Sadiq S A, Downes R N
Department of Ophthalmology Queen's Medical Centre Nottingham, UK.
Eye (Lond). 1998;12 ( Pt 2):219-23. doi: 10.1038/eye.1998.52.
BACKGROUND/AIMS: Facial nerve palsy can be a sight-threatening complication. We have developed a flow diagram to aid in the management of these patients so that corneal complications may be avoided. This involves the recognition of a facial palsy and institution of treatment as guided by the flow chart.
Fifty-six patients suffered a facial nerve palsy following acoustic neuroma surgery. All received regular topical ocular lubrication, followed by either botulinum toxin A (BTXA)-induced ptosis (if corneal exposure developed despite conservative treatment) or definitive eyelid surgery.
Twenty-one patients required regular lubrication only. Of these patients treated for corneal exposure, 20 received BTXA with good resulting corneal cover. Unfortunately, 9 of these suffered diplopia, although in 4 this resolved quickly. Twenty-four patients underwent a total of 64 eyelid procedures including levator recession, lateral tarsorraphy, lateral canthal sling, medical canthoplasty and gold weight insertion. All patients had good corneal cover post-operatively and were cosmetically improved. Of the 56 patients with a facial nerve palsy, 7 presented with a corneal epithelial defect or an infected corneal ulcer. These all responded to treatment with BTXA, topical antibiotics and/or lubrication, and eyelid surgery.
Post-operative facial palsy may result in a significant ophthalmic workload. Although a proportion of patients with a facial nerve palsy manage well with regular lubrication, additional help with eyelid closure, either in the way of BTXA-induced ptosis in the short term or definitive eyelid surgery in the long term, is often required. Eyelid surgery seems to be the mainstay of treatment, for both function and cosmesis, with many patients requiring a combination of procedures.
背景/目的：面神经麻痹可能是一种威胁视力的并发症。我们制定了一个流程图来辅助这些患者的管理，以便避免角膜并发症。这包括识别面神经麻痹并按照流程图进行治疗。
56例患者在听神经瘤手术后出现面神经麻痹。所有患者均接受常规局部眼部润滑，随后根据情况进行肉毒杆菌毒素A（BTXA）诱导的上睑下垂治疗（如果尽管进行了保守治疗仍出现角膜暴露）或确定性眼睑手术。
21例患者仅需常规润滑。在这些接受角膜暴露治疗的患者中，20例接受了BTXA治疗，角膜覆盖良好。不幸的是，其中9例出现复视，不过4例很快恢复。24例患者共接受了64次眼睑手术，包括提上睑肌后退、外侧睑裂缝合、外侧眦悬吊、内眦成形术和植入金重。所有患者术后角膜覆盖良好，外观得到改善。在56例面神经麻痹患者中，7例出现角膜上皮缺损或感染性角膜溃疡。这些患者均通过BTXA、局部抗生素和/或润滑以及眼睑手术治疗后好转。
术后面神经麻痹可能导致大量眼科工作量。尽管一部分面神经麻痹患者通过常规润滑管理良好，但通常仍需要额外的眼睑闭合帮助，短期可采用BTXA诱导的上睑下垂，长期则可采用确定性眼睑手术。眼睑手术似乎是治疗的主要手段，兼顾功能和美观，许多患者需要多种手术联合进行。
