The management of the lower eyelid in facial paralysis

Lateral Tarsoplasty for Managing Ectropion and Laxity of the Lower Eyelid

BACKGROUND

The most challenging complication associated with lower blepharoplasty is ectropion, and the traditional lateral canthopexy or canthoplasty procedure may carry the risk of eyelid malposition or subsequent chemosis. We propose lateral tarsoplasty with a detailed description of the techniques to treat and even prevent ectropion by not involving the medial or lateral canthal ligament so as to avoid complications.

MATERIALS AND METHODS

Lower eyelid laxity was analyzed with the snap-back test and distraction test before surgery. Approximately 5 mm medial to the lateral canthus, lateral tarsoplasty is performed through a full-thickness pentagonal tarsal-conjunctival resection according to the "overlapping test" for an accurate measurement of the amount of the tarsus to be resected. Seventy-two eyelids that received either ectropion correction or prevention with lateral tarsoplasty over an 8-year period at a single institution were collected and analyzed for this retrospective review.

RESULTS

Lateral tarsoplasty was performed in 39 patients with a mean age of 63.8 years. Thirteen patients with 20 eyelids presented for ectropion correction, in whom 5 to 10 mm of tarsus was resected, 6.0 mm in average. The other 26 patients with 52 eyelids presented for ectropion prevention, in whom 3 to 7 mm of tarsus was resected, 4.1 mm in average. Apart from temporary mild chemosis, all patients experienced highly satisfactory results without any ectropion or malposition of the involved lower eyelids after a follow-up of 8.1 months in average.

CONCLUSIONS

For patients with moderate and severe laxity of lower eyelids, lateral tarsoplasty without involvement of the lateral canthal ligament proves to be an effective way to treat and prevent lower eyelid ectropion.

[Novel approach to treatment of lagophthalmos-associated neuroparalytic keratitis]

Aim - to develop effective treatment approaches to lagophthalmos-associated neuroparalytic keratitis.

MATERIAL AND METHODS

A total of 34 patients (36 eyes) with neuroparalytic keratitis were enrolled. Group 1 consisted of 20 patients (21 eyes), in whom autoconjunctivoplasty was performed in combination with eyelid surgery. Group 2 consisted of 12 lagophthalmic patients (13 eyes) with purulent corneal ulcers, who additionally underwent corneal transplantation. Group 3 included 2 patients (2 eyes) with central corneal ulcer in the only seeing eye, who received, besides other things, upper sector iridectomy intended to serve as a pupil (RU 2299048 with priority date of 15.07.2005).

RESULTS

In group 1, corneal re-epithelization and complete recovery was achieved in all patients within 3.00±0.69 weeks. Visual acuity (VA) has generally increased over the first year after treatment from 0.14±0.06 to 0.25±0.13 in group 1 and from 0.09±0.05 to 0.21±0.13 in group 2. In group 3, sector iridectomies also yielded an increase in VA - from 0.01 to 0.02 in one case and from 0.2 to 0.6 in the other. Autoconjunctivoplasty enabled rapid and stable re-epithelization of corneal defects in all cases.

CONCLUSION

One-stage corneal and eyelid surgery has been shown to be more effective in treating lagophthalmos-associated neuroparalytic keratitis than previous methods. The novel approach ensures acute symptoms of keratitis resolve and the eye is saved, moreover, it allows to maintain visual acuity and prevent recurrences in 64% and 65% of patients, respectively.

Treatment of the Periocular Complex in Paralytic Lagophthalmos

Objectives:

Paralytic lagophthalmos can lead to devastating exposure keratitis. The main surgical intervention consists of upper eyelid loading. However, adjunctive lower eyelid and brow procedures are also available as necessary. We sought to analyze the use of periocular procedures in paralytic lagophthalmos at Johns Hopkins.

Methods:

The method was a retrospective review of patients treated at a single tertiary care center from 2006 to 2012.

Results:

One hundred one patients met inclusion criteria, and 20 patients were excluded for not meeting the minimum follow-up. Upper eyelid loading was required on 95/101 patients (95%). Adjunctive procedures were necessary in 73% (73/101) of patients. Lower eyelid procedures were used in 47% (47/101) and brow lifts in 47% (47/101). Older patients (>50 years) were more likely to require lower eyelid procedures ( P = .04) and more likely to require revision ( P = .003). Medial canthopexy and direct brow lift were associated with the need for revision ( P = .006, P = .03).

Conclusion:

Paralytic lagophthalmos management is not one-size-fits-all. Upper eyelid loading is the mainstay of treatment; however, adjunctive procedures to the lower eyelid and brow are indicated in the majority of patients. Our retrospective review has allowed us to continue to refine our strategy for managing these patients.

Ocular protection in facial paralysis

PURPOSE OF REVIEW

Facial nerve paralysis has a profound impact on patients' quality of life, of which one of the most important sequelae is a risk of corneal surface disease. Herein, we discuss methods to protect the eye following insult to the facial nerve.

RECENT FINDINGS

Protection of the ocular surface in patients with facial nerve injury is of paramount importance to prevent corneal injury and potential blindness. Many interventions on the eye are temporary and therefore easily reversible. A systematic approach to managing the eye is required in these patients.

SUMMARY

This article provides a review of current methods used for ocular protection in patients with facial nerve paralysis.