ABSTRACT
Trigeminal trophic syndrome (TTS) is a condition whereby persistent facial ulceration presents consequent to central or peripheral insult to the trigeminal nerve. Lesions are created by repetitive self-inflicted manipulation and trauma of dysaesthetic skin within the trigeminal dermatome. We discuss four cases with aetiologies varied from presumed microvascular compromise to resection of cerebral meningioma, cerebrovascular accident, and herpes zoster ophthalmicus. We discuss the management of the under-recognised associated periocular skin ulcerations that result from physical manipulation of dysesthic skin and prove to be persistent and challenging to treat. Patient education and counselling are crucial in understanding and preventing the detrimental effect of physical manipulation of the skin. Occlusive dressings can reduce recurrent trauma. Topical lubricants, antibiotics, or autologous serum may be needed in cases with corneal involvement or exposure. Surgical interventions may be used, but frequently fail if the underlying neurological pathology and skin manipulation has not been adequately addressed. TTS should be suspected in persistent or recurrent facial ulceration with concomitant anaesthesia and paraesthesia in the trigeminal distribution, with alar nasi involvement being a key feature.
Subject(s)
Eyelid Diseases/diagnosis , Orbital Diseases/diagnosis , Paresthesia/diagnosis , Skin Ulcer/diagnosis , Trigeminal Nerve Diseases/diagnosis , Adult , Aged , Eyelid Diseases/therapy , Face , Female , Humans , Male , Middle Aged , Orbital Diseases/therapy , Paresthesia/therapy , Skin Ulcer/therapy , Trigeminal Nerve Diseases/therapyABSTRACT
PURPOSE: To assess the effects of central corneal thickness (CCT) and corneal curvature (CC) on the measurements of intraocular pressure (IOP) using Goldmann applanation tonometer (GAT) and the ocular blood flow pneumatonometer (OBFT). METHODS: 104 patients were recruited from a glaucoma clinic. The CCT was measured using ultrasound pachymetry and the mean radius of CC using a keratometer. The IOP of each eye was measured using both GAT and the OBFT in a random order. Right eyes only were analysed for statistical purposes. RESULTS: The mean (+/-SD) IOP by GAT and OBFT was 18.2 mmHg (+/-4.4) and 18.2 mmHg (+/-4.0), respectively, with no statistically significant difference. IOP measurement with both instruments varied with CCT and CC. GAT showed an IOP increase of 0.40 mmHg per 10 microm increase of CCT and OBFT showed an increase of 0.38 mmHg in IOP per 10 microm increase of CCT. Multiple regression analysis showed that the effect of CCT was statistically significant (P<0.001) on IOP recorded by both the GAT and OBFT but CC did not have a statistically significant effect on IOP recordings performed by either technique. CONCLUSION: IOP measurements by GAT and OBFT are positively correlated with CCT with both tonometers being similarly affected. There was no significant correlation between CC and IOP measured by either tonometer.
