EC Ophthalmology

Purpose: Demonstrate the need of exhaustive studies to fully diagnose a bleb dysesthesia through a case report, and assess the need for surgical treatment and appropriate management.

Case Report: A 44 years old female diagnosed with juvenile open-angle glaucoma presented bleb dysesthesia on late post trabeculectomy. At the consultation, visual loss of the same eye was further detected. Complementary studies were conducted to rule out differential diagnoses.

Results: Topography revealed an irregular astigmatism that explained the reduced visual acuity. The need for bleb surgical revision was evaluated. Patient’s discomfort, significant visual loss, bleb morphology and risk factors for bleb-related infections made surgical treatment preferable. Conjunctival flap advancement with relaxing incisions, excision of avascular tissue and amniotic membrane transplant were carried out.

Conclusion: Bleb dysesthesia can be associated to numerous other complications; if visual loss is presented, astigmatism shift as a differential diagnosis should be always ruled out. Management of a dysesthetic bleb is very challenging. To assess the need for surgery, patient’s symptoms, long-term risk factors for bleb-related infections and target IOP required should be considered.

 Keywords: Dysesthesia; Filtering Bleb; Surgical Bleb Revision; Astigmatism; Complication

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