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A 6-week-old baby boy with discharge
Digital Journal of Ophthalmology 2011
Volume 17, Number 3
August 15, 2011
DOI: 10.5693/djo.03.2011.07.001
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David G. Cupp, MD | Department of Ophthalmology, Tulane University School of Medicine, New Orleans, Louisiana



Treatment
The pseudomembranes in both eyes were surgically removed (Figure 3). Immediately after removal, the patient was placed on prednisolone acetate (1%), 1 drop instilled hourly in both eyes; moxifloxacin (0.5%), 1 drop every 4 hours in both eyes; and heparin 1000 U/ml, 1 drop hourly in both eyes. By 1 month after the procedure, the prednisolone acetate and moxifloxacin had been tapered off completely, and the heparin was reduced to 1 drop every 3 hours. There was no membrane recurrence, but epiphora was present.

By 2 months after surgery, the heparin dosage remained unchanged and a small membrane had recurred along both lower lids. The new membrane was removed, and the patient subsequently started on Maxitrol (Neomycin sulfate 3.5mg, polymyxin B sulfate 10,000 units, dexamethasone 0.1%) and heparin 1000 U/ml, 1 drop each hourly in both eyes. The Maxitrol was tapered off by 2 months after surgery, and the heparin continued 1 drop every 3 hours; there was no recurrence at this time, but epiphora persisted and a mild entropion of the left lower eyelid was noted.

By 4 months after surgery the membrane had recurred along both lower eyelids and the left lower eyelid entropion persisted, as did the epiphora. A third membrane peel was performed. This time an amniotic membrane graft was placed along the palpebral conjunctiva of both lower lids. Postoperatively, prednisolone acetate, 1 drop hourly, moxifloxacin 4 times daily and heparin, 1 drop hourly, were started. The moxifloxacin was discontinued after 2 weeks and the prednisolone acetate tapered off over 2 months. At last follow-up, 7 months following the second membrane removal, there was no recurrence of membrane formation, the entropion and epiphora were improved, and the heparin (after a slow taper) was discontinued.
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Figure 3
 Removal of pseudomembrane.


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