Case Report: Dry Eye Management Leads to Early Diagnosis of Seventh Nerve Schwannoma.

SIGNIFICANCE: Facial nerve schwannomas are rare tumors that are usually benign and relatively slow in their progression. Common symptoms include facial neuropathy, auditory deficiencies, and parotid masses. Because of slow progression, symptoms are often present for over a year before an appropriate diagnosis is made.

PURPOSE: The purpose of this study was to present a case in which comprehensive dry eye assessments and management led to diagnosis of facial nerve shwannoma in a patient who had no presenting symptoms of auditory deficiencies or facial weakness.

CASE REPORT: A 36-year-old woman presented for a contact lens examination with concerns of progressively worsening symptoms of irritation and dryness in her right eye that began 6 months earlier. Dry eye assessment visits and management strategies were implemented. Although this regimen was initially successful, symptoms returned after 7 months. At this visit, a new finding of incomplete blink in her right eye was manifested. Further in-office assessments revealed a weakened right orbicularis oculi and right frontalis muscle. These findings, combined with patient risk factors and no history of trauma, prompted MRI of the seventh nerve. Imaging revealed the presence of seventh nerve schwannoma, the location of which correlated with the geniculate ganglion and greater superficial petrosal nerve. This patient was later referred to a neurosurgeon, who assessed the risks and benefits of schwannoma removal. It was decided that the risks of the surgery outweighed the benefits, and regular MRI was scheduled for monitoring purposes. Appropriate management of the patient's chronic dry eye disease continues.

CONCLUSIONS

Facial nerve schwannomas can and do present with no presenting subjective facial neuropathy symptoms aside from mild unilateral dry eye and can be detected with comprehensive dry eye management. This case may contribute to future minor adjustments in clinical practice guidelines for asymmetric dry eye assessments.