A case of a neurotrophic perforated corneal ulcer complicated by the herpesvirus infection after the cosmetic botulinum toxin therapy of the face.

Abstract

Purpose To present a case of neurotrophic perforated corneal ulcer induced by a cosmetic botulinum toxin therapy, complicated by the herpesvirus infection. Setting For the correction of the aesthetic disorders of facial muscles and skin, the most popular procedure in modern cosmetology is a botulinum toxin (BoNT) therapy. Sometimes, for several reasons, cosmetic BoNT therapy can have a negative effect on muscles and nerve endings, causing various neurotrophic eye disorders. Report of case 46-year-old patient, was admitted to the Сorneal Pathology Department with a peripheral corneal ulcer with descemetocele of irregular shape, and mild infiltration zone. The inflammation has developed the two weeks after a cosmetic BoNT therapy on the face (injections of botulinum toxin around the eyes and in the forehead area). The presence of chronic herpesvirus infection in the anamnesis. Lamellar/Penetrating keratoplasty 3x5 mm was performed. 1 month after the surgery, a well-adapted clear graft was visualized, visual acuity with maximum correction was 0.8. 1.5 months after the stress, a recurrence of inflammation occurred with partial lysis of the corneal graft. Taking into account the neurotrophic etiology of the process and lysis of the previous graft, we repeated the Lamellar/Penetrating keratoplasty 6 mm. in diameter with covering the surface of the graft with amniotic membrane. 2 months after the operation, the amniotic membrane was partially resorbed, the graft was semitransparent, with newly formed vessels in its own layers. After 18 months, the surface of the cornea was epithelialized, the amniotic membrane was completely resorbed, the borders of the therapeutic corneal graft were not visualized. There is a limited opacification in the own, deep layers of the cornea. Visual acuity with maximum correction was 0.5. Conclusion/Take home message Cosmetological botulinum toxin therapy may be complicated not only by a decrease of corneal sensitivity, but also by the development of a neurotrophic perforated corneal ulcer. The complication that was developed as a result of a stress, as well as the activation of a herpes viral infection, induced a relapse with lysis of the graft. Thanks to well-timed, adequate surgical treatment with the most gentle approach to the surrounding tissues of the cornea, we were able to stop the inflammatory process and maintain a high visual acuity.