Título

ANATOMOPATHOLOGICAL STUDY OF BULBAR CONJUNCTIVA AFTER INDISCRIMINATE USE OF TOPICAL CORTICOSTEROID IN PEDIATRICS

Objetivo

It is known that long-term use of corticosteroids may be associated with the onset of cataracts, glaucoma, and other ocular pathologies (1,2). Our objectiv will be describ a inedit case of Vigadexa® (moxifloxacin 0.5%/dexamethasone 0.1%) daily use in the both eyes for one year.

Relato do Caso

Female patient, 12 years old, black race, from Salvador (Bahia), with complaint of lacrimation and photophobia, in both eyes (OU), 2 years ago. Since then it has been in irregular use of the topical Vigadexa®. No systemic comorbidities. At the ophthalmologic examination, the visual acuity with the best corrected measure was 20/20 in the right eye and 20 / 30P in the left eye. She presented a cronic blepharitis posterior, conjunctival hyperemia +2/+4 and unusual punctate whitish deposits scattered throughout the conjunctiva bulbar (OU) (Figure 1). Intraocular pressure of 10mmHg (OU). The fundoplication revealed papillary enlargement, being 0.70 with loss of temporal rhyme in right eye and 0.65 in left. The Humphrey campimetry 24-2 stimulus 3 reliably, not evidence losses (OU). Rotinare treatment was started for chronic blepharitis and observed progressive improvement of the symptoms. However, punctate lesions on the bulbar conjunctiva persisted after one year (Figure 1). The pathological anatomy revealed foci of calcification surrounded by granulomatous reaction with giant cells (Figure 2).

Conclusão

The use of systemic and / or topical corticosteroids used for long periods can trigger side effects already known (1,2) but have some efects to be discreab. Calcium deposition caused by the topical use of antimicrobial associated with corticosteroid is an unusual side effect, with few reports in the literature on ocular tissues. Calcium accumulation in the conjunctiva has been described for decades, but it is related to other pathologies (dialytic renal insufficiency, hyperparathyroidism and AIDS) (3-6). No studies correlated calcium deposits wuth moxifloxacin.