Ask an Eye M.D. Answer Archive

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Question:
Our 10-year-old son just had brain surgery to remove a very large dermoid. The dermoid was involving his left frontal lobe, bilateral carotids, and hypothalmus. He had decreased peripheral vision in his right eye prior to the surgery. After surgery he is not able to open his left eye at all voluntarily, nor can he raise his left eyebrow. At first we were told it was because of the swelling but now the swelling is much improved and he still cannot open his left eye. We are very concerned that since his vision was so compromised in his right eye due to the tumor, that we need to find the cause for his inability to open his left eye, so that he will be able to see. Any ideas or suggestions are greatly appreciated.

Answer:
I am sorry to read that your son has had to undergo such extensive surgery. The brow weakness may be due to swelling around the temporal branch of the seventh nerve. This nerve can become stretched if a bicoronal flap was created to access the frontal lobe. In many cases this nerve regains strength with time. Your son may have involvement of the levator muscle or third cranial nerve, leading to a droopy eyelid. There could also be injury to sympathetic fibers that can lead to a Horner's syndrome (droopy eyelid, small pupil, decreased sweating) on the ptotic side. Evaluation by an EyeM.D./oculofaicial plastic surgeon will help determine the cause of the droopy eyelid and present options for improvement.

Answered by: Rona Silkiss, MD Dr. Rona Silkiss

Categories: Eye Conditions, Eye Surgery

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Answered: Aug 31, 2013

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