Keratopathy Caused By Bells Palsy

DEFINITION:  It is characterized by drying of the corneal surface due to inadequate closing of the eyelid and changes taking place in the cornea.

SYMPTOMS AND FINDINGS: Patients complain about dry eyes. Symptoms can be stinging in the eye, irritation, sensitivity to light, feeling of dryness, paradoxical watering, and blurred vision. Findings can be epithelium defect in the type of superficial punctuate, stromal thinning (this thinning may cause even perforation), and vascularization of the cornea.

Figure 1. Exposure keratopathy in the right eye caused by cranial nerve VII palsy.

CAUSES AND RISK FACTORS:  It may occur after facial nerve palsy. Apart from this, it may accompany such diseases as Parkinson’s Disease where muscle tonus is attenuated or diseases such as cicatricial pemphigoid, burns, trauma, eczema, and solar keratosis where the skin or conjunctiva flexibility decreases. Exposure keratopathy can be seen in severe proptosis cases such as thyroid ophthalmopathy.

AUXILIARY INVESTIGATIONS AND DIAGNOSIS: Diagnosis is made through clinical history and biomicroscopic examination.

TREATMENT: Artificial tear drops and gels can be used. The eyelid can be strapped when sleeping. Scleral contact lenses and temporary tarsorrhaphy (closing the eyelid by stitching) can be used. In advanced cases, permanent tarsorrhaphy, conjunctival flap covers, golden weight implantation into the eyelid, and decompression surgeries can be employed.