Severe keratopathy in patients with AIDS with undiagnosed lagophthalmos.

PURPOSE: To report 2 cases of severe keratopathy in patients with AIDS with delayed diagnosis of lagophthalmos.

METHODS

Observational case report.

RESULTS

The first patient presented with a corneal abscess attributed to old trauma. He responded poorly to topical treatment and suffered corneal penetration. Penetrating keratoplasty was performed, but persistent epithelial defects appeared. Finally, occult lagophthalmos was discovered. Topical ocular lubrication, eye occlusion, and lateral tarsorrhaphy were insufficient, and the graft became conjunctivalized. The second patient had corneal opacity and severe pannus in his right eye and mild punctate keratopathy in his left eye. The left cornea worsened despite treatment with lubricants. In an examination 2 weeks later, we detected a subtle lagophthalmos, which was complicated by upper eyelid retraction in the right eye. A bilateral upper blepharotomy improved the keratopathy.

CONCLUSIONS

Patients with AIDS with severe weight loss can present with lagophthalmos because of adipose and muscular atrophy in the so-called wasting syndrome. Lagophthalmos in patients with AIDS can be difficult to detect. Clinically significant lagophthalmos is associated with ocular surface lesions in patients with AIDS with wasting syndrome.