Acoustic neuroma and the eye

A retrospective survey is presented of the case records of 138 patients who had undergone operative treatment for acoustic neuroma. The nature and incidence of ophthalmic features prior to and following surgery is documented. The study covers 12 years in two regional neurosurgical centres, under the care of six different neurosurgeons, one otolaryngologist and nine ophthalmologists. Of the 138 records examined, 61 patients (44%) required lid surgery of one variety or another. 18 (13%) developed minor superficial exposure keratopathy, 13 (9%) developed corneal opacification or clouding, two had recurrent infective abscesses and four developed optic atrophy. The development of corneal complications strongly correlates with the presence of documented preoperative fifth nerve involvement. Postoperative oculomotor cranial nerve palsies were seen in 10 patients (7%). Ophthalmologists should be involved in the perioperative management of these patients and certainly before irreversible corneal damage has occurred.