Pigmented conjunctival lesions as initial manifestation of ochronosis.

tients are at risk for lagophthalmos and exposure-related keratitis. The post-LASIK neurotrophic status of these patients may further predispose them to infectious keratitis. The first case represents, to our knowledge, the earliest postLASIK human histopathologic finding (9 days post-LASIK). The neurotrophic cornea would certainly be a risk factor in the immediate postoperative period. The first patient had evidence of probable traumatic displacement of the LASIK flaps, which may have contributed to the development of keratitis (Figures 1A and 3A). Late traumatic displacement of LASIK flaps occurring more than 2 years after the procedure, complicated by diffuse lamellar keratitis, has been reported. Late postLASIK fungal keratitis related to trauma has also been reported. Based on the well-healed scar of the second case, the neurotrophic status of the cornea may predispose the cornea to infection even months after the LASIK procedure. Postmortem microbial contamination of the donor corneas is unlikely given the chronic inflammatory cell response documented by histopathologic examination. These cases suggest that intensive care unit personnel consider adding a refractive surgery query to the eye history taken from family members of trauma patients and other obtunded patients. Intubated and sedated patients who have had LASIK surgery require close monitoring for exposure keratopathy and prompt diagnosis of keratitis. These patients would probably benefit from aggressive lubrication and prophylactic antibiotic ointment.