Bilateral neurotrophic keratopathy complicating Vidian neurectomy

PURPOSE: To present a case of bilateral neurotrophic keratopathy with miosi s after bilateral Vidian neurectomy for vasomotor rhinitis. METHODS: Observational case report. RESULTS: A 68 year-old man presented with irritation and blurred vision in both eyes 2 weeks after bilateral Vidian neurectomy. Slit-lamp examination revealed a large epithelial defect, typical of neurotrophic keratopathy, in the inferior two-thirds of cornea in both eyes. Corneal sensitivity test w ith a Cochet-Bonnet anesthesiometer and electrical study of the blink refle x indicated bilateral trigeminal dysfunction. Both pupils were miotic, and tests with hydroxyamphetamine 1% and epinephrine 0.1% showed postganglionic sympathetic nerve damage. The corneal epithelial defects healed after 2 mo nths of treatment with systemic prednisolone, vitamin Bit and tarsorrhaphy. CONCLUSION: Neurotrophic keratopathy associated with dry eye syndrome may b e a serious complication of Vidian neurectomy, (Am J Ophthalmol 2001;132: 1 06-108. (C) 2001 by Elsevier Science Inc. All rights reserved).