Superficial punctate keratopathy in a pediatric patient was related to adenoid hypertrophy and obstructive sleep apnea syndrome: a case report

Abstract

BackgroundKnown causes of superficial punctuate keratopathy (SPK) in children include entropion, viral infection, blepharokeratoconjunctivitis (BKC), and toxicity of eye drops. However, there are some SPK patients whose causes could not be identified well. Herein, we describe the history, diagnosis, treatment, and prognosis of a rare case.Case presentationTo report a case of superficial punctate keratopathy (SPK) which coexisted with floppy eyelid syndrome (FES) and presented as intermittent red eye and blurred vision in an 11-year-old boy who slept in the prone position. His condition did not improve despite treatment with topical antibiotics (levofloxacin, tobramycin), steroid eye drops (prednisolone), and artificial tears. The patient was diagnosed with tonsil hypertrophy and nasopharyngeal adenoid hypertrophy and obstructive sleep apnea syndrome (OSAS). He underwent tonsillectomy and adenoidectomy. Then he started sleeping in the supine position postoperatively. The SPK, red eye and blurred vision completely resolved after surgery without additional treatment. The corneal sensation also recovered gradually during the next 7 years. However, the floppy eyelid did not resolve.ConclusionRecurrent SPK of childhood might be related to tonsil hypertrophy, adenoid hypertrophy and OSAS, which can be rehabilitated by a surgical approach.

Evaluation of eyelid, angle and anterior segment parameters using scheimpflug camera and topography system in obstructive sleep apnea syndrome

“…In the same study, this rate was 6.8% in keratoconus patients and that the eyelid laxity syndrome showed a significant association with the patient's side of sleeping preference. In another case report, floppy eyelid and superficial punctate keratopathy were detected in a child with OSAS with adenoid hypertrophy, and the family stated that the child had a habit of sleeping in the prone position (14). In the most studies investigating the relationship between eyelid hyperlaxity syndrome and OSAS, it was associated the increased FES rate in OSAS with the increment in matrix metalloproteinase activity triggered by reasons such as hypoxia-reperfusion damage, leptin resistance or mechanical friction, and elastin breakdown in tars tissue (15).…”

Evaluation of eyelid, angle and anterior segment parameters using scheimpflug camera and topography system in obstructive sleep apnea syndrome

“…In the same study, this rate was 6.8% in keratoconus patients and that the eyelid laxity syndrome showed a significant association with the patient's side of sleeping preference. In another case report, floppy eyelid and superficial punctate keratopathy were detected in a child with OSAS with adenoid hypertrophy, and the family stated that the child had a habit of sleeping in the prone position (14). In the most studies investigating the relationship between eyelid hyperlaxity syndrome and OSAS, it was associated the increased FES rate in OSAS with the increment in matrix metalloproteinase activity triggered by reasons such as hypoxia-reperfusion damage, leptin resistance or mechanical friction, and elastin breakdown in tars tissue (15).…”

Interleukin-8 concentrations in obstructive sleep apnea syndrome: a systematic review and meta-analysis

“…This could be related to immature and reduced immune functions in children. It has been reported that chronic rhinitis in children is related to adenoid hypertrophy, thereby causing upper airway obstruction leading to OSAS, especially at night [ 54 ]. Inflammation has been suggested as a potential mechanism for children with OSAS.…”

Evaluation of eyelid, angle and anterior segment parameters using scheimpflug camera and topography system in obstructive sleep apnea syndrome

“…In the same study, this rate was 6.8% in keratoconus patients and that the eyelid laxity syndrome showed a significant association with the patient's side of sleeping preference. In another case report, floppy eyelid and superficial punctate keratopathy were detected in a child with OSAS with adenoid hypertrophy, and the family stated that the child had a habit of sleeping in the prone position (14). In the most studies investigating the relationship between eyelid hyperlaxity syndrome and OSAS, it was associated the increased FES rate in OSAS with the increment in matrix metalloproteinase activity triggered by reasons such as hypoxia-reperfusion damage, leptin resistance or mechanical friction, and elastin breakdown in tars tissue (15).…”

Interleukin-8 concentrations in obstructive sleep apnea syndrome: a systematic review and meta-analysis

“…This could be related to immature and reduced immune functions in children. It has been reported that chronic rhinitis in children is related to adenoid hypertrophy, thereby causing upper airway obstruction leading to OSAS, especially at night [ 54 ]. Inflammation has been suggested as a potential mechanism for children with OSAS.…”

Evaluation of eyelid, angle and anterior segment parameters using scheimpflug camera and topography system in obstructive sleep apnea syndrome

“…In the same study, this rate was 6.8% in keratoconus patients and that the eyelid laxity syndrome showed a significant association with the patient's side of sleeping preference. In another case report, floppy eyelid and superficial punctate keratopathy were detected in a child with OSAS with adenoid hypertrophy, and the family stated that the child had a habit of sleeping in the prone position (14). In the most studies investigating the relationship between eyelid hyperlaxity syndrome and OSAS, it was associated the increased FES rate in OSAS with the increment in matrix metalloproteinase activity triggered by reasons such as hypoxia-reperfusion damage, leptin resistance or mechanical friction, and elastin breakdown in tars tissue (15).…”

Interleukin-8 concentrations in obstructive sleep apnea syndrome: a systematic review and meta-analysis

“…This could be related to immature and reduced immune functions in children. It has been reported that chronic rhinitis in children is related to adenoid hypertrophy, thereby causing upper airway obstruction leading to OSAS, especially at night [ 54 ]. Inflammation has been suggested as a potential mechanism for children with OSAS.…”