Topic: ESOPRS 2021 ePoster sessions
Time: Sep 17, 2021 16:00 Amsterdam, Berlin, Rome, Stockholm, Vienna, 15:00 London
(plain text version here)
From Pain to Palsy – A Rare Complication of Radiofrequency Ablation
Author: Conor Malone
ePoster Number: 285
Purpose
A 91-year-old patient presented to the emergency department with right eye discomfort. 5 days before this, he had undergone uncomplicated radiofrequency ablation (RFA) of the right trigeminal nerve as treatment for chronic trigeminal neuralgia. Although his trigeminal pain had reduced, within 2 days he developed right eye pain, blurred vision, and epiphora.
Methods
Visual acuity (VA) was 6/60 in the right eye and 6/9 in the left eye. Examination showed a right-sided facial nerve palsy with infectious keratitis and exposure keratopathy secondary to poor lid closure. Physical examination was otherwise normal and the patient was systemically well with no other neurological signs.
Results
The patient was treated with intensive topical antibiotics, lubricants, and lid taping. One week later the stromal keratitis had resolved but a large epithelial defect remained. Antibiotics were discontinued and we performed a temporary tarsorrhaphy. After 4 weeks, the tarsorrhaphy was opened and the ocular surface was almost completely healed with VA improved to 6/48.
As corneal sensation was reduced and there was a residual facial palsy with poor lid closure, we performed a lateral tarsal strip. At 6 months follow-up, the patient was pain free with good lid position and the ocular surface was quiet. There was moderate residual facial weakness and VA remained at 6/48 due to stromal scarring.
Conclusion
RFA is a popular and effective treatment for trigeminal neuralgia. Known adverse effects include ocular conditions such as corneal paraesthesia (6%) and keratitis (<1%). This is the first documented case of facial nerve palsy after trigeminal nerve RFA. Patients should be counselled on the risks of ophthalmic complications and should be advised to seek urgent ophthalmology review to avoid long-term sequelae.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Shivona | Chetty | Sligo University Hospital, Sligo, Ireland |
Abstract ID: 21-192