Прогнозирование роговичных осложнений у пациентов с паралитическим лагофтальмом

Abstract

Introduction. Paralytic lagophthalmos can be accompanied by the development of severe complications up to the loss of visual functions and even the eye as an organ. Purpose. To identify the causes of severe corneal complications in patients with paralytic lagophthalmos. Material and methods. We conducted a retrospective analysis of 114 clinical cases of paralytic lagophthalmos. All the patients received tear replacement therapy. For diagnostics, all of them underwent ophthalmological examination, corneal estesiometry, eyeball mobility assessment, Schirmer test 1, photography of the corneal surface with and without fluorescein staining, Hertel exophthalmometry, measurement of the ocular slit parameters and determination of the severity of Bell's symptom. Results. In patients with preserved corneal sensitivity and a positive Bell's symptom, the cornea was transparent. Although, in patients with normal corneal sensitivity and a weakened Bell's symptom, regardless of the severity of lagophthalmos, there was epithelial roughness in the lower parts of the cornea and uneven staining were noted. All the patients with decreased corneal sensitivity had neurotrophic keratopathy with various pathological changes of the cornea, up to perforation, in combination with pronounced uneven staining of the epithelium over its entire surface. Conclusion. In paralytic lagophthalmos, the risk of developing corneal complications increases significantly in patients with decreased corneal sensitivity and weakened or negative Bell's symptom on the affected side. Keywords: Bell's symptom, protective function of the eyelids, facial nerve, oculomotor nerve, trigeminal nerve, tear replacement therapy, neurotrophic keratopathy