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A 39-year-old male with epidermolysis bullosa hereditaria dystrophica was scheduled for surgical excision of squamous cell carcinoma in the lower leg. Spinal anesthesia was chosen, because the skin of the puncture site for spinal anesthesia appeared to be dry and scarred, and to have less chance of infection. To avoid shear stress to the skin, we carefully performed anesthetic management including attachment of equipments associated with anesthesia, monitoring and surgery. However, we experienced some troubles and complications associated with anesthetic technique, such as pain on removing a dressing sheet, burning sensations induced by alcoholic stimuli for cold sign test and tent-like traction of the punctured skin on withdrawing the spinal needle.

A 35-year-old female had been clinically diagnosed as having epidermolysis bullosa hereditaria since her skin formed blisters from the time of her birth. Her left and right corneas become clouded at the age of 17 and 31 years, respectively. She was diagnosed as having bilateral secondary glaucoma at the age of 31 years and was medicated with antiglaucoma drugs. When examined by us, both corneas were invaded by conjunctival tissues and intraocular pressure in both eyes was 38 mmHg. Visual acuity was 0.09 (n.c.) in the right eye and she had no light perception in the left eye. A trabeculectomy OD was performed at our hospital. For confirmatory diagnosis, a pathological examination of the conjunctival and dermal tissues was done. Electron microscopic study demonstrated blister formation beneath the basal lamina and lost anchoring fibrils of both tissues. This finding confirmed that she had a receive form of dystrophic epidermolisis bullosa. This is a rare case of dystrophic epidermolisis bullosa with severe corneal changes and glaucoma diagnosed from electron microscopic observations.