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Ocular and palpebral manifestations of facial palsy | OPTH


The facial nerve (CN VII) comprises a number of fiber varieties, equivalent to motor, sensory and parasympathetic fibers and their corresponding nuclei.1–4 Facial Palsy (FP) has a myriad of etiologies, from using forceps throughout sophisticated vaginal supply to neoplastic lesions, however the most typical wrongdoer is Bell’s Palsy, which is believed to have its origin in a reactivation of viral replication by herpes simplex virus type-1 (HSV-1) within the nerve’s cranial ganglia.1,5,6 Different vital etiologies embrace Ramsay-Hunt syndrome, Lyme’s illness, ear infections, iatrogenic, tumoral, congenital, granulomatous and traumatic situations, and plenty of extra.3,6–9 Relying on the diploma of nerve injury, the top end result can vary from a whole and protracted FP to an entire restoration in operate.7 Its incidence can range from 11 to 40 instances per 100,000 folks yearly.10

Analysis of this ailment is principally medical, with an acute onset, a period of hours or days, and is usually accompanied by retroauricular ache. In peripheral FP, a complete laxity of the hemiface is noticed, with absent expression and a downward deviation of the ipsilateral mouth.1–5 The severity of FP is graded with the Home-Brackmann medical scale, though the Sunnybrook scale has gained extra recognition internationally on account of a extra complete scoring system.11 Inferior palpebral laxity and, in the end, lagophthalmos could cause quite a lot of ocular floor injury, equivalent to conjunctival irritation, corneal dryness and erosions, and even ulceration and/or perforation of the cornea.1–5 Bell’s phenomenon needs to be assessed to find out whether or not it’s current or absent, because it represents a protecting issue.2,6 It is usually vital to evaluate Meibomian gland dysfunction, since a rising physique of proof demonstrates structural alterations in these glands, which in the end result in tear movie instability.12,13

Nearly 90% of sufferers expertise spontaneous restoration, albeit not a whole one. Round 70–80% of FP sufferers will expertise a whole restoration, whereas the remaining can current acute or persistent issues, equivalent to persistent facial weak spot, irregular axonal branching, in addition to synkinesis in muscle tissue innervated by CN VII.5,8 Immediate therapy of this illness is essential in avoiding issues, and it consists of medical, surgical, and rehabilitation modalities. It’s of the utmost significance to guard the eyeball from continued publicity to environmental insults, equivalent to air and pollution, so ointments and protecting eye shields needs to be prescribed. Medical therapy with corticosteroids, antivirals, analgesics and even botulinum toxin may be employed.3,5 Surgical therapy is often reserved as a final resort and sufferers needs to be conscious that it has various levels of success.1,9,14

Rehabilitation needs to be initiated as quickly as doable, there are various completely different choices, and an vital rehabilitation modality is tailor-made facial muscle tissue workout routines. These workout routines have average proof of enhancing outcomes in sufferers with average and/or persistent FP and current just about no adversarial results, so they need to be thought of.15 Strategies equivalent to neuromuscular re-education, biofeedback, electrostimulation, and facial features workout routines can be found, however they don’t have a robust stage of proof.5,15,16 The time period “facial incapacity” was coined to explain affected person’s high quality of life impairments, equivalent to consuming and talking handicaps, in addition to the emotional and social facets that this ailment can entail.17,18

Supplies and Strategies

This research was registered on November 2th, 2021 underneath the registration quantity: P000602-MOPPAF-CI-CR002 and was permitted by the native Ethics Committee. It was a retrospective and descriptive observational research. A complete of 43,656 digital information from two main third-level well being establishments had been surveyed, and 60 sufferers with a prognosis of FP within the final 5 years had been recruited. Sufferers had been from the metropolitan space of Monterrey, Nuevo León in Mexico.

Demographic information, equivalent to age, intercourse, illness evolution, visible acuity, ocular signs, in addition to ocular and periocular medical options had been obtained. Previous medical historical past pertaining to systemic and/or ocular illness was additionally investigated. Additionally, historical past of ophthalmologic surgical procedure was recorded.

Central tendency measurements had been in contrast with the T-student methodology as soon as they had been adjusted for the homogeneity of the variance, Mann–Whitney take a look at was used for non-parametric variables, and Odds Ratio evaluation was carried out. Information evaluation was carried out utilizing IBM SPSS 26 and R Studio 4.1-1-1-383. Lastly, a comparative evaluation (Odds Ratio) was carried out to find out whether or not an affiliation between completely different indicators, signs and therapy modalities could possibly be discovered.


An FP prevalence of 0.14% (CI 0.13–1.12) was calculated based mostly on our pattern dimension. Out of all 60 sufferers, 34 (56.7%) had been feminine, imply age at presentation was 55.63 ± 17.2 years, and illness evolution time was 96.69 ± 135.4 months. Bell’s palsy was the most typical etiology, with 46 (76.7%) sufferers presenting as such, adopted by vascular illness in 5 (8.3%) sufferers and an iatrogenic origin in 4 (6.70%) sufferers. Additionally, 58 (96.7%) sufferers introduced as unilateral FP. Synkinesis occurred in 18 sufferers (30%), whereas 42 skilled persistent flaccid FP.

The primary illness related to FP on this pattern was Arterial Hypertension in 24 (40%) sufferers, adopted by Diabetes Mellitus (DM) in 22 (36.30%) and previous facial nerve surgical procedure and cerebrovascular illness in 4 (6.70%). A abstract of related illnesses may be consulted in Desk 1. By way of ocular and periocular illness affiliation, the principle entity was cataract in 12 (20%) sufferers, in addition to glaucoma and diabetic retinopathy in 4 (6.70%), the remainder of related ocular/periocular illnesses are summarized in Desk 2.

Desk 1 Systemic Comorbidities in Our Inhabitants Pattern

Desk 2 Ocular Comorbidities in Our Inhabitants Pattern

Symptomatology related to FP consisted of overseas physique sensation in 33 (54.50%) sufferers, blurred imaginative and prescient in 30 (50%), facial asymmetry in 26 (43.90%), epiphora in 17 (28.30%) and ocular ache in 16 (26.30%). 85% of sufferers introduced two or extra signs. Ocular indicators equivalent to superficial punctate keratopathy introduced in 41 (68.30%) sufferers, publicity keratopathy in 26 (43.30%), corneal pannus and corneal ulcer in 5 (8.80%), conjunctivitis in 2 (3.30%), and conjunctival chemosis and protracted epithelial defect in 1 affected person every (1.80%).

Periocular medical options seek advice from palpebral and adnexal alterations, equivalent to lagophthalmos in 25 (41.70%) sufferers, ptosis in 18 (30%), blepharospasm in 16 (26.70%), hemifacial spasm in 12 (20%), palpebral laxity in 10 (17.50%), and ectropion and forehead ptosis in 8 (13.30%).

The completely different therapy modalities utilized in these sufferers may be grouped into medical or surgical administration. You will need to point out that many sufferers underwent each sorts of therapy, and a few even had a number of therapies in the identical class. A whole abstract of therapies may be considered in Desk 3.

Desk 3 Therapy Modalities Utilized in Our Sufferers

Sufferers presenting with comorbidities had an elevated danger of needing surgical therapy (63.64%, OR 5.64 [1.79–17.74], P = 0.0051). A robust affiliation between having a comorbidity and epiphora (59.09%, OR 12.28 [3.21–46.89], P < 0.001). The primary periocular options that had an affect in future morbidity had been palpebral laxity (45.5%, P < 0.001), irregular regeneration (54.5%, P < 0.001), and ectropion (31.82%, P = 0.0027). Lastly, sufferers with morbidity secondary to FP had been extra more likely to require therapy with lubricant eye gel (45.45% OR 3.69 [1.14–11.93], P < 0.0376) or lateral canthopexy (40.9%, P < 0.001).


The outcomes reported in our research mirror these described by Tavares-Brito et al, the place 920 sufferers with FP had been evaluated and the predominant intercourse was feminine, most instances had been unilateral, and probably the most frequent etiology was Bell’s palsy.18,19 The prevalence calculated in our pattern was similar to that reported by Chang et al, being 0.12%.20

Our evaluation yielded a robust affiliation between the presence of a beforehand recognized comorbidity and the eventual want of a surgical therapy. Regardless that most sufferers had been feminine, there was no correlation between intercourse and the event of comorbidities, and this was additionally mirrored with age, whereas growing age didn’t correlate with an elevated danger of comorbidity. It could have been fascinating to find out whether or not the severity of FP was correlated with this final result, however a limitation of this research was its retrospective nature, and never all sufferers had been graded with the Home-Brackmann scale.

There was a robust affiliation between epiphora and comorbidities pertaining to the ocular floor. Different medical options that had an vital affect on whether or not a morbidity may develop, or a surgical therapy could be ultimately wanted, had been palpebral laxity, aberrant regeneration and paralytic ectropion. Some research have estimated that aberrant regeneration can current in as much as 9% of instances, whereas 30% of instances suffered from this final result in our research, which displays more moderen proof.20–22 You will need to observe that 56.7% of the sufferers in our research underwent medical therapy with 2 or extra choices.


FP is a crucial explanation for ocular morbidity and never many research report epidemiologic information on Hispanic sufferers. The significance of this assertion is that illnesses have to be analyzed with completely different views, since various factors equivalent to tradition, politics and economics have an effect on their prognosis and therapy. The state of affairs in lower-income nations is dire and, in lots of situations, prognosis is delayed. This additionally impacts the result of therapy of many illnesses, and early detection is essential in FP, since immediate therapy could make an excellent distinction in a affected person’s high quality of life.21

One limitation of this research, as beforehand talked about, was its retrospective nature. Since medical analysis in our nation is just not frequent follow, medical information are usually not at all times stuffed out with analysis functions in thoughts. This in the end interprets to lacking items of data, which have an effect on information precision. Nonetheless, priceless epidemiologic information could possibly be reported on this research, in addition to data on vital medical options and therapy modalities.

In abstract, physicians needs to be conscious that early prognosis of FP can have a robust affect in outlining an environment friendly therapy plan and avoiding morbidity. The toll that FP takes on sufferers’ high quality of life is a serious subject that shouldn’t be missed, and one have to be able to deal with, or refer if the necessity arises, this ailment to enhance affected person care.


FP, facial palsy; CN VII, cranial nerve VII; HSV-1, herpes simplex virus 1; DM, diabetes mellitus; OR, odds ratio.

Ethics Declaration

The current research was permitted by the Monterrey Institute of Know-how and Greater Training Ethics in Analysis Committee (Comité de Ética en Investigación de la Escuela de Medicina del Instituto Tecnológico y de Estudios Superiores de Monterrey) and the Monterrey Institute of Know-how and Greater Training Analysis Committee (Comité de Investigación del Instituto Tecnológico y de Estudios Superiores de Monterrey) underneath the registration quantity: P000602-MOPPAF-CI-CR002. All sufferers agreed to take part on this research and knowledgeable consent was obtained. This research follows the rules of the Helsinki Declaration.


The authors want to thank all sufferers included on this research.


There isn’t any funding to report.


The authors report no conflicts of curiosity on this work.


1. Seneviratne SO, Patel BC. Facial nerve anatomy and medical purposes. Treasure Island (FL): StatPearls Publishing; 2022. Accessible from: Accessed March 29, 2023.

2. Spencer CR, Irving RM. Causes and administration of facial nerve palsy. Br J Hosp Med. 2016;77(12):686–691. doi:10.12968/hmed.2016.77.12.686

3. Lee V, Currie Z, Collin JRO. Ophthalmic administration of facial nerve palsy. Eye. 2004;18(12):1225–1234. doi:10.1038/sj.eye.6701383

4. De Seta D, Mancini P, Minni A, et al. Bell’s palsy: signs previous and accompanying the facial paresis. Sci World J. 2014;2014:54.

5. Agostini F, Mangone M, Santilli V, et al. Idiopathic facial palsy: umbrella evaluation of systematic critiques and meta-analyses. J Biol Regul Homeost AGENTS. 2020;34(4):1245–1255.

6. Mavrikakis I. Facial nerve palsy: anatomy, etiology, analysis, and administration. Orbit. 2008;27(6):466–474. doi:10.1080/01676830802352543

7. Jowett N, Basic A. Strategy to Facial Palsy. Otolaryngol Clin North Am. 2018;51(6):1019–1031. doi:10.1016/j.otc.2018.07.002

8. Gilchrist JM. Seventh cranial neuropathy. Semin Neurol. 2009;29(1):5–13. doi:10.1055/s-0028-1124018

9. Hohman MH, Hadlock TA. Etiology, prognosis, and administration of facial palsy: 2000 sufferers at a facial nerve heart. Laryngoscope. 2014;124:7. doi:10.1002/lary.24542

10. Melvin TAN, Limb CJ. Overview of facial paralysis: present ideas. Facial Plast Surg. 2008;24(2):155–163. doi:10.1055/s-2008-1075830

11. Kanerva M, Jonsson L, Berg T, et al. Sunnybrook and Home-Brackmann techniques in 5397 facial gradings. Head Neck Surg. 2011;144(4):570–574. doi:10.1177/0194599810397497

12. Shah CT, Blount AL, Nguyen EV, Hassan AS. Cranial nerve seven palsy and its affect on meibomian gland operate. Ophthal Plast Reconstr Surg. 2012;28(3):166–168. doi:10.1097/IOP.0b013e31823f2f82

13. Ekin A. The function of meibomian gland dysfunction on the event of dry eye illness in sufferers with facial nerve palsy. Arq Bras Oftalmol. 2021;1–8.

14. Custer PL. Ophthalmic administration of facial nerve palsy sufferers. Semin Plast Surg. 2004;18(1):31–38.

15. Teixeira LJ, Valbuza JS, Prado GF. Bodily remedy for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Sys Rev. 2011;(12):CD006283. doi:10.1002/14652858.CD006283.pub3

16. Khan AJ, Szczepura A, Palmer S, et al. Bodily remedy for facial nerve paralysis (Bell’s palsy): an up to date and prolonged systematic evaluation of the proof for facial train remedy. Clin Rehabil. 2022;36(11):1424–1449. doi:10.1177/02692155221110727

17. Kahn JB, Gliklich RE, Boyev KP, Stewart MG, Metson RB, McKenna MJ. Validation of a patient-graded instrument for facial nerve paralysis: the FaCE Scale. Laryngoscope. 2001;111(3):387–398. doi:10.1097/00005537-200103000-00005

18. Fonseca KM, Mourão AM, Motta AR, Vicente LCC. Scales of diploma of facial paralysis: evaluation of settlement. Braz J Otorhinolaryngol. 2015;81(3):288–293. doi:10.1016/j.bjorl.2014.04.005

19. Tavares-Brito J, van Veen MM, Dusseldorp JR, Bahmad F, Hadlock TA. Facial Palsy-Particular High quality of Life in 920 Sufferers: correlation with Clinician-Graded Severity and Predicting Components. Laryngoscope. 2019;129(1):100–104. doi:10.1002/lary.27481

20. Chang YS, Choi JE, Kim SW, Baek SY, Cho YS. Prevalence and related elements of facial palsy and life-style traits: information from the Korean Nationwide Well being and Diet Examination Survey 2010-2012. BMJ Open. 2016;6(11):1–7. doi:10.1136/bmjopen-2016-012628

21. Yamamoto E, Nishimura H, Hirono Y. Prevalence of sequelae in bell’s palsy. Acta Otolaryngol. 1987;104(S446):93–96. doi:10.3109/00016488709121848

22. Guntinas-Lichius O, Prengel J, Cohen O, et al. Pathogenesis, prognosis and remedy of facial synkinesis: a scientific evaluation and medical follow suggestions by the worldwide head and neck scientific group. Entrance Neurol. 2022;13:1019554. doi:10.3389/fneur.2022.1019554

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