Recovery of corneal sensation following eyelid surgery for neurotrophic keratopathy and pre-ganglionic facial palsy
Author: Malik Moledina
Base Hospital / Institution: Queen Victoria Hospital NHS Foundation Trust
ePoster presentation
Abstract ID: 25-301
Purpose
Facial nerve palsy (FNP) is a consequential condition impacting the ocular and periocular regions. Pre-ganglionic trigeminal nerve palsy (PrGTP) may complicate pre-ganglionic FNP (PrGFP), where the insult is proximal to the geniculate ganglion, resulting in neurotrophic keratopathy (NK), raising the risk of corneal sequelae. We present the first case series where comprehensive eyelid surgery to manage the eyelid sequelae of PrGFP, complicated by PrGTP, resulted in the recovery of corneal sensation, avoiding corneal neurotisation surgery.
Methods
A retrospective case series of three patients with PrGFP and PrGTP in whom eyelid malposition and dysfunction were addressed through comprehensive eyelid surgery. Outcome measures include markers of trophic function, including ocular surface integrity as determined by fluorescein assessment of cornea staining and corneal sub-basal nerve plexus density via In-vivo confocal microscopy where available. Corneal scarring was also assessed, and corneal sensitivity was determined via Cochet-Bonnet or corneal whisp testing.
Results
A total of three patients with longstanding PrGFP and PrGTP (mean of 28.3 (range 18-49) months, underwent extensive surgery to correct the eyelid sequelae of facial nerve palsy. On presentation, two of the three cases had a complete absence of corneal sensation, whilst one case had reduced but not absent sensation. All cases had signs of absent trophic nerve function. Following comprehensive eyelid surgery, trophic function and corneal sensation started to improve on average 19 days later and 10 months later, respectively. Corneal sub-basal nerve density had nearly doubled by six months post-operative in the patient where in vivo confocal microscopy was performed.
Conclusion
In cases of NK due to PrGFP complicated by trigeminal nerve palsy, comprehensive eyelid surgery should be attempted before considering corneal neurotisation since improvement in corneal sensation and trophic function may occur. Comprehensive eyelid surgery, helps to reduce exposure and may improve corneal sensation regardless of aetiology.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Christina | Lim | Maidstone and Tunbridge Wells NHS Foundation Trust |
| Harminder | Dua | University of Nottingham |
| Raman | Malhotra | Queen Victoria Hospital NHS Foundation Trust |
