As with all medical conditions, there may be many causal factors. Further relevant information on causes of Corneal reflex, absent may be found in:
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Acoustic neuroma affects the trigeminal nerve, causing a diminished or absent corneal reflex, tinnitus, and unilateral hearing impairment. Facial palsy and anesthesia, palate weakness, and signs of cerebellar dysfunction (ataxia, nystagmus) may result if the tumor impinges on the adjacent cranial nerves, brain stem, and cerebellum.
A common cause of diminished or absent corneal reflex, Bell's palsy causes paralysis of CN VII. It can also produce complete hemifacial weakness or paralysis and drooling on the affected side, which also sags and appears masklike. The eye on this side can't be shut and tears constantly.
An absent corneal reflex can occur on the side opposite the lesion when infarction or injury affects CN V or VII or their connection in the central trigeminal tract. Associated findings include a decreased level of consciousness, dysphagia, dysarthria, contralateral limb weakness, and early signs and symptoms of increased intracranial pressure, such as a headache and vomiting.
With massive brain stem infarction or injury, the patient also displays respiratory changes, such as apneustic breathing or periods of apnea; bilateral pupillary dilation or constriction with decreased responsiveness to light; rising systolic blood pressure; a widening pulse pressure; bradycardia; and coma.
With this polyneuropathic disorder, a diminished or absent corneal reflex accompanies ipsilateral loss of facial muscle control. Muscle weakness, the dominant neurologic sign of this disorder, typically starts in the legs, and then extends to the arms and facial nerves within 72 hours. Other findings include dysarthria, dysphagia, paresthesia, respiratory muscle paralysis, respiratory insufficiency, orthostatic hypotension, incontinence, diaphoresis, and tachycardia.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
This tumor affects the trigeminal nerve, causing a diminished or absent corneal reflex, tinnitus, and unilateral hearing impairment. Facial palsy and anesthesia, palate weakness, and signs of cerebellar dysfunction (ataxia, nystagmus) may result if the tumor impinges on the adjacent cranial nerves, brain stem, and cerebellum.
A common cause of diminished or absent corneal reflex, Bell’s palsy causes paralysis of cranial nerve VII. It can also produce complete hemifacial weakness or paralysis and drooling on the affected side. The affected side also sags and appears masklike. The eye on this side can’t be shut and tears constantly.
An absent corneal reflex can occur on the side opposite the lesion when a brain stem infarction or injury affects cranial nerve V or VII or their connection in the central trigeminal tract. Associated findings include decreased level of consciousness, dysphagia, dysarthria, contralateral limb weakness, and early signs and symptoms of increased intracranial pressure, such as headache and vomiting.
In a massive brain stem infarction or injury, the patient also displays respiratory changes, such as apneustic breathing or periods of apnea; bilateral pupillary dilation or constriction with decreased responsiveness to light; rising systolic blood pressure; widening pulse pressure; bradycardia; and coma.
In this polyneuropathic disorder, a diminished or absent corneal reflex accompanies ipsilateral loss of facial muscle control. Muscle weakness, the primary neurologic sign of this disorder, typically starts in the legs, then extends to the arms and facial nerves within 72 hours. Other findings include dysarthria, dysphagia, paresthesia, respiratory muscle paralysis, respiratory insufficiency, orthostatic hypotension, incontinence, diaphoresis, and tachycardia.
This disorder may cause corneal anesthesia, usually unilaterally. Other findings include regional adenopathy, blepharitis, and vesicles on the eyelid.
A diminished or absent corneal reflex may stem from a superior maxillary lesion that affects the ophthalmic branch. The patient with trigeminal neuralgia characteristically experiences sudden bursts of intense pain or shooting sensations, lasting from 1 to 15 minutes, in one of the divisions of the trigeminal nerve, primarily the superior mandibular or maxillary division. An attack may be triggered by local stimulation, such as a light touch to the cheeks, exposure to hot or cold temperatures, or eating or drinking hot or cold food or beverages. Areas around the patient’s nose and mouth may be hypersensitive.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
This infarction causes absent doll’s eye sign with a coma. It also causes limb paralysis, cranial nerve palsies (facial weakness, diplopia, blindness or visual field deficits, and nystagmus), bilateral cerebellar ataxia, variable sensory loss, a positive Babinski’s reflex, decerebrate posture, and muscle flaccidity.
Absent doll’s eye sign accompanies a coma in this type of tumor. This sign may be preceded by hemiparesis, nystagmus, extraocular nerve palsies, facial pain or sensory loss, facial paralysis, diminished corneal reflex, tinnitus, hearing loss, dysphagia, drooling, vertigo, dizziness, ataxia, and vomiting.
Accompanying absent doll’s eye sign are a coma, Weber’s syndrome (oculomotor palsy with contralateral hemiplegia), contralateral ataxic tremor, nystagmus, and pupillary abnormalities.
Whether associated with abscess, hemorrhage, or tumor, a cerebellar lesion that progresses to a coma may also cause an absent doll’s eye sign. The coma may be preceded by headache, nystagmus, ocular deviation to the side of the lesion, unequal pupils, dysarthria, dysphagia, ipsilateral facial paresis, and cerebellar ataxia. Characteristic signs of increased ICP may also occur, including decreased LOC, abnormal pupillary responses, increased systolic blood pressure, widening pulse pressure, bradycardia, altered respiratory pattern, papilledema, and vomiting.
Absent doll’s eye sign and a coma develop within minutes in this life-threatening disorder. Other ominous signs—such as complete paralysis, decerebrate posture, a positive Babinski’s reflex, and small, reactive pupils—may rapidly progress to death.
A subdural hematoma at this location typically causes absent doll’s eye sign and a coma. These signs may be preceded by characteristic signs and symptoms, such as headache, vomiting, drowsiness, confusion, unequal pupils, dysphagia, cranial nerve palsies, stiff neck, and cerebellar ataxia.
Barbiturates may produce severe central nervous system depression, resulting in a coma and absent doll’s eye sign.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Acoustic neuroma.Acoustic neuroma affects the trigeminal nerve, causing a diminished or absent corneal reflex, tinnitus, and unilateral hearing impairment. Facial palsy and anesthesia, palate weakness, and signs of cerebellar dysfunction (for example, ataxia or nystagmus) may result if the tumor impinges on the adjacent cranial nerves, brain stem, and cerebellum.
Bell's palsy.A common cause of diminished or absent corneal reflex, Bell's palsy causes paralysis of CN VII. It can also produce complete hemifacial weakness or paralysis and drooling on the affected side, which also sags and appears masklike. The eye on this side can't be shut and tears constantly.
Brain stem infarction or injury.An absent corneal reflex can occur on the side opposite the lesion when infarction or injury affects CN V or VII or their connection in the central trigeminal tract. Associated findings include a decreased level of consciousness, dysphagia, dysarthria, contralateral limb weakness, and early signs and symptoms of increased intracranial pressure, such as a headache and vomiting.
With massive brain stem infarction or injury, the patient also displays respiratory changes, such as apneustic breathing or periods of apnea; bilateral pupillary dilation or constriction with decreased responsiveness to light; rising systolic blood pressure; a widening pulse pressure; bradycardia; and coma.
Guillain-Barré syndrome.With this polyneuropathic disorder, a diminished or absent corneal reflex accompanies ipsilateral loss of facial muscle control. Muscle weakness, the dominant neurologic sign of this disorder, typically starts in the legs, and then extends to the arms and facial nerves within 72 hours. Other findings include dysarthria, dysphagia, paresthesia, respiratory muscle paralysis, respiratory insufficiency, orthostatic hypotension, incontinence, diaphoresis, and tachycardia.
Source: Nursing: Interpreting Signs and Symptoms, 2007
Brain stem infarction.Brain stem infarction causes absent doll's eye sign with coma. It also causes limb paralysis, cranial nerve palsies (facial weakness, diplopia, blindness or visual field deficits, and nystagmus), bilateral cerebellar ataxia, variable sensory loss, a positive Babinski's reflex, decerebrate posture, and muscle flaccidity.
Brain stem tumor.Absent doll's eye sign accompanies coma with a brain stem tumor. This sign may be preceded by hemiparesis, nystagmus, extraocular nerve palsies, facial pain or sensory loss, facial paralysis, a diminished corneal reflex, tinnitus, hearing loss, dysphagia, drooling, vertigo, dizziness, ataxia, and vomiting.
Central midbrain infarction.With a central midbrain infarction, absent doll's eye sign is associated with coma, Weber's syndrome (oculomotor palsy with contralateral hemiplegia), contralateral ataxic tremor, nystagmus, and pupillary abnormalities.
Pontine hemorrhage.Absent doll's eye sign and coma develop within minutes with pontine hemorrhage, a life-threatening disorder. Other ominous signs—such as complete paralysis, decerebrate posture, a positive Babinski's reflex, and small, reactive pupils—may rapidly progress to death.
Posterior fossa hematoma.A subdural hematoma at the posterior fossa typically causes absent doll's eye sign and coma. These signs may be preceded by characteristic signs and symptoms, such as a headache, vomiting, drowsiness, confusion, unequal pupils, dysphagia, cranial nerve palsies, a stiff neck, and cerebellar ataxia.
Drugs.Barbiturates may produce severe central nervous system depression, resulting in coma and absent doll's eye sign.
Source: Nursing: Interpreting Signs and Symptoms, 2007
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