Management Of Neonatal Bilateral Infectious Keratitis Through Amniotic Membrane Graft: A Case Report

to report the case of a male newborn treated for bilateral bacterial keratitis revealing congenital alacrimia treated by an amniotic membrane transplantation.

A male two-months-old infant was referred to our department for suspicion of keratitis of the right eye (RE).  He was hospitalized in neonatology for superinfected severe bronchiolitis. He developed multiples episodes of eye redness with transient improvement. Ophthalmological examination showed a corneal ulcer with corneal thinning and central perforation, athalamia, and hypotony. The ultrasound didn't show an intraocular extension of the infection.  The left eye (LE) examination showed a central corneal ulcer with corneal edema. We practiced corneal scraping for smears and cultures under general anesthesia. Culture was positive for multidrug sensitive Pseudomonas Aeruginosa. Schirmer's test confirmed alacrimia. Exhaustive etiological exploration for the triple-A syndrome (including brain MRI and oesogastroduodenal barium swallow) was normal. The left eye ulcer evolved positively with topical antibiotic therapy and intensive topical wetting agents. As for the RE, corneal graft being unavailable and conjunctival reconstruction impossible, we opted for an amniotic membrane patch graft. We sewed a five by ten mm graft in with the epithelium/basement membrane side facing outwards, using 10-0 nylon sutures, following wound debridement. The evolution was favorable with the sealing of the corneal perforation.

Congenital alacrimia is a rare cause of neonatal keratitis. Its management requires a multidisciplinary effort. Amniotic membrane patch graft is to be considered for impending or actual perforations.