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Is Skin Grafting A Permanent Solution For Corneal Ulcer And Corneal Perforation?

Posted on Tue, 25 Nov 2014

Question: My brother Aged 35 went through chemo therapy and radiation treatment for oral cancer. Post radiation, he developed Stevens-Johnson syndrome and under treatment for the same in past 3 months. He developed corneal ulcer and corneal perforation over the period due to dry eyes issue on the left eye and both are cured now. But to avoid re occurrence of them, the doctors suggesting to go for skin grafting using mucous membrane on the left eye for the permanent solution for dry eyes issue. Is it necessary to do this operation? Does the dry eyes issue will not recover naturally? Kindly confirm.

Answered by Dr. Dadapeer K (1 hour later)

Brief Answer:
Dry eyes will not recover naturally.

Detailed Answer:
Hello
Welcome to Health care magic.

I reviewed your history. It seems from the history that your brother had XXXXXXX XXXXXXX syndrome following treatment for chemotherapy an radiation treatment for oral cancer.
Since the corneal perforation has healed now, the next treatment is to prevent recurrence of the corneal ulcer. Since the corneal epithelium an its natural defences are damaged there is high risk for development of corneal ulcer. Hence your doctor is right in advising mucous membrane grafting operation. The other temporary options are use of artificial tears, amniotic membrane grafting.
If possible do send a photo of the affected eye so that I can advice you more accurately.

Hope this information is helpful to you.
Do write back to me for further questions.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dadapeer K (29 minutes later)

Dear Sir,

Thanks for the response. Please find the latest eye images attached.
please let me know if any more information needed.

Answered by Dr. Dadapeer K (1 hour later)

Brief Answer:
It appears like mild to moderate dry eye.

Detailed Answer:
Hello
Thank you for the follow up question.

I saw the photo attached with the question.
It appears mild to moderate dryness and may respond to use of artificial tears eye drops.
Since the corneal perforation also appears to be healed you can wait before going for surgery.
Hence I advice you to go for second opinion with another ophthalmologist or preferably a cornea specialist before going ahead with mucous membrane graft.

Hope this is helpful to you.
Do write back to me for further questions.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dadapeer K (2 hours later)

Dear Sir,

Thanks for the response.We will go for second opinion before surgery.
Radiation treatment was over by XXXXXXX Post radiation, he developed eye related issues.But he was given only refresh tears and cloromycetin capsules by the hospital. Is it possible that if we treated earlier, we would have avoided this dry eyes issue? With this i am attaching the photo taken 4 months back.

Answered by Dr. Dadapeer K (1 hour later)

Brief Answer: XXXXXXX XXXXXXX syndrome occurs by immune mechanism

Detailed Answer:
Hello
Thank you for the follow up question.

I reviewed history and the photo attached with the question.

XXXXXXX XXXXXXX syndrome usually occurs as an immune related mechanism and there is no satisfactory treatment for this.
It is unfortunate that your brother developed it.
But there is no way the damage can be prevented once it starts. It takes its own course till it resolves. But to be XXXXXXX I have seen many worse conditions and your brother will improve with treatment.
Hence it cannot be told whether treatment in the initial stages would have caused quicker recovery.

Hope the information is helpful to you.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dadapeer K (58 minutes later)

Dear Sir,

Thanks for the response. Post dry eyes issue, his vision is reduced in the left eye.
He is feeling like having mild white mist while seeing the objects.Currently doctor suggested to use SYSTANE® ULTRA Lubricant Eye Drops for a week and decide on the operation after that. I would like to know Artificial tears drops are different from SYSTANE® ULTRA Lubricant Eye Drops or any drops name can you suggest?

Thanks and Regards

Answered by Dr. Dadapeer K (56 minutes later)

Brief Answer:
Systane ultra is artificial tear eye drops.

Detailed Answer:
Hello
Thank you for the follow up question.

Decrease in vision in left eye is because of corneal opacity as a result of healing of the corneal ulcer.
Artificial tears are same as lubricant eye drops. Systane ultra is a preservative free eye drops and it can be used.
This will help in rapid healing of the ulcer.
He can use this eye drops.

Hope this information is helpful to you.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar