Occurrence and severity of upper eyelid skin contracture in facial nerve palsy

Implantation of gold weights into the upper eyelid is a proven method of treating lagophthalmos and exposure keratopathy in patients with unresolved facial nerve palsy. The aim of this study was to evaluate the factors affecting visual acuity and corneal complications in patients after upper eyelid gold weight lid loading. Material and methods: This prospective consecutive clinical study was conducted in years 2012–2018. In total, 59 people (40 women, 19 men aged 55.5 ± 17.4 years) meeting the inclusion criteria were treated with gold weights. The ordered multinomial logit model was used to analyze the factors affecting best-corrected visual acuity (BCVA) and degree of exposure keratopathy after surgery. The influence of the following variables was analyzed: patient age, etiology and duration of the facial nerve palsy, history of the previous eyelid surgery, degree of lagophthalmos in mm, presence of Bell’s phenomenon, and corneal sensation, Schirmer test results. Results: Implantation of gold weights into the upper eyelid effectively reduced lagophthalmos and exposure keratopathy in the study group (p < 0.001). BCVA was maintained or better in 95% of patients after surgery. Patient age, presence of the Bell’s phenomenon, and corneal sensation significantly affected the final BCVA (p < 0.1). The presence of Bell’s phenomenon and corneal sensation had a positive effect on the degree of keratopathy after surgery (p < 0.1). In turn, patient age and history of tarsorrhaphy were significant negative prognostic factors of exposure keratopathy and BCVA after surgery (p < 0.05). Etiology and duration of facial nerve palsy, degree of corneal exposure in mm, and results of the Schirmer test did not have a significant impact on the outcome after surgery (p > 0.1). Conclusions: The results of our study may help to answer the question of how to direct ophthalmologists and other specialists who refer to ophthalmologists for management advice in patients with facial nerve palsy. Elderly patients with a history of tarsorrhaphy who present with poor Bell’s phenomenon and/or a lack of corneal sensation should be the first candidates for immediate correction of lagophthalmos.

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Quality of Life in Patients with Unresolved Facial Nerve Palsy and Exposure Keratopathy Treated by Upper Eyelid Gold Weight Loading

Clinical Ophthalmology ◽

10.2147/opth.s254533 ◽

2020 ◽

Vol Volume 14 ◽

pp. 2211-2222

Author(s):

Izabela Nowak-Gospodarowicz ◽

Radosław Różycki ◽

Marek Rękas

Keyword(s):

Quality Of Life ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Upper Eyelid ◽

Gold Weight ◽

Weight Loading

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Müllerectomy for Upper Eyelid Retraction and Lagophthalmos Due to Facial Nerve Palsy

Archives of Ophthalmology ◽

10.1001/archopht.123.9.1221 ◽

2005 ◽

Vol 123 (9) ◽

pp. 1221 ◽

Cited By ~ 13

Author(s):

Adam S. Hassan

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Eyelid Retraction ◽

Upper Eyelid ◽

Upper Eyelid Retraction

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Upper Eyelid Gold Weight Implantation for Facial Nerve Palsy—Short-Term and Long-Term Results

Indian Journal of Surgery ◽

10.1007/s12262-018-1854-9 ◽

2019 ◽

Vol 81 (6) ◽

pp. 525-530

Author(s):

Hitesh Verma ◽

Sandeep Puthiya Koiloorveetil ◽

Veena Jain ◽

Namrata Sharma ◽

Alok Thakar

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Long Term Results ◽

Short Term ◽

Upper Eyelid ◽

Gold Weight

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Functional and aesthetic outcomes of eyelid skin grafting in facial nerve palsy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312311 ◽

2018 ◽

Vol 103 (5) ◽

pp. 686-691 ◽

Cited By ~ 1

Author(s):

Sundas Ejaz Maqsood ◽

Nikhil Cascone ◽

Andre Grixti ◽

Ruben Kannan ◽

Charles Nduka ◽

...

Keyword(s):

Facial Nerve ◽

Postoperative Period ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Skin Grafting ◽

Eyelid Skin ◽

Thickness Skin ◽

Dynamic Function ◽

The Mean ◽

The Aesthetic

AimTo report the functional and aesthetic outcomes of eyelid full-thickness skin grafting (FTSG) in patients with facial nerve palsy (FNP).MethodsThis is a retrospective, non-comparative, single-centre review of all patients with FNP who underwent FTSG over an 8-year period. Functional outcomes were collected through case notes review: CADS (cornea, staticasymmetry anddynamic andsynkinesis) score facial nerve grading and lagophthalmos on blink, gentle and forced closure. Marginal reflex distance (MRD1 and MRD2) was calculated on standardised photographs. The aesthetic outcomes were assessed objectively by two blinded independent assessors who assessed standardised photographs based on a mutually agreed grading scale. Both functional and aesthetic outcomes were measured preoperatively, and at early (1–3 months), intermediate (3–6 months) and late (>9 months) postoperative periods.ResultsA total of 28 eyelid FTSGs were performed on 21 patients (11 female, 10 male) between 2008 and 2016. The mean age was 68 (range, 16–89) years and the mean follow-up was 20.8 (range, 12–30) months. The CADS score (cornea (p<0.001), static asymmetry (p<0.001), dynamic function (p<0.001)), MRD2 (p=0.002) and lagophthalmos (blink (p=0.003), gentle (p<0.001), forced (p=0.003)) improved through early and late postoperative periods. Aesthetically, the grafts appeared to look natural in terms of colour, surface contour and graft edge from the intermediate postoperative period and continued to improve significantly by the late postoperative period.ConclusionThe use of periocular FTSG is effective in improving lagophthalmos and periorbital symmetry in patients with FNP where skin contraction exists. They should be considered as an adjunct to other oculoplastic procedures for both functional and aesthetic rehabilitation.

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