Descemetocele and Corneal Neovascularization as Unusual Complication of Blepharokeratoconjunctivitis in Pediatric Patient : A Case Report

Abstract

Introduction: Blepharokeratoconjunctivitis is a chronic and recurrent inflammatory eyelid disorder that often leads to secondary conjunctival and corneal complications, and frequently underdiagnosed in children.

Case Presentation: A 5-year-old girl presented with a blackish lump in her cornea, whitish spot,  eye redness, and excessive tearing for 1 year. Her medical history included intermittent right eyelid swelling and eye redness over 3 years, which improved with eye drops, as well as a dust mite allergy. Visual acuity in the right eye was limited to hand movements. Examination showed eyelid telangiectasia, conjunctival inflammation, extensive corneal blood vessel growth, corneal thinning, and scarring. The patient received an anti-VEGF injection and amniotic membrane transplantation. At the two-month follow-up, her visual acuity improved to counting fingers at two meters and there was a notable reduction in corneal neovascularization.

Discussion: This case illustrates that severe blepharokeratoconjunctivitis can lead to serious complications such as corneal neovascularization and descemetocele. In this patient, the use of anti-VEGF injections was aimed at inhibiting further neovascularization in the cornea, while amniotic membrane transplantation was performed to manage the descemetocele and promote corneal healing.

Conclusion: Pediatric blepharokeratoconjunctivitis, along with its associated complications can pose a significant threat to vision. Early recognition and appropriate management of this condition are crucial in reducing disease progression and risk of long-term visual impairment.