Ocular factors predicting requirement for corneal protective oculoplastic surgery

Area of Science:

• Ophthalmology
• Oculoplastics
• Facial Nerve Surgery

Background:

• No universal schema exists for predicting ocular morbidity in facial nerve palsy (FNP).
• The House Brackmann Scale has limitations in assessing FNP-related ocular morbidity.
• Need for a quantitative tool to guide decisions on corneal protective surgery.

Purpose of the Study:

• To develop a novel scoring system for quantifying ocular morbidity in FNP.
• To predict the necessity of corneal protective oculoplastic surgery.

Main Methods:

• Large cohort study of 606 FNP patients (March 2002 - October 2017).
• Retrospective multivariate analysis of clinical predictors for 316 patients needing surgery.
• Formulation of a new FNP scoring instrument using β coefficients.

Main Results:

• House Brackmann Scale, corneal lagophthalmos, and loss of corneal sensation are significant predictors.
• The developed scoring system demonstrated accurate and repeatable prediction (AUC 0.769).
• A cutoff score of 5/8 recommended surgery with 75% sensitivity and 67% specificity.

Conclusions:

• Corneal lagophthalmos, sensation, and House Brackmann Scale are key predictors for surgery.
• The new scoring tool aids clinical decision-making for ophthalmic and ENT specialists.
• This instrument improves the management of ocular complications in facial nerve palsy.