Jiang Jay Ruzhang, Khankan Rima, Ridder William H, Paugh Jerry R
Southern California College of Optometry at Marshall B. Ketchum University, 2575 Yorba Linda Blvd, Fullerton, CA, USA.
Am J Ophthalmol Case Rep. 2024 Dec 19;37:102241. doi: 10.1016/j.ajoc.2024.102241. eCollection 2025 Mar.
To report a case of recalcitrant dry eye disease caused by acoustic neuroma and subsequent microsurgery.
A 51-year-old female presented with refractory unilateral (right eye) severe dry eye disease (DED). The patient had a history of right acoustic neuroma with surgical excision 14 years prior. With normal eyelid closure, the patient reported persistent dry eye symptoms despite use of several tear substitutes and ointments. The patient was a subject in a clinical trial, and was found to be in the active treatment arm following unmasking. The patient had been dosed with a topical eyelid application of testosterone 4.5 % wt./wt. gel twice per day for 4 weeks and followed up to 8 weeks after discontinued drug application. Dry eye symptoms were significantly improved and brought to near normal range (Ocular Surface Disease Index (OSDI) < 13). Tear break up time, meibomian secretion quality, and tear osmolarity were also improved to near normal levels in both the affected and unaffected eyes. In the affected eye, ocular surface staining and Schirmer result were improved from baseline at week 12, but remained below normal values.
The recalcitrant DED secondary to an acoustic neuroma and subsequent microsurgery resection was due to injury of the nervus intermedius, resulting in aqueous deficient DED. Topical testosterone treatment on the eyelids ameliorated the DED by improving symptoms and restoring some clinical signs to near-normal levels, suggesting that this may potentially be a new treatment approach in aqueous deficient dry eye.
报告一例由听神经瘤及后续显微手术引起的顽固性干眼病例。
一名51岁女性出现难治性单侧（右眼）严重干眼疾病（DED）。该患者有14年前行右侧听神经瘤手术切除病史。尽管使用了多种泪液替代物和眼膏，在眼睑闭合正常的情况下，患者仍报告有持续性干眼症状。该患者是一项临床试验的受试者，揭盲后发现处于积极治疗组。患者接受了每天两次局部眼睑涂抹4.5%重量/重量的睾酮凝胶治疗，持续4周，并在停药后随访8周。干眼症状显著改善并恢复至接近正常范围（眼表疾病指数（OSDI）<13）。患眼和未患眼的泪膜破裂时间、睑板腺分泌质量和泪液渗透压也改善至接近正常水平。在患眼中，眼表染色和泪液分泌试验结果在第12周时较基线有所改善，但仍低于正常值。
听神经瘤及后续显微手术切除继发的顽固性DED是由于中间神经损伤，导致水液缺乏型DED。局部眼睑涂抹睾酮通过改善症状并使一些临床体征恢复至接近正常水平，从而改善了DED，这表明这可能是水液缺乏型干眼的一种新的治疗方法。
