Ocular Disease III - Trigeminal & Facial
Ocular Disease III - Trigeminal & Facial
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 Quiz!
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Oculo-facial hypesthesia of the nasociliary branch can be caused by... |
HSV |
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Oculo-facial hypesthesia of the ophthalmic branch can be caused by... |
- Neoplasm in the orbit or cavernous sinus |
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If the cavernous sinus had a neoplasm or aneurysm, what branch of the trigeminal would be affected if there was Oculo-facial hypesthesia? |
Ophthalmic branch |
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An orbital floor fracture would most likely damage this structure if the pt had Oculo-facial hypesthesia? |
maxillary branch of CN V |
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A maxillary antrum carcinoma would most likely damage this structure if the pt had Oculo-facial hypesthesia? |
maxillary branch of CN V |
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A cerebellopontine angle tumor would most likely damage this structure if the pt had Oculo-facial hypesthesia? |
corneal - nasociliary branch of CN V |
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A nasopharyngeal carcinoma would most likely damage this structure if the pt had Oculo-facial hypesthesia? |
mandibular branch of CN V |
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A middle cranial fossa tumor would most likely damage this structure if the pt had Oculo-facial hypesthesia? |
mandibular branch of CN V |
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These are the most likely reasons for causing complete CN V palsy... |
Brainstem, middle cranial fossa dz, nasopharyngeal carcinoma, demyelinating dz |
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Your pt presents with ptosis, inverse ptosis, and anhydrosis all on the left side. He also complains of headaches and face pain on the left side. You suspect ____. Why? |
Raeder's paratrigeminal neuralgia Pain and Horner's on left side due to compression of V nerve and sympathetic plexus on left side by dilation of left internal carotid. |
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T/F - Raeder's paratrigeminal neuralgia is typically in middle age to older females. |
False - males |
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T/F - Rash occurs first, then pain in Herpes Zoster Oph by 4-7 days. |
False - pain first |
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T/F - Post-herpetic neuralgia lasts 1-2 weeks. |
False - months to yrs |
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Hutchinson's sign means... |
nasociliary branch involvement of HZV |
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Your 50yo female pt complains of recurrent "lightning" pain on half of the face about 20-30 sec, triggered by combing her hair around the hairline. Dx? |
Tic Douloureaux |
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T/F - Tic douloureaux can affect all three branches of CN V |
True |
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T/F - Temporomandibular syndrome affects the maxillary branch of CN V. |
True |
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Your patient has a weak lower right part of the face. You immediately suspect ____ located on the (right/left). |
Left upper motor neuron lesion |
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T/F - Pts with upper motor neuron lesions have a weak lower half of the face but can still involuntarily laugh with both sides appearing symmetrical. |
True - upper motor neuron affects voluntary muscles only |
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Upper motor lesions affect (voluntary/involuntary) muscles? |
voluntary |
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What kind of paresis do lower motor neuron lesions cause? |
ipsilateral half of face (both upper and lower) |
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Lesions in the facial nucleus causes (ipsi/contra)lateral paralysis and (ipsi/contra)lateral facial palsy. |
contra, ipsi |
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Lesions in the motor cortex causes (ipsi/contra)lateral paralysis and (ipsi/contra)lateral facial palsy. |
contra, contra |
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Lesions in the internal capsule causes (ipsi/contra)lateral paralysis and (ipsi/contra)lateral facial palsy. |
contra, contra |
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Lesions in the pons causes (ipsi/contra)lateral paralysis and (ipsi/contra)lateral facial palsy. |
contra, ipsi |
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T/F - Ramsay-Hunt is self limiting, non-progressive |
True |
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What is Ramsay-Hunt? |
HZV of the ear - affects CN VII & VIII (Bell's Palsy & lesions on ear); pain around ear, facial numbness, changes in taste (ant 1/3 of tongue), numbness of tongue |
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Your pt has a ptosis, poor apposition of lower lid to the globe, drooling, and a facial droop all on the left side. Dx? |
Bell's palsy |
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Etiology of Bell's Palsy? |
idiopathic - possibly viral-inflammatory inmmune mech (HSV?) |
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Tx of Bell's Palsy? |
Supportive - lubrication |
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How long does Bell's palsy take to recover? |
weeks to months, usually within 3 weeks |
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T/F - Most Bell's palsy pts recover completely. |
True - 71% |
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What can happen 24-39 weeks after initial event of Bell's palsy? Prevalence? |
Aberrant regeneration, 29-34% of bell's palsy pts |
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T/F - Prognosis is poorer with complete paralysis in Bell's palsy. |
True |
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T/F - Prognosis is poorer with pregnant Bell's palsy pts. |
True |
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Your pt complains of excessive tearing while eating. What caused this and what is it called? |
Aberrant regeneration of nerves involving tearing and salivation - Crocodile tears (stimulation of salivation results in lacrimation) |
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Normal fissure ht = ? |
9-10 mm |
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Upper lid margin should lie ___ mm below the superior limbus. |
1-2 |
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When DDxing ptosis vs Duane's retraction syndrome, you must ask... |
does the ptosis change with eye movement? |
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When DDxing ptosis vs MG, you must ask... |
does the ptosis vary? |
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Involutional, RGP wear, chronic edema are causes of this type of ptosis... |
aponeurotic |
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CN III palsy, marcus gunn jaw winking, blepharophimosis are causes of this type of ptosis... |
congenital |
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Chalazia, trachoma, scarring, tumor, edema, filtering bleb, dermatochalasis, cellulitis are causes of this type of ptosis... |
mechanical |
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What drugs mentioned can cause ptosis? |
steroids, botox |
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CPEO, muscular dystrophy are causes of this type of ptosis... |
myogenic |
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T/F - Horner's is a myogenic type ptosis. |
False - neurologic |
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CN III palsy, Horner's, facial palsy, MS, PSP are causes of this type of ptosis... |
neurologic |
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What type of ptosis does MS cause? |
neurologic |
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MG is a cause of this type of ptosis... |
neuromuscular junction |
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Post-surgical and lid laceration are causes of this type of ptosis... |
trauma |
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An aberrant development of the levator, where it is "stiff" and produces laophthalmos in downgaze is... |
congenital ptosis |
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What is Blepharophimosis? |
hypoplasia of the eyelids |
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What other signs can be present with congenital ptosis? |
- co-existent strab/amb |
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What is Marcus-gunn jaw winking? |
Open mouth, ptosis opens up |
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Senile involutional ptosis etiology? |
Disinsertion of levator accompanied by loss of tone in Mueller's muscle |
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Your pt has a higher lid crease and drooping upper lid margin on the right eye. Dx? |
Senile (involutional) ptosis |
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List the traumatic causes of ptosis... |
- Trapped CL in upper fornix |
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T/F - Most ptosis are involutional. |
True - 40-50% 30% is post-traumatic |
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What are the four clinical measurements of a ptosis? |
MICE: |
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T/F - Anisocoria is an indication to take lid measurements. |
True - pupil asymmetry |
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T/F - Thyroid dysfxn is an indication to take lid measurements. |
True (i.e. exophthalmos???) |
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MRD1 measures... |
upper eyelid margin to corneal light reflex |
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MRD2 measures... |
lower eyelid margin to corneal light reflex |
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MRD1 + MRD2 = ? |
vert palpebral ht |
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Normal MRD1? |
>2.5mm |
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Normal MRD2? |
>5.0mm |
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What is MCD? |
Margin-crease Distance Dist b/w upper eyelid crease and upper lid margin |
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Range of MCD in caucasian women? Caucasian men? |
Women = 10-11 |
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How do you do the levator excursion test? |
Pt looks down, set zero of PD rule at lid margin, have pt look up and meas amt of vert mvt |
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Excellent range in levator excursion test? Poor? |
Excellent >10 |
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Where is the eyebrow supposed to be located relative to the superior orbital rim in men? |
At the sup orbital rim (low, flat brow) |
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Where is the eyebrow supposed to be located relative to the superior orbital rim in women? |
above sup orbital rim (higher arched brow) |
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Your pt has a smaller MRD2 in the right eye. You should suspect... |
Horner's on the right eye |
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Bilateral ptosis suggests... |
central lesion in midbrain |
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Most common cause of lid retraction? |
thyroid eye dz |
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Possible mechanisms of lid retraction? |
overactive levator |
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Neurogenic causes of lid retraction? |
Dorsal midbrain syndrome (post commissure) |
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Grave's ophthalmopathy results in these lid problems... |
contracture of levator |
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What two congenital causes are mentioned for lid retraction? |
Myotonic dystrophy |
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T/F - Myopia can cause lid retraction |
True - axial myopia hence prominent globe |
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T/F - CL wear can cause lid retraction |
True |
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What surgical procedures can cause a lid retraction afterwards? |
Scleral buckle, trabeculotomy, cataract |
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T/F - Radiation therapy does not cause lid retraction. |
False - it can cause lid retraction |
