Document Detail


Neurotrophic corneal endothelial failure complicating acute Horner syndrome.
MedLine Citation:
PMID:  10485536     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The authors report the clinical findings of a unique case of rapid corneal endothelial decompensation in association with acute Horner syndrome. STUDY DESIGN: Case report and literature review. METHODS: The authors followed a 38-year-old woman who developed Horner syndrome after right jugular vein catheterization during cardiac valvular surgery. Shortly after the operation, Horner syndrome accompanied by conjunctival hyperemia and stromal corneal edema developed in the right eye. Over the course of 4 months, the eye became painful, the corneal endothelial cell count dropped precipitously, and the stromal edema worsened, causing a difference of 100 microm in central corneal thickness compared to the unaffected eye. Deep stromal vascularization started at the limbus, resembling interstitial keratitis. RESULTS: A 3-week course of topical steroid treatment resulted in a dramatic improvement in the stromal corneal edema and regression of the deep stromal vascularization. Ocular and right hemicranial pain subsided shortly thereafter. CONCLUSION: The authors hypothesize that corneal endothelial failure in this unique case may have resulted from traumatic sympathectomy. According to experimental evidence in the reviewed ophthalmologic literature, sympathetic innervation may have a neurotrophic role in the cornea. Corneal pathology similar to the authors' case has been described in hemifacial atrophy (Parry-Robson syndrome), a disorder that is assumed to result from sympathetic denervation and that can be produced in animals by cervical sympathectomy. The authors therefore hypothesize that sympathetic denervation of the cornea may rarely cause endothelial decompensation and corneal edema. To the authors' knowledge, this is the first reported case of corneal endothelial failure in Horner syndrome.
Authors:
E Zamir; I Chowers; E Banin; J Frucht-Pery
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Ophthalmology     Volume:  106     ISSN:  0161-6420     ISO Abbreviation:  Ophthalmology     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-09-20     Completed Date:  1999-09-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1692-6     Citation Subset:  IM    
Affiliation:
Hadassah University Hospital, Jerusalem, Israel. zami@md2.huji.ac.il
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Administration, Topical
Adult
Anti-Inflammatory Agents / therapeutic use
Aortic Valve / surgery
Aortic Valve Stenosis / surgery
Cardiac Surgical Procedures / adverse effects
Catheterization, Central Venous
Cell Count
Conjunctival Diseases / drug therapy,  etiology,  pathology
Corneal Diseases / drug therapy,  etiology*,  pathology
Corneal Edema / etiology,  pathology
Corneal Stroma / innervation,  pathology
Endothelium, Corneal / pathology*
Female
Glucocorticoids
Horner Syndrome / complications*,  drug therapy
Humans
Hyperemia / drug therapy,  etiology,  pathology
Methylprednisolone / therapeutic use
Sympathetic Nervous System / injuries
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Glucocorticoids; 83-43-2/Methylprednisolone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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