97th DOG Annual Meeting 1999



J. Horwath, J. Berglöff, R. Stacher, C. Walch, A. Haas

Case report: A 27-year-old patient developed a peripheral facial palsy with exposure keratitis of the right eye after bilateral fractures of the laterobasal skull base. Two months after restitution of the facial palsy, he noticed foreign body sensation in both eyes. Conjunctival irritation and punctate keratitis with normal corneal sensitivity was found. The tear film breakup time was less than 5 seconds and repeated Schirmer I test scores were 0 mm in both eyes. The conjunctiva showed squamous metaplasia of epithelial cells with a high nucleus-cytoplasma ratio and a reduction of globlet cell density. In the HRCT of the skull base, crush fracture of the sphenoid with consecutive hematosinus and fractures of both pterygoid processes could be delineated. Obliteration of the petrous and mastoid cells and bilateral hematotympanon could be seen as indirect signs of pyramidal fractures.

Conclusion: The reason for decreased aqueous tear production of both eyes was obviously due to the damage of the secretory fibers of the nervus intermedius and/or the greater superficial petrosal nerve. Reduced tear production in both eyes can be the result of skull trauma even if facial palsy occurs only unilaterally.

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