Surgical treatment of posterior cranial fossa and cerebellopontine angle tumors is associated with a risk of facial nerve dysfunction. The causes for facial muscle paresis include nerve compression by the tumor, destruction of the nerve structure by the tumor growing from nerve fibers, nerve injury during surgical removal of the tumor, etc. The first 3 months after facial nerve injury are a potential therapeutic window for the use of botulinum toxin type A (BTA). During this period, the drug is introduced both in the healthy side to improve the facial symmetry at rest and during mimetic movements and in the affected side to induce drug-induced ptosis. Post-paralytic syndrome develops 4-6 months after facial nerve injury. At this stage, administration of BTA is also an effective procedure; in this case, drug injections are performed on the affected side at small doses and symmetrically on the healthy side at doses doubling those for the affected side. BTA injections are mandatory in complex treatment of facial muscle paralysis.

G Ключевые слова: трофическая кератопатия; лагофтальм; кератопротекторная терапия; индуцированный птоз; лечебные мягкие контактные линзы; кровавая блефарорафия.ФГБУ «НИИ Нейрохирургии им. акад. Н. Н. Бурденко» РАМН, Москва

Traumatic brain injury can cause various pathological conditions both in the eyeball and in the cranial cavity. The presented clinical case demonstrates the features of differential diagnosis of direct carotid-cavernous fistula and secondary post-traumatic glaucoma. Direct carotid-cavernous fistula is the formation of a communication between the internal carotid artery and the cavernous sinus and the discharge of arterial blood into it. The first symptom of a carotid-cavernous fistula is a pulsating noise in the head and above the eye. The manifest signs in the clinical picture are the signs of obstruction of venous outflow from the eye and the orbit: proptosis, eyelid edema and chemosis, congestive redness of the eye, varicose subcutaneous veins of the eyelids, as well as dilated ophthalmic vein visualized by ultrasound of the orbit, ophthalmic hypertension, oculomotor disorders, state of the fundus. The clinical picture in patients with secondary post-traumatic contusion glaucoma, in addition to an increase in intraocular pressure, is characterized by the presence of a congestive redness of the eye, changes in the cornea from mild superficial opacities to more dense ones, luxation or subluxation of the lens into the anterior chamber or vitreous, destruction of the vitreous or intraocular hemorrhage. The similarity of clinical manifestations of traumatic carotid-cavernous fistula and secondary post-traumatic glaucoma can cause difficulties in differential diagnosis.

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