Cicatricial Eyelid Paralysis Secondary to Trigeminal Trophic Syndrome

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A 65-year-old male with a history of trigeminal-nerve involving CNS lymphoma currently in remission following multiple rounds of chemotherapy and autologous stem-cell transplant subsequently developed trigeminal trophic syndrome. Trigeminal trophic syndrome is a rare consequence of trigeminal nerve damage that yields anesthesia, paresthesia, dysesthesia, and ulceration typically due to self-induced trauma. The patient had known tumor involvement of the right trigeminal nerve before treatment as identified by MRI. Biopsy of the skin lesion demonstrated acanthosis, hypergranulosis, and hyperkeratosis with fibrotic papillary dermis without evidence of organisms, all of which was felt to be consistent with lichen simplex chronicus with superficial erosion consistent with a history of chronic rubbing and irritation. The patient confirmed this suspicion with reports of picking and peeling the skin in the affected distribution to relieve the dysesthesias. The extensive nature of his trigeminal trophic syndrome caused total eyelid paralysis secondary to cicatricial changes of the eyelids and surrounding tissue. Trigeminal trophic syndrome can often result in eyelid involvement, typically manifesting as ulceration with corneal exposure that responds poorly to surgical intervention given poor tissue healing. Given this patient’s paralysis was protecting his cornea, he was observed with conservative measures only including topical mupirocin ointment and mirtazapine for neuropathic pain (Figs. 1–3).
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