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Pathology · patient case question

A patient is drooling and cannot close the eye on the affected side. All of the following may occur EXCEPT:

Patient case: Case: facial palsy with an ipsilateral rash

Scenario: The case describes unilateral facial paralysis accompanied by a vesicular rash on the same side.

  1. Glaucoma
  2. Loss of the ability to raise the eyebrow on that side
  3. Corneal drying and exposure keratitis
  4. Drooping of the corner of the mouth with food pooling
Show answer and explanation

Correct answer: A. Glaucoma

  • A. Correct — this is the exception. Glaucoma results from raised intraocular pressure and has nothing to do with facial nerve function. The eye complication here is surface drying, not pressure.
  • B. This does occur, and it is the key distinction: a lower motor neuron lesion paralyses the forehead too. In a stroke the forehead is spared.
  • C. This does occur. Without a blink reflex the cornea dries and ulcerates, which is why these patients need lubricating drops, a patch, and often taping of the lid at night.
  • D. This does occur. Loss of buccinator and orbicularis oris tone lets the commissure droop and food collect in the vestibule.

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