A CLINICAL ALGORITHM FOR THE MANAGEMENT OF FACIAL-NERVE PALSY FROM ANOCULOPLASTIC PERSPECTIVE

Background/Aims Facial nerve palsy can be a sight-threatening complica tion. We have developed a flow diagram to aid in the management of the se patients so that corneal complications may be avoided. This involve s the recognition of a facial palsy and institution of treatment as gu ided by the flow chart. Method Fifty-six patients suffered a facial ne rve palsy following acoustic neuroma surgery. All received regular top ical ocular lubrication, followed by either botulinum toxin A (BTXA)-i nduced ptosis (if corneal exposure developed despite conservative trea tment) or definitive eyelid surgery. Results Twenty-one patients requi red regular lubrication only. Of these patients treated for corneal ex posure, 20 received BTXA with good resulting corneal cover. Unfortunat ely, 9 of these suffered diplopia, although in 4 this resolved quickly . Twenty-four patients underwent a total of 64 eyelid procedures inclu ding levator recession, lateral tarsorrhaphy, lateral canthal sling, m edial canthoplasty and gold weight insertion. All patients had good co rneal cover post-operatively and were cosmetically improved. Of the 56 patients with a facial nerve palsy, 7 presented with a corneal epithe lial defect or an infected corneal ulcer. These all responded to treat ment with BTXA, topical antibiotics and/or lubrication, and eyelid sur gery. Conclusions Post-operative facial palsy may result in a signific ant ophthalmic workload. Although a proportion of patients with a faci al nerve palsy manage well with regular lubrication, additional help w ith eyelid closure, either in the way of BTXA-induced ptosis in the sh ort term or definitive eyelid surgery in the long term, is often requi red. Eyelid surgery seems to be the mainstay of treatment, for both fu nction and cosmesis, with many patients requiring a combination of pro cedures.