The "silent brain syndrome" creating a severe form of the "giant fornix syndrome"

John J Chen; Alex W Cohen; Michael D Wagoner; Richard C Allen

doi:10.1097/ICO.0b013e31823f8e65

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The "silent brain syndrome" creating a severe form of the "giant fornix syndrome"

Journal article

Peer reviewed

The "silent brain syndrome" creating a severe form of the "giant fornix syndrome"

John J Chen, Alex W Cohen, Michael D Wagoner and Richard C Allen

Cornea, Vol.31(9), pp.1065-1067

09/2012

DOI: 10.1097/ICO.0b013e31823f8e65

PMID: 22357388

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Abstract

To describe the clinical course of a patient requiring ophthalmic care for entropion and fungal keratitis in the setting of undiagnosed enophthalmos after previous ventriculoperitoneal shunting consistent with silent brain syndrome. Case report. A 33-year-old man who had a history of ventriculoperitoneal shunting for an encephalocele during infancy presented because of ocular irritation and entropion, which was presumed to be entirely due to a chemical injury he had sustained 2 years before. He underwent 2 upper eyelid entropion repairs and developed fungal aspergilloma keratitis in the postoperative period. He underwent 2 penetrating keratoplasties and a limbal stem cell transplant but had complications with reinfection of the graft, eventually leading to a prephthisical painful eye. During enucleation, an aspergilloma was found within an enlarged superior fornix. Computed tomographic scan revealed severe enophthalmos with air between the lids and the globe, which was consistent with silent brain syndrome. In patients with silent brain syndrome, the lack of apposition between the eyelids and the globe results in entropion, trichiasis, lagophthalmos, and ocular irritation. This can complicate entropion repair and the severity of infectious keratitis. We also propose that the enlarged fornices seen in silent brain syndrome can also serve as a reservoir for infection, similar to the pathogenesis seen in the giant fornix syndrome.

Humans

Corneal Ulcer - diagnosis

Aspergillosis - diagnosis

Male

Tomography, X-Ray Computed

Eye Infections, Bacterial - diagnosis

Eye Infections, Bacterial - drug therapy

Enophthalmos - diagnosis

Anti-Bacterial Agents - therapeutic use

Burns, Chemical - microbiology

Eye Infections, Bacterial - microbiology

Eyelid Diseases - etiology

Eye Burns - chemically induced

Keratoplasty, Penetrating

Adult

Corneal Ulcer - microbiology

Enophthalmos - drug therapy

Staphylococcal Infections - microbiology

Corneal Injuries

Aspergillosis - drug therapy

Eye Infections, Fungal - diagnosis

Eyelid Diseases - drug therapy

Staphylococcal Infections - drug therapy

Eye Enucleation

Ventriculoperitoneal Shunt - adverse effects

Visual Acuity

Eye Infections, Fungal - microbiology

Corneal Ulcer - drug therapy

Staphylococcal Infections - diagnosis

Enophthalmos - etiology

Eye Infections, Fungal - drug therapy

Eyelid Diseases - diagnosis

Aspergillosis - microbiology

Details

Title: Subtitle: The "silent brain syndrome" creating a severe form of the "giant fornix syndrome"
Creators: John J Chen - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
Alex W Cohen
Michael D Wagoner
Richard C Allen
Resource Type: Journal article
Publication Details: Cornea, Vol.31(9), pp.1065-1067
Publisher: United States
DOI: 10.1097/ICO.0b013e31823f8e65
PMID: 22357388
ISSN: 0277-3740
eISSN: 1536-4798
Language: English
Date published: 09/2012
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9983979951802771

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8 Times Cited - Web of Science