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Ocular Ramsay Hunt syndrome refers to involvement of the eye and surrounding structures in Ramsay Hunt syndrome (RHS), a neurological condition caused by reactivation of the varicella-zoster virus in the facial nerve. Eye complications in RHS arise from the facial nerve's role in eyelid closure (aka blinking) and tear production. Patients with RHS often have difficulty fully closing their eye, potentially resulting in dry eye, eye irritation, corneal damage, and vision problems.
Dry Eye
When the eyelid doesn't close properly, the eye's surface is too exposed leading to dryness, irritation, discomfort, and blurred vision. Patients with RHS often do not make enough tears exacerbating eye dryness.
Corneal Damage
Prolonged exposure to air, due to decreased ability to blink, can cause the cornea (the clear front part of the eye) to become damaged, potentially leading to corneal ulcers, infections, and even temporary or permanent vision loss. Difficulty blinking also leads to poor eye protection, and wind, dirt, and other irritants can directly damage the cornea due to this poor protection.
Excessive Tearing
In patients with RHS who have difficulty blinking, tears accumulate and spill over the lower eyelid onto the cheek. This excessive tearing (aka epiphora) occurs because blinking is necessary to spread tears across the surface of the eye and help them drain. Decreased blinking is why your eyes can feel dry, but there are tears running down your cheek at the same time. In patients with long-term (aka chronic) RHS, abnormal nerve regeneration can lead to tear production during eating. This phenomenon is known as "crocodile tears."
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