Unilateral punctate keratitis secondary to Wallenberg Syndrome

Abstract

We studied three patients who developed left unilateral punctate keratitis after suffering left-sided Wallenberg Syndrome. A complex evolution occurred in two of them. In all cases, neurophysiological studies showed damage in the trigeminal sensory component at the bulbar level. Corneal involvement secondary to Wallenberg syndrome is a rare cause of unilateral superficial punctate keratitis. The loss of corneal sensitivity caused by trigeminal neuropathy leads to epithelial erosions that are frequently unobserved by the patient, resulting in a high risk of corneal-ulcer development with the possibility of superinfection. Neurophysiological studies can help to locate the anatomical level of damage at the ophthalmic branch of the trigeminal nerve, confirming the suspected etiology of stroke, and demonstrating that prior vascular involvement coincides with the location of trigeminal nerve damage. In some of these patients, oculofacial pain is a distinctive feature.

Keywords: Corneal sensitivity; Lateral medullary syndrome; Neurotrophic ulcer; Punctate keratitis; Trigeminal nerve.

Fig. 1

Case 1. Superficial punctate keratitis, Oxford grade II, affecting visual axis.

Fig. 2

Blink reflex (neurophysiological examination). This technique involves placing an electrode in the orbicularis oculi muscle and a reference electrode in the outer canthus, and then recording the electrical response (mA). ^*Stimulation.

Fig. 3

Case 3. Three months after keratoplasty. Central corneal thinning of 3 mm × 3.5 mm, fluorescein stain, and a hypopyon level of less than 2 mm.

Fig. 4

Case 3. Button with irregular greyish epithelium. Endothelial pigmented precipitates. Open-angle. Tyndall-negative. Calm eye.