View 2019 Abstracts

Facial nerve palsy (FNP) often significantly affects eyelid position and blink. Platinum segment chains (PSC) have been shown to improve lagophthalmos in patients with facial palsy. Debate exists as to the effectiveness of weights placed in the supratarsal location when the patient lies supine.
We report our findings to answer this question.

Prospective case series of patients with FNP following PSC insertion. Lagophthalmos on blink, gentle and forced closure was observed in the seated position, lying flat supine at 0 degrees, lying supine with one pillow and lying on the side, with the non-facial palsy side to the pillow.

20 eyes with PSC for facial palsy-related lagophthalmos were assessed in 19 patients.
There was no statistical difference in the amount of lagophthalmos between sitting up and lying flat with no pillow on gentle closure (P = 0.0804) and blink (P = 0.1567).
Clinically, 12 out of the 20 eyes had no change in lagophthalmos on gentle closure when sitting up compared to supine (no pillow). The remaining 8 eyes had an increase of lagophthalmos of mean 2.3 mm (range 1-6mm) when lying supine (no pillow) and mean 2.2 mm (range 1-5mm) when lying supine with one pillow.
50% of patients have ongoing requirements for evening lubricating ointment application but only one patient in our cohort experienced morning ocular symptoms.
No patient was taping their eyelids.

The prevalence of lagophthalmos increasing on gentle closure when supine is 40%, with a mean increase of 2.3mm. Statistically, there is no difference between gentle closure in the sitting and supine position.
Provided patients use nocturnal lubricant, they remain asymptomatic and do not require taping or surgery.