Dr. Himangshu Das, D18685, Dr. Jawahar Jyoti Kuli
Pt.presented with double vision in right gaze & a 3x2x0.5mm stain(+)central corneal lesion,R/E.He gives h/o RTA 3 weeks back with LOC.O/E R/E:Pupillary reaction normal,hypotropia,esotropia,restricted Bell’s phenomenon,negative FDT,no limitation in movement of muscles supplied by 3rd nerve.Facial sensation lost in the ophthalmic division 5th nerve,jaw jerk reflex absent.Corneal sensation lost,LR palsy R/E.USG B scan:mild choroidal edema.CT scan: multiple fractures(#)in the zygomatic process of temporal & maxillary bones,temporalbone,posterolateral wall of right orbit.The case was diagnosed to be post-traumatic palsy of 5th&6th cranial nerves with neurotrophic ulceration R/E.In this case 5thnerve palsy could be related to zygomatic and temporal bones # while 6th nerve palsy could be due to posterolateral wall #right orbit.Mx :inj.Methylprednisolone,inj.Mecobalamin,Folic acid & Niacinamide,e/d moxifloxacin,e/d atropine sulphate 1%,tear substitute,patching followed by Lateral Tarsorrhaphy.