Sohrab Mahsa, Abugo Usiwoma, Grant Michael, Merbs Shannath
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Ophthalmology, Howard University Hospital, Washington, District of Columbia.
Facial Plast Surg. 2015 Apr;31(2):140-4. doi: 10.1055/s-0035-1549292. Epub 2015 May 8.
Facial nerve palsy, whether the cause is idiopathic, or following such insults as surgery, trauma, or malignancy, places the health of the ocular surface at risk. Reduced or absent orbicularis oculi function results in lagophthalmos and exposure of the cornea, which is exacerbated by eyelid malposition. Management of the exposure keratopathy is paramount to prevent corneal breakdown, scarring, and permanent vision loss. Significant exposure keratopathy can be complicated by loss of corneal sensation, leading to a neurotrophic corneal ulcer. Initial management consists of artificial tear drops and ointment for corneal lubrication and strategies to address the lagophthalmos. Once the condition of the ocular surface has been stabilized, a variety of surgical treatment options are available depending on the severity and persistence of eyelid and ocular findings. The most common surgical options include temporary or permanent tarsorrhaphy for lagophthalmos, upper eyelid weight placement for retraction, and lateral canthoplasty with or without a middle lamellar spacer for lower eyelid retraction. External eyelid loading is a good option in patients who are poor surgical candidates or who have a known temporary palsy of short duration. The goal of all such procedures must be protection of the ocular surface through optimization of eyelid position.
面神经麻痹，无论病因是特发性的，还是继发于手术、创伤或恶性肿瘤等损伤，都会使眼表健康面临风险。眼轮匝肌功能减退或丧失会导致兔眼和角膜暴露，而眼睑位置异常会使这种情况更加严重。暴露性角膜病变的处理对于预防角膜破裂、瘢痕形成和永久性视力丧失至关重要。严重的暴露性角膜病变可能会因角膜感觉丧失而复杂化，导致神经营养性角膜溃疡。初始治疗包括使用人工泪液和眼膏来润滑角膜，以及采取解决兔眼问题的策略。一旦眼表状况稳定，根据眼睑和眼部表现的严重程度和持续时间，有多种手术治疗选择。最常见的手术选择包括用于治疗兔眼的临时性或永久性睑裂缝合术、用于上睑退缩的上睑负重植入术，以及用于下睑退缩的带或不带中间层间隔物的外眦成形术。对于手术条件较差或已知有短期暂时性麻痹的患者，外部眼睑负重是一个不错的选择。所有这些手术的目标都必须是通过优化眼睑位置来保护眼表。
