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Ophthalmology
Neurological Disorders of Eyelids and Facial Pain
Built from Khurana — Neuro-Ophthalmology
What’s inside
11 sections · 78 slides
Overview
- What this topic covers
Neurological Disorders of Eyelids
Why nerve faults make the lid spasm, droop or retract
- The eyelid is a nerve-driven shutter
- The neurological eyelid disorders at a glance
Benign Essential Blepharospasm
Involuntary forced closure of the lids: a focal dystonia
- What is benign essential blepharospasm?
- Why it happens: a brain wiring problem, cause unknown
- How it looks and behaves at the bedside
- The company it keeps: spasm that spreads
- Making the diagnosis: rule out the mimics first
- Jankovic rating scale: grading the spasm 0 to 4
- Treatment aim and where drugs fit
- Botulinum toxin: the treatment of choice
- Botulinum toxin: dosing and side-effects
- Surgery when injections are not enough: the myectomies
- Surgery, and why it is not first choice
Neurogenic Eyelid Retraction
When the lid pulls too far open and sclera shows
- What counts as eyelid retraction?
- The many causes: a long neurological list
- Evaluation starts with a careful history
- Periocular examination: measure, then probe
- Pseudoretraction: the lid that only looks retracted
- Management: fix the cause, protect the cornea
- Surgery for eyelid retraction
- Plus-minus lid syndrome: one lid down, the other up
- The neurological basis: a shared lid-lifting nucleus
Marcus Gunn Jaw-Winking Syndrome
A droopy lid that pops up when the jaw moves
- What is jaw-winking? Miswired nerves crossing signals
- Recognising and grading the wink
- Managing jaw-wink, and its mirror image
- Gluten ataxia: when a food protein attacks the brain
- Clinching and treating gluten ataxia
Parinaud's Syndrome
Dorsal midbrain syndrome: a cluster of eye-movement and pupil signs
- What is Parinaud's syndrome?
- The classic signs, and why they occur
- Working it up, treating it, and outlook
Facial Pain: General Considerations
How to classify and approach pain in the face
- Framing facial pain: not everything is neurological
- Classifying orofacial pain into three groups
- Causes of orofacial pain, by group
- Diagnosis and management principles
Trigeminal Neuralgia
Lightning-like facial pain in the fifth-nerve territory
- Applied anatomy: the trigeminal nerve's three branches
- Trigeminal nerve and its three divisions
- Definition: what trigeminal neuralgia is
- Why it happens: a compressed, irritated nerve
- Clinical picture: the classic tic douloureux
- Atypical trigeminal neuralgia and diagnosis
- First-line treatment: medication
- When drugs fail: two open surgical options
- Percutaneous needle (rhizotomy) procedures
- Peripheral neurectomy and radiation
- Trigeminal neuralgia: immediate relief by procedure
Idiopathic (Atypical) Facial Pain
Pain with no findings and no clear cause
- What is atypical facial pain (now PIFP)?
- Recognising it: a diagnosis of exclusion
- ICHD-2 criteria and management
- Gradenigo's syndrome: pain plus a sixth-nerve palsy
Postherpetic Neuralgia
Pain that outlasts the shingles rash
- From chickenpox to shingles to lasting pain
- How common it is, and who is at risk
- Clinical features of PHN
- Confirming it and its look-alikes
- Treating PHN: dampen the misfiring nerve
Tolosa-Hunt Syndrome
Painful ophthalmoplegia from cavernous-sinus inflammation
- What is Tolosa-Hunt syndrome?
- The inflammation behind it (etiology)
- Clinical features and work-up
- A diagnosis of exclusion: rule these out first
- Investigations for Tolosa-Hunt syndrome
- Axial skull-base imaging in painful ophthalmoplegia
- Treatment and prognosis
- Key takeaways: the eyelid disorders
- Key takeaways: the facial pains
- A 55-year-old has brief, shock-like jabs over the right cheek triggered by shaving. How would you diagnose and treat this?
- References
- Neuro-Ophthalmology