Lim Christina S, Neville Catriona, Nduka Charles, Kannan Ruben, Malhotra Raman
From the Corneoplastic Unit (C.S.L., R.M.), Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex, UK.
Department of Plastic Surgery (C.N., C.N. R.K.), Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex, UK.
Am J Ophthalmol. 2025 Oct;278:292-304. doi: 10.1016/j.ajo.2025.06.038. Epub 2025 Jun 20.
Facial nerve palsy (FNP) in children presents treatment challenges and may lead to neurotrophic keratopathy and vision loss. Limited literature exists regarding its ophthalmic features and surgical management beyond tarsorrhaphy. This study reports characteristics of FNP unique to children, surgical procedures without the use of tarsorrhaphy, and patient outcomes.
Retrospective case series study.
A 9-year retrospective case series was conducted in a specialist unit. Patients under the age of 18 years at the time of referral with the diagnosis of FNP were included. Electronic records were reviewed for demographics, etiology and laterality of FNP, and ophthalmic findings. Statistical analysis was performed using a linear mixed-effects model.
A total of 26 patients were identified, with 29 affected eyes (3 bilateral). Three children had neurotrophic keratopathy. Periocular surgery was performed in 14 children, which included levator recession, platinum segment insertion, correction of meibomian gland inversion (MGI), full-thickness skin graft (FTSG), and lower eyelid elevation. No children underwent tarsorrhaphy. The CADS Grading Scale scores improved significantly post-treatment in Cornea, Asymmetry, and Dynamic function (P < .05). Vision was maintained in 4 patients (21%) and improved in 11 (58%). Deterioration was seen in 4 cases (21%). Neurotrophic keratopathy improved in 2 children without corneal neurotization.
Corneal involvement was common in children with corneal anesthesia. Upper eyelid skin contracture was a common feature. Lagophthalmos was better addressed by levator recession, platinum segment insertion, correction of MGI, and FTSG, which improved the ocular surface and corneal sensation. Vision improvement was notable without tarsorrhaphy-related field loss. Synkinesis was rare.
儿童面神经麻痹（FNP）带来了治疗挑战，并可能导致神经营养性角膜病变和视力丧失。关于其眼部特征及睑裂缝合术以外的手术治疗的文献有限。本研究报告了儿童特有的FNP特征、不采用睑裂缝合术的手术方法及患者预后。
回顾性病例系列研究。
在一个专科单位进行了一项为期9年的回顾性病例系列研究。纳入转诊时年龄在18岁以下、诊断为FNP 的患者。查阅电子记录以获取FNP的人口统计学、病因及患侧情况，以及眼部检查结果。使用线性混合效应模型进行统计分析。
共确定了26例患者，累及29只眼（3例为双侧）。3名儿童患有神经营养性角膜病变。14名儿童接受了眼周手术，包括提上睑肌后退术、铂金段植入术、睑板腺内翻矫正术（MGI）、全厚皮片移植术（FTSG）和下睑上提术。没有儿童接受睑裂缝合术。治疗后，角膜、不对称性和动态功能方面的CADS分级量表评分显著改善（P < 0.05）。4例患者（21%）视力得以维持，11例（58%）视力改善。4例（21%）视力恶化。2名儿童的神经营养性角膜病变在未进行角膜神经化的情况下得到改善。
角膜麻醉的儿童中角膜受累情况常见。上睑皮肤挛缩是一个常见特征。通过提上睑肌后退术、铂金段植入术、MGI矫正术和FTSG能更好地解决兔眼问题，这些方法改善了眼表和角膜感觉。未出现与睑裂缝合术相关的视野缺损，视力改善显著。联带运动罕见。
