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Case 3.16
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
This is a sight-threatening condition – caused by the loss of corneal sensory innervation due to the trigeminal nerve injury – which may result in corneal ulceration and eventual vision loss. This is compounded by a concomitant facial nerve injury with potential lagophthalmos, altered lacrimation, and lower eyelid malposition – resulting in environmental exposure – in addition to the inability to sense damage, if and when it occurs.
Blepharoplasty
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Lagophthalmos following an upper eyelid blepharoplasty is avoided by ensuring a conservative skin resection in the upper eyelids. Overzealous resection may require a skin graft if exposure symptoms do not respond to conservative treatment.
Medical Negligence in Otorhinolaryngology
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Great care must be taken over the amount of skin that is excised. Lagophthalmos, incomplete upper eyelid closure, is a normal occurrence in the first 48 hours after surgery. It usually resolves spontaneously but a large lagophthalmos (greater than approximately 3 mm), or if it persists, indicates overexcision of upper eyelid skin. If left untreated, dry eye symptoms and corneal exposure occur. The best treatment is replacement of the excised skin, providing that this has been stored in a refrigerator at the time of the operation, as this provides the best match. Ectropion is often due to excessive removal of skin but may be due to other causes such as scar contracture or a lax lid margin. Taping of the lower lid, and if necessary a support stitch, for a few weeks may resolve the problem but permanent ectropion will require skin grafting that will leave additional scars.
Ocular involvement in facial nerve paralysis: risk factors for severe visual impairment and ocular surface exposure in 1870 patients
Published in Orbit, 2023
S. Singh, AV Das, Mohammad Hasnat Ali
A list of patients diagnosed with facial nerve palsy or Bell’s palsy using the International Classification of Diseases revision 9 (ICD-9) (code H19.3) compiled during any clinical visit has been reviewed from an electronically generated database since 2012. The retrieved data included patient history, age, gender, duration of FNP and etiology of FNP, eye symptoms at presentation, visual acuity, oculoplastic surgery details, if any performed, and ocular findings. House-Brackmann scores and CADS (Cornea, Static Asymmetry, Dynamic function, and Synkinesis) grading were not calculated, as this scale was designed for dynamic evaluation of recovering unilateral palsy and ours was a cross-sectional study.6,7 The etiology of FNP was classified as surgical, neoplastic, traumatic, congenital, or idiopathic. Neoplastic cases included FNPs secondary to head and neck tumors or resection of these tumors. Surgical cases included those after parotidectomy or ear surgeries. The amount of lagophthalmos (in mm), presence of ectropion, and ocular surface exposure (punctate epithelial erosions, corneal epithelial defects, corneal ulcer/perforation, corneal scar with erosions) were also recorded. The degree of lagophthalmos was categorized into three grades – 1 to 2 mm, 3 to 5 mm, 6 to 10 mm. Lagophthalmos represents lagophthalmos on gentle or forced closure throughout the manuscript. All medical records were reviewed by two consultant ophthalmologists (A.V.D. and S.S.).
3D printing for low cost, rapid prototyping of eyelid crutches
Published in Orbit, 2019
Michael G. Sun, Duangmontree Rojdamrongratana, Mark I. Rosenblatt, Vinay K. Aakalu, Charles Q. Yu
Regardless of these improvements, a possible long-term complication of eyelid crutch overuse is ocular desiccation. Lagophthalmos, or incomplete eyelid closure, can be a complication as it can be difficult to close the eyelid while wearing an eyelid crutch. Incomplete blinking may cause corneal compromise, even in the face of minimal lagophthalmos.13 It is important with any eyelid crutch to adequately educate the patient on the need for lubrication, proper fitting, and avoiding overuse. Another advantage of our design is that it is removable, unlike many traditional crutches. Patients are therefore able to easily adjust their usage to prevent desiccation-related complications. Additionally, our crutches can be 3D printed with flexible materials that potentially allow for better eye closure compared to rigid tradition crutches, although further studies will have to be done to compare to the traditional crutches. Finally, eyelid crutch manufacturing is not limited to 3D printing. With our 3D design, eyelid crutches have the potential for large-scale, cheap manufacturing through alternate methods such as injection molding. The crutches could therefore be used in developing countries and could potentially provide many individuals temporary relief from ptosis who may otherwise not have access to traditional interventions.
Transitioning from a gold weight to an “enhanced” palpebral spring in the management of paralytic lagophthalmos secondary to facial nerve palsy
Published in Orbit, 2019
George Salloum, Bryant P. Carruth, Robert H. Hill, Craig N. Czyz, Thomas A. Bersani
The amount of lagophthalmos and blink deficiency are important factors in determining the choice of weight versus spring placement. Terzis and Sampson felt if there is no functional ability of the eyelid to close at all, then the gold weight is preferred, as the palpebral spring requires at least a small amount of functionality in order to reanimate the lid.9 However, our data refute this position, as all of the patients in this study improved with palpebral springs, regardless of eyelid closure strength. Despite varying etiologies of CN 7 palsy, 100% of patients in this study experienced more complete closure of their eyelid with gentle closure and 60% experienced a more rapid and satisfactory blink rate. Lagophthalmos improvement was also noted in all patients, and this was found to be clinically and statistically significant. The data support that those who require complete, dependable lid closure, such as those with neurotrophic keratitis or an absent Bell’s phenomenon, may benefit from transition from a gold weight to a palpebral spring.8