Trigeminal dermatome distribution in patients with glaucoma and facial port wine stain

The importance of glaucoma screening in patients with upper eyelid involvement of facial port wine stain (PWS) is well known. This study questions the validity of this concept and reports the cutaneous patterns of PWS in 66 patients known to have glaucoma.

Clinical records of 66 patients with glaucoma were reviewed, and the pattern of facial PWS involvement of the dermatomes of the trigeminal nerve was catalogued. The Pearson chi(2) test was applied. The literature supporting previous conclusions was reviewed.

39 cases had ipsilateral and 27 had bilateral PWS; 9.3% had isolated ophthalmic branch (V(1)) involvement, 30.2% had ophthalmic and maxillary branch (V(1)V(2)) involvement, 5.8% had maxillary and mandibular branch (V(2)V(3)) involvement, and 52.3% had all 3 branches (V(1)V(2)V(3)) involved.

Patients demonstrated to have glaucoma and facial PWS are approximately 7 times more likely to have multiple dermatomes of the trigeminal nerve involved (88.3%) in contrast to isolated V(1) involvement (9.3%). PWS patterns did not correlate with embryological segments of facial development. A review of the relevant literature resolves conflicting concepts and emphasizes the importance of glaucoma screening in all patients with trigeminal dermatome involvement of the PWS.