Lu Tracy J, Nguyen John, Kossler Andrea L, Fay Aaron, Homer Natalie A
Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA.
Department of Ophthalmology, West Virginia University, Morgantown, West Virginia, USA.
Orbit. 2025 Aug;44(4):390-394. doi: 10.1080/01676830.2024.2444497. Epub 2025 Jan 7.
Lagophthalmos from facial nerve palsy is traditionally measured with patients in an upright position and may fail to identify positional variability. This study aims to assess the effects of body position, surgical technique, implant material, and patient demographics on lagophthalmos.
A multicenter prospective study was performed to evaluate positional changes in paralytic lagophthalmos and the effects of various patient and surgical factors.
Sixty-four eyelids were included. Thirty-two (50%) of eyelids had upper eyelid weight implantation with a median post-operative follow-up of 67 weeks. The mean change in lagophthalmos from sitting to supine was a 1.4 mm increase ( < 0.001). There was a larger lagophthalmos variability in patients with eyelid weights compared to those without ( = 0.047), and in patients with gold compared to platinum weights ( = 0.026). Positional increase in lagophthalmos did not correlate with weight position (i.e. pretarsal vs. supratarsal) ( = 0.26), weight load ( = 0.70), House-Brackmann severity ( = 0.16), age ( = 0.14), or gender ( = 0.13).
Surgeons should routinely measure lagophthalmos in the supine position, as nocturnal corneal exposure may warrant ocular lubrication, occlusion, or additional surgery. Platinum weights may be preferred over gold due to less positional lagophthalmos variability.
传统上，面神经麻痹所致兔眼症是让患者直立位进行测量的，可能无法识别位置变异性。本研究旨在评估体位、手术技术、植入材料和患者人口统计学因素对兔眼症的影响。
进行了一项多中心前瞻性研究，以评估麻痹性兔眼症的位置变化以及各种患者和手术因素的影响。
纳入了64只眼睑。32只（50%）眼睑进行了上睑负重植入，术后中位随访时间为67周。从坐位到仰卧位兔眼症的平均变化为增加1.4毫米（<0.001）。与未植入眼睑负重的患者相比，植入眼睑负重的患者兔眼症变异性更大（=0.047），与植入铂质负重的患者相比，植入金质负重的患者兔眼症变异性更大（=0.026）。兔眼症的位置增加与负重位置（即睑板前与睑板上）（=0.26）、负重负荷（=0.70）、House-Brackmann严重程度（=0.16）、年龄（=0.14）或性别（=0.13）均无相关性。
外科医生应常规在仰卧位测量兔眼症，因为夜间角膜暴露可能需要眼部润滑、遮盖或额外手术。由于兔眼症位置变异性较小，铂质负重可能比金质负重更可取。
