Predicting Factors Influencing Visual Function of the Eye in Patients with Unresolved Facial Nerve Palsy after Upper Eyelid Gold Weight Loading

Abstract

Implantation of gold weights into the upper eyelid is a proven method of treating lagophthalmos and exposure keratopathy in patients with unresolved facial nerve palsy. The aim of this study was to evaluate the factors affecting visual acuity and corneal complications in patients after upper eyelid gold weight lid loading. Material and methods: This prospective consecutive clinical study was conducted in years 2012–2018. In total, 59 people (40 women, 19 men aged 55.5 ± 17.4 years) meeting the inclusion criteria were treated with gold weights. The ordered multinomial logit model was used to analyze the factors affecting best-corrected visual acuity (BCVA) and degree of exposure keratopathy after surgery. The influence of the following variables was analyzed: patient age, etiology and duration of the facial nerve palsy, history of the previous eyelid surgery, degree of lagophthalmos in mm, presence of Bell’s phenomenon, and corneal sensation, Schirmer test results. Results: Implantation of gold weights into the upper eyelid effectively reduced lagophthalmos and exposure keratopathy in the study group (p < 0.001). BCVA was maintained or better in 95% of patients after surgery. Patient age, presence of the Bell’s phenomenon, and corneal sensation significantly affected the final BCVA (p < 0.1). The presence of Bell’s phenomenon and corneal sensation had a positive effect on the degree of keratopathy after surgery (p < 0.1). In turn, patient age and history of tarsorrhaphy were significant negative prognostic factors of exposure keratopathy and BCVA after surgery (p < 0.05). Etiology and duration of facial nerve palsy, degree of corneal exposure in mm, and results of the Schirmer test did not have a significant impact on the outcome after surgery (p > 0.1). Conclusions: The results of our study may help to answer the question of how to direct ophthalmologists and other specialists who refer to ophthalmologists for management advice in patients with facial nerve palsy. Elderly patients with a history of tarsorrhaphy who present with poor Bell’s phenomenon and/or a lack of corneal sensation should be the first candidates for immediate correction of lagophthalmos.