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Abstract: This is a case of an elderly female, 73 years old. 3 years ago, she developed blurred vision in her right eye with progressive worsening, but she was not treated. 10 days ago, she came to our hospital because of worsening pain in her right eye, and after examination and diagnosis of corneal chyloma, she underwent surgery and recovered well after surgery.
Basic information】Female, 73 years old
Type of disease】Corneal staphyloma
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】January 2022
Treatment plan】Surgical treatment (right eyeball removal, prosthetic table implantation) + topical medication (levofloxacin hydrochloride eye drops, tobramycin dexamethasone eye drops, diclofenac sodium eye drops)
Treatment period】10 days of hospitalization and regular outpatient follow up
Treatment effect】The pain in the right eye was relieved and the condition was stable.
I. Initial consultation
The patient is a 73-year-old female. The patient’s family complained that 3 years ago, she found that her right eye had blurred vision with no obvious reason or cause, and it was progressively aggravated, with occasional discomfort such as eye redness and foreign body sensation. The physical examination showed that the right eye was lightless and the left eye was 4.8; the right eye pressure was Tn+1; the right eye was congested, with large corneal vesicles, peripheral neovascularization, disappearance of the anterior chamber, pupil membrane closure, internal ambiguity, and mild clouding of the crystal. The fundus mold grain was visible with clear optic disc border, tortuous veins and unclear central reflection. A preliminary diagnosis of corneal grapheme in the right eye was made and the patient was admitted to the hospital for treatment. In addition, the patient’s medical history revealed that he had a history of coronary artery disease, and his condition was stabilized after stenting.
II. Treatment history
After admission, the patient’s slit lamp examination showed that the cornea was grayish white, cloudy, and with thicker patchy wings, and the diagnosis of right corneal staphyloma could be confirmed with the examination before admission. The patient and his family were informed of the patient’s condition and briefly explained the currently available treatment options, and the patient chose to undergo surgery. After completing the preoperative examination, right eye removal and prosthetic table implantation were performed. The patient was given low-flow oxygen inhalation, and the right eyeball was first removed under local anesthesia, then the posterior scleral cavity was enlarged and the prosthetic table was implanted, and the layers of tissue were sutured together layer by layer, and the transparent prosthetic piece was placed and bandaged with pressure. The surgery was relatively smooth, and the patient was hospitalized for a total of 10 days. Levofloxacin hydrochloride eye drops, tobramycin dexamethasone eye drops, and diclofenac sodium eye drops were given before discharge, and he was discharged home with medication for treatment.
III. Treatment effect
The patient had no intraoperative or postoperative complications and her general condition was stable. The physical examination before discharge indicated that there was pain in the right eye, but it was mild, the right eyelid was mildly swollen, the conjunctiva was congested and edematous, the incision was healing well, the prosthetic eye was in a position to move, the visual acuity of the left eye was 4.8, the intraocular pressure was 18 mmHg, the eye was not congested, and the atrial fluid was clear, which indicated that the treatment plan was effective. At the 3-month postoperative visit, no sunken orbital deformity occurred, and the follow-up is ongoing.
IV. Notes
The surgery of the patient’s condition was relatively smooth and there were no sudden accidents. Postoperatively, the patient and his family were instructed that the patient should rest with eyes closed for about 48 hours after surgery, and at the same time, the patient’s family should carefully observe the patient’s condition, and if discomfort such as nausea and pain occurs, they should promptly notify me or other medical personnel for timely treatment; in addition, no obstacle should be placed at the patient’s bedside so that the patient will not fall inadvertently. After a period of time, the patient basically recovered and was very happy. I was also happy that the patient could be discharged for his improvement and instructed the patient’s family that he should return to the hospital 1 week after discharge to customize the prosthetic eye piece and assist the patient to use the eye drops regularly to promote postoperative recovery.
V. Personal insight
Older patients like the one in this article, when they have ocular symptoms such as blurred vision, eye redness, and ocular foreign body sensation, usually mistake them for presbyopia and do not take curative measures, thus giving corneal chylomicron the opportunity to take advantage of them. Therefore, it is recommended that elderly patients with symptoms such as vision loss, blurred vision, and eye pain should go to the hospital in time to get a clear diagnosis through relevant examinations, and then promptly undergo medication and surgery to control the development of the disease.