Mastoid Infection Leads to Ulcer?
Discussion Due to incomplete wound healing following the performance of the Gunderson flap, the patient underwent an amniotic membrane transplant over the entire Gunderson flap. The patient was placed on a regimen of Ciloxan (ciprofloxacin, Alcon) qid and Pred Forte (prednisolone acetate) qid in the left eye. It has been three months since the amniotic membrane transplant and she now uses the steroid bid. She remains comfortable and we continue our monthly follow-up visits.
The patient was diagnosed with neurotrophic keratopathy of the left eye as a result of chronic exposure. Damage to the temporal and zygomatic branches of left facial nerve resulted in paralysis of the frontalis, procerus, corrugator and orbicularis muscles. The paralysis of these muscles resulted in poor lid function and, ultimately, exposure of the cornea.
A Gunderson flap procedure was performed to facilitate corneal wound healing. This procedure involves a conjunctival overlay graft using the bulbar conjunctiva. It is used to treat ulcerative corneal disease and corneal perforations. A tarsorrhaphy was also performed to further promote wound healing. The patient was prescribed TobraDex (dexamethasone/tobramycin, Alcon) ung qid.
The primary goal of surgery was to improve comfort of the left eye. The patient did report improved comfort postoperatively, but she had no significant improvement in visual acuity.
