Amyloidosis-associated neurotrophic keratopathy precipitated by overcorrected blepharoptosis

PURPOSE: To describe amyloidosis-associated neurotrophic keratopathy. METHODS: In this interventional case report, we describe the clinical findings of a patient with amyloidosis-associated neurotrophic keratopathy, precipitated by exposure from overcorrected blepharoptosis. RESULTS: A 70-year-old woman with a history of amyloidosis was referred with bilateral eyelid retraction 1 month after levator aponeurosis advancement surgery. Examination demonstrated visual acuities of count-fingers OD and 20/400 OS and severe corneal epithelial irregularity with diffuse fluorescein staining. She had marked eyelid retraction with 5-mm right and 3-mm left superior scleral show and incomplete closure. Corneas were anesthetic, and neurologic examination was notable for peripheral sensory loss. Despite eyelid position normalization, the corneal abnormalities progressed to large epithelial defects refractory to aggressive lubrication, punctal occlusion, bandage contact lenses, extended patching, and ultimately tarsorrhaphy consistent with neurotrophic keratopathy. One year postoperatively, the epithelial disease persists. CONCLUSION: Neurotrophic keratopathy can occur in association with amyloidosis and may be precipitated by exposure related to blepharoptosis repair.