Joseph Shannon S, Joseph Andrew W, Smith Jane I, Niziol Leslie M, Musch David C, Nelson Christine C
a Department of Ophthalmology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
b Department of Otolaryngology-Head and Neck Surgery , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
Ophthalmic Epidemiol. 2017 Oct;24(5):341-345. doi: 10.1080/09286586.2017.1294186. Epub 2017 Mar 20.
Facial palsy (FP) can result in serious ophthalmic sequelae including loss of vision. We describe the clinical characteristics of FP patients presenting for ophthalmologic evaluation and the timing for initiating ophthalmologic care.
We performed a retrospective review of 96 consecutive FP patients presenting between 1992 and 2015 at a tertiary eye center. The main outcome measures were time interval from the diagnosis of FP and onset of ocular symptoms to the initial ophthalmologic evaluation (IOE), and the severity of exposure keratopathy and eyelid malposition on IOE.
The median time interval from the diagnosis of FP to the IOE was 1.6 years (interquartile range; IQR = 0.5-9.2), and from the onset of ocular symptoms to IOE was 0.8 years (IQR = 0.3-2.3). The most common ocular symptoms were dryness (47.9%; n = 46), irritation (39.6%; n = 38), and tearing (30.2%; n = 29). A total of 26.0% (n = 25) of patients were bothered by the appearance of their eyes. Only 13.5% (n = 13) noted change in vision. On IOE, 81.6% (n = 75) of patients had punctate epithelial erosions (PEE), of which 52.3% (n = 35) had moderate to severe PEE, 3.3% (n = 3) had corneal ulcers and 2.2% (n = 2) had corneal abrasions. The average margin-reflex distance 2 was 6.4 mm (SD = 2.4) with average lagophthalmos of 3.5 mm (SD = 3.1).
Among FP patients presenting for ophthalmologic evaluation, exposure keratopathy (as evidenced by PEE and corneal ulcers/abrasions) is highly prevalent and moderately severe on IOE, despite only 13.5% of patients noting decreased vision. These findings underscore the importance of timely and thorough ophthalmologic evaluation of FP patients.
面神经麻痹（FP）可导致包括视力丧失在内的严重眼部后遗症。我们描述了前来接受眼科评估的FP患者的临床特征以及开始眼科治疗的时机。
我们对1992年至2015年间在一家三级眼科中心连续就诊的96例FP患者进行了回顾性研究。主要观察指标为从FP诊断和眼部症状出现到首次眼科评估（IOE）的时间间隔，以及IOE时暴露性角膜病变和眼睑位置异常的严重程度。
从FP诊断到IOE的中位时间间隔为1.6年（四分位间距；IQR = 0.5 - 9.2），从眼部症状出现到IOE为0.8年（IQR = 0.3 - 2.3）。最常见的眼部症状是干涩（47.9%；n = 46）、刺激感（39.6%；n = 38）和流泪（30.2%；n = 29）。共有26.0%（n = 25）的患者对眼部外观感到困扰。只有13.5%（n = 13）的患者注意到视力变化。在IOE时，81.6%（n = 75）的患者有点状上皮糜烂（PEE），其中52.3%（n = 35）有中度至重度PEE，3.3%（n = 3）有角膜溃疡，2.2%（n = 2）有角膜擦伤。平均边缘反射距离2为6.4 mm（标准差 = 2.4），平均眼睑闭合不全为3.5 mm（标准差 = 3.1）。
在前来接受眼科评估的FP患者中，暴露性角膜病变（以PEE和角膜溃疡/擦伤为证）非常普遍，且在IOE时为中度严重，尽管只有13.5%的患者注意到视力下降。这些发现强调了对FP患者进行及时、全面眼科评估的重要性。
