Filamentary keratopathy as a chronic problem in the long-term care of patients in a vegetative state

Purpose: To emphasize that filamentary keratopathy may occur in the long-term care of patients in a vegetative state. Methods: Clinical observation of 2 young patients who had survived 16 and 81/2 years, respectively, in a vegetative state after an acute traumatic brain accident. Interventions were analyzed against the background of the different speculations about the relationship between filamentary keratopathy and the vegetative state. Results: Both patients' medical records registered 36 and 24 episodes of "a red eye," respectively, which in most cases were due to filamentary keratopathy. The episodes lasted 1-51/2 months, despite lubrication, removal of filaments, and regular application of corticoid ointment. The longest remission occurred when the eyes were frequently opened, and no topical medications were applied. This experience supports the hypothesis that prolonged eyelid closure is more likely related to filamentary keratopathy in these patients, more so than a moistening disturbance. Conclusions: Filamentary keratopathy can be a chronic problem in the long-term course of a patient in a vegetative state with remissions and exacerbations. These cases substantiate a relationship, although the precise mechanism is speculative. The incidence and effective treatment await further reports. Copyright © 2005 by Lippincott Williams & Wilkins.