Conjunctival Neuroma After Corneal Neurotization in a Patient With Neurotrophic Keratopathy

To report a rare case of conjunctival neuroma after a successful corneal neurotization surgery.

The clinical file and histopathology slides of this patient who underwent surgical corneal neurotization for a neurotrophic keratopathy in the right eye were reviewed.

A 70-year-old man with a history of severe herpetic (varicella zoster) neurotrophic keratopathy and keratouveitis in the right eye developed a corneal perforation, which required tectonic keratoplasty (May 2020). Corneal neurotization was performed 1 year later without complication, using the ipsilateral supraorbital and supratrochlear nerves to reinnervate the right cornea (April 2021), followed by repeat penetrating keratoplasty (September 2021). Three months later, a superonasal conjunctival mass was observed with a contiguous corneal delle and melt at the corneal-host junction. In vivo confocal microscopy showed numerous nerve fibers within the conjunctival mass, suggesting a diagnosis of conjunctival neuroma. The mass was surgically debulked, and the diagnosis was confirmed by histopathology and immunohistochemistry. The delle and corneal melt were successfully treated with an amniotic membrane.

To the best of our knowledge, this is the first case of confirmed conjunctival neuroma reported after corneal neurotization. Confocal microscopy, histopathology, and immunohistochemistry have proven to be highly useful tools for the prompt recognition and accurate diagnosis necessary for the proper management of this rare complication.