Recovery of corneal sensation following eyelid surgery for neurotrophic keratopathy and preganglionic facial palsy

Abstract

Background/aims Facial nerve palsy (FNP) impacts the ocular and periocular regions. Preganglionic trigeminal nerve palsy (PrGTP) may complicate preganglionic FNP (PrGFP), resulting in neurotrophic keratopathy (NK), risking corneal sequelae. We present a case series where comprehensive eyelid surgery (CES) to manage the eyelid sequelae of PrGFP, complicated by PrGTP, resulted in the recovery of corneal sensation, avoiding corneal neurotisation surgery (CNS).

Methods A retrospective case series of three patients with PrGFP and PrGTP in whom eyelid abnormalities were addressed through CES. 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 (CSND) via in vivo confocal microscopy where available. Corneal scarring was assessed, and corneal sensitivity was determined via Cochet-Bonnet or corneal wisp testing.

Results Three patients with longstanding PrGFP and PrGTP (mean of 28.3 (range 18–49) months) underwent CES to correct the eyelid sequelae of FNP. On presentation, two out of three cases had a complete absence of corneal sensation, while one out of three had reduced sensation. All cases had absent trophic nerve function. Following CES, trophic function and corneal sensation started to improve on average 19 days and 10 months later, respectively, for the three patients. CSPD had nearly doubled at 6 months postoperatively in the patient who had this assessed.

Conclusions In cases of NK due to PrGTP complicated by PrGFP, CES should be attempted before considering CNS since improvement in corneal sensation and trophic function may occur. CES helps to reduce exposure and may improve corneal sensation regardless of aetiology.