multiple granulomatous nodules in the right eye, (F, G) FAG shows multiple progressively fluorescent dots at the level of the RPE, disc leakage, coalescence of the dye, (H) patternless growth and abundant miotic figures (HE ×40). KP's = keratic precipitates; FAG = fluorescent angiography; RPE = retinal pigment epithelium.

• 

  Figure 2. (A) Decreased inflammation at anterior chamber in the right eye, (B) mildly swollen disc and improved serous retinal detachment in the right eye.

Reference

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