Association of Eyelid Position and Facial Nerve Palsy With Unresolved Weakness

Sinha, Kunal R.; Rootman, Daniel B.; Azizzadeh, Babak; Goldberg, Robert A.

doi:10.1001/jamafacial.2016.0533

Cited by 17 publications

(9 citation statements)

References 18 publications

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“…When a patient has brow ptosis, the eyelids seem to droop, which can be mistaken for blepharoptosis. Ptosis and upper eyelid asymmetry were defined based on the degree of MRD1 in our study and the study by Sinha et al [4]. But in many cases of brow ptosis, it can be measured.…”

Section: Discussionmentioning

confidence: 86%

“…Eyelid retraction is commonly thought to accompany facial nerve palsy, as it is related to unopposed levator function. But according to a study by Sinha et al [4], this retraction occurs somewhat rarely, and most cases have a high-normal eyelid position (regardless of facial nerve palsy). In other words, patients do not have significant MRD1 asymmetry.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, no patient had retraction, and 53.6% of patients with unilateral facial nerve palsy had upper eyelid asymmetry greater than 1.0 mm (with the facial nerve palsy eyelid lower in most [13 of 15, 86.7%] of these cases). In the study by Sinha et al [4], ptosis (MRD <2.5 mm) was uncommon on the facial nerve palsy side, with a prevalence of only 8%. But in our study, over 50% of patients had ptosis on the facial nerve palsy side.…”

Section: Discussionmentioning

confidence: 99%

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Ophthalmologic Clinical Features of Facial Nerve Palsy Patients

Lee

Lew

2019

Korean J Ophthalmol

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PurposeTo 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.MethodsA 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.ResultsThe 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.ConclusionsThe 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.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ophthalmologic Clinical Features of Facial Nerve Palsy Patients

Lee

Lew

2019

Korean J Ophthalmol

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“…The ptosis is probably a manifestation of eyelid malposition which is well known to occur with lower motor neuron (LMN) facial palsy, where contralateral ptosis is also seen quite often. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

Nine syndrome: Case report and review of clinical signs in internuclear ophthalmoplegia

Singhdev

Asranna

Sureshbabu

et al. 2018

Ann Indian Acad Neurol

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“…Eyelid asymmetry is frequent in severe facial weakness as the eyelid maintenance and recalibration system may be overwhelmed. 12 There may be either ptosis or retraction on the FNP side, depending on factors such as ipsilateral synkinesis and contralateral ptosis. Other potential ocular sequelae include the following 13 :…”

Section: Ocular Sequelae After Fnpmentioning

confidence: 99%

The Treatment of Facial Asymmetry with Botulinum Toxin: Current Concepts, Guidelines, and Future Trends

Heydenrych

2020

Indian J Plast Surg

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This article will describe facial asymmetry secondary to facial nerve paralysis (FNP), and review current concepts, guidelines, and future trends. Despite the increasing use of botulinum toxin (BoNTA) in treating FNP, ideal dosage, timing, and additional therapies are not unequivocally established. Facial asymmetry significantly impacts quality of life (QOL) by strongly affecting self-perception and social interactions; injectables may mediate great clinical improvement. This article provides practical guidelines for the use of BoNTA and provides schemes for accurate assessment and documentation. A systematic, stepwise approach is recommended with methodical assessment, meticulous placement, conservative dosage, and careful follow-up. Future trends include the potential use of newly developed toxins, muscle modification with fillers, improved imaging techniques, and targeted QOL studies. Hopefully, a growing number of aesthetic injectors may become technically proficient and join multidisciplinary teams for managing FNP.

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Association of Eyelid Position and Facial Nerve Palsy With Unresolved Weakness

Abstract: IMPORTANCE Understanding the prevalence and clinical features of eyelid malpositions in facial nerve palsy (FNP) may inform proper management of patients with FNP and supplement our knowledge of eyelid physiology.OBJECTIVE To describe eyelid malposition in FNP.

Cited by 17 publications

References 18 publications

Ophthalmologic Clinical Features of Facial Nerve Palsy Patients

Ophthalmologic Clinical Features of Facial Nerve Palsy Patients

Nine syndrome: Case report and review of clinical signs in internuclear ophthalmoplegia

The Treatment of Facial Asymmetry with Botulinum Toxin: Current Concepts, Guidelines, and Future Trends

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