Objective assessment of eyelid position and tear meniscus in facial nerve palsy

Abstract

ABSTRACT Purpose To evaluate lower lid position and tear meniscus in peripheral idiopathic facial nerve palsy (FNP). Methods A prospective study enrolled patients with peripheral idiopathic FNP and epiphora. Data were collected on patient demographics,House-Brackmann (HB) scale, digital photographs of the face, and tear meniscusat the 1st, 30, and 90 day after onset of FNP. Marginal reflex distance to theupper (MRD1) and lower eyelid (MRD2) were evaluated using ImageJ software.Anterior segment optical coherence tomography(OCT) was performed to measure the tear menis- cus. P< .05 was consideredstatistically significant. Results Sixteen patients were evaluated. The HB scale at presentation was grade III in six patients (37.5%). At 90 day, nine patients(56.25%) were grade I-normal. Three (18.7%) had upper lid retraction, three(18.7%) upper eyelid asymmetry and 7 (43.75%), lower eyelid retraction. Thedifference between MRD2-FNP with MRD2-healthy side was 0.51 ± 1.9 mm at the 1stvisit, decreasing to 0.09 ± 1.47 mm at 90 days (P= .877). Tear meniscusmeasurements were significantly higher in FNP at the 1st visit (P= .001). Thedecrease in MRD2 was statistically correlated with the reduction of the tearmeniscus area (TMA) (r = 0.67; P= .007) at 90 days. No correlation was foundbetween HB and TMA. There is a difference in TMA between age groups at the 1stday(p= .009). Eldest group had higher HB scales. Conclusion Quantitative evaluation of eyelid position and tear meniscus are effective to document the evolution of FNP and can serve as aclue of orbicularis recovery.