Positional lagophthalmos variability in facial nerve palsy with and without upper eyelid loading

Lagophthalmos from facial nerve palsy is traditionally measured with patients in an upright position and may fail to identify positional variability. This study aims to assess the effects of body position, surgical technique, implant material, and patient demographics on lagophthalmos.

A multicenter prospective study was performed to evaluate positional changes in paralytic lagophthalmos and the effects of various patient and surgical factors.

Sixty-four eyelids were included. Thirty-two (50%) of eyelids had upper eyelid weight implantation with a median post-operative follow-up of 67 weeks. The mean change in lagophthalmos from sitting to supine was a 1.4 mm increase (p < 0.001). There was a larger lagophthalmos variability in patients with eyelid weights compared to those without (p = 0.047), and in patients with gold compared to platinum weights (p = 0.026). Positional increase in lagophthalmos did not correlate with weight position (i.e. pretarsal vs. supratarsal) (p = 0.26), weight load (p = 0.70), House-Brackmann severity (p = 0.16), age (p = 0.14), or gender (p = 0.13).

Surgeons should routinely measure lagophthalmos in the supine position, as nocturnal corneal exposure may warrant ocular lubrication, occlusion, or additional surgery. Platinum weights may be preferred over gold due to less positional lagophthalmos variability.