Korean J Ophthalmol.  2019 Feb;33(1):1-7. 10.3341/kjo.2018.0010.

Ophthalmologic Clinical Features of Facial Nerve Palsy Patients

Affiliations
  • 1Department of Ophthalmology, CHA Bundang Medical Center, Seongnam, Korea. eye@cha.ac.kr

Abstract

PURPOSE
To understand the ophthalmic clinical features and outcomes of facial nerve palsy patients who were referred to an ophthalmic clinic for various conditions like Bell's palsy, trauma, and brain tumor.
METHODS
A retrospective study was conducted of 34 eyes from 31 facial nerve palsy patients who visited a clinic between August 2007 and July 2017. The clinical signs, management, and prognosis were analyzed.
RESULTS
The average disease period was 51.1 ± 20.6 months, and the average follow-up duration was 24.0 ± 37.5 months. The causes of facial palsy were as follows: Bell's palsy, 13 cases; trauma, six cases; brain tumor, five cases; and cerebrovascular disease, four cases. The clinical signs were as follows: lagophthalmos, 24 eyes; corneal epithelial defect, 20 eyes; conjunctival injection, 19 eyes; ptosis, 15 eyes; and tearing, 12 eyes. Paralytic strabismus was found in seven eyes of patients with another cranial nerve palsy (including the third, fifth, or sixth cranial nerve). Conservative treatments (like ophthalmic ointment or eyelid taping) were conducted along with invasive procedures (like levator resection, tarsorrhaphy, or botulinum neurotoxin type A injection) in 17 eyes (50.0%). Over 60% of the patients with symptomatic improvement were treated using invasive treatment. At the time of last following, signs had improved in 70.8% of patients with lagophthalmos, 90% with corneal epithelium defect, 58.3% with tearing, and 72.7% with ptosis. The rate of improvement for all signs was high in patients suffering from facial nerve palsy without combined cranial nerve palsy.
CONCLUSIONS
The ophthalmic clinical features of facial nerve palsy were mainly corneal lesion and eyelid malposition, and their clinical course improved after invasive procedures. When palsy of the third, fifth, or sixty cranial nerve was involved, the prognosis and ophthalmic signs were worse than in cases of simple facial palsy. Understanding these differences will help the ophthalmologist take care of patients with facial nerve palsy.

Keyword

Bell palsy; Facial nerve palsy; Ptosis

MeSH Terms

Bell Palsy
Brain Neoplasms
Cerebrovascular Disorders
Cranial Nerve Diseases
Cranial Nerves
Epithelium, Corneal
Eyelids
Facial Nerve*
Facial Paralysis
Follow-Up Studies
Humans
Paralysis*
Prognosis
Retrospective Studies
Strabismus
Tears

Figure

  • Fig. 1 Before and after injection of botulinum neurotoxin type A (BoNT-A) and hyaluronic acid. (A–F) The patients with only facial nerve palsy. (G,H) The patient with facial nerve palsy and other cranial nerve paralysis. (A) A 1-year-old male patient who had postpartum right facial nerve injury. (B) A 8-year-old male patient who had postpartum right facial nerve injury after 7 years of injection of BoNT-A and hyaluronic acid. (C) A 70-yearold female patient who had right facial nerve palsy. (D) A 70-year-old female patient who had right facial nerve palsy after 3 months of injection of BoNT-A and hyaluronic acid. (E) A 78-year-old male patient who had left facial nerve palsy. (F) A 78-year-old male patient who had left facial nerve palsy after 3 months of injection of BoNT-A and hyaluronic acid. (G) A 42-year-old male patient who had brain tumor surgery and had facial nerve palsy and other cranial nerve palsy. (H) A 42-year-old male patient who had brain tumor surgery and had facial nerve palsy and other cranial nerve palsy after 1 month of injection of BoNT-A at extraocular muscle and hyaluronic acid at left upper and lower lid. Informed consent was obtained from all study participants.


Reference

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