Blepharitis With Facial Numbness and Ocular Pain

Abstract

A man in his 60s presented to the emergency department with a 3-week history of numbness of the right side of the forehead and cheek and severe right-sided ocular discomfort that was relentless and kept him awake at night. He had been seen 2 weeks previously with similar symptoms and was diagnosed as having blepharitis and discharged with instructions for eyelid hygiene. His symptoms failed to improve, and he visited his family physician the following week. His physician prescribed a course of amoxicillin and clavulanate potassium, but the symptoms remained.The patient had no other ocular history or history of facial surgery. His medical history included ischemic heart disease and hypercholesterolemia, and he was an ex-smoker of 20 pack-years.Examination revealed unaided visual acuity of 20/20 OD and 20/20 OS. He had no evidence of proptosis, no relative afferent pupillary defect, and a full range of extraocular eye movement. Slitlamp examination demonstrated moderate bilateral blepharitis and extensive punctate keratopathy of the right eye. Findings from posterior segment examination were unremarkable. Examination of the cranial nerves demonstrated reduced sensation in the distribution of the ophthalmic and maxillary branches of the right trigeminal nerve, including complete corneal anesthesia. All other cranial nerve functions remained normal. Diagnosis Space-occupying lesion of the right Meckel caveWhat to Do Next C. Order contrast-enhanced magnetic resonance imaging of the brain Discussion