Periocular Management of Pediatric Facial Nerve Palsy

Facial nerve palsy (FNP) in children presents treatment challenges and may lead to neurotrophic keratopathy and vision loss. Limited literature exists regarding its ophthalmic features and surgical management beyond tarsorrhaphy. This study reports characteristics of FNP unique to children, surgical procedures without the use of tarsorrhaphy, and patient outcomes.

Retrospective case series study.

A 9-year retrospective case series was conducted in a specialist unit. Patients under the age of 18 years at the time of referral with the diagnosis of FNP were included. Electronic records were reviewed for demographics, etiology and laterality of FNP, and ophthalmic findings. Statistical analysis was performed using a linear mixed-effects model.

A total of 26 patients were identified, with 29 affected eyes (3 bilateral). Three children had neurotrophic keratopathy. Periocular surgery was performed in 14 children, which included levator recession, platinum segment insertion, correction of meibomian gland inversion (MGI), full-thickness skin graft (FTSG), and lower eyelid elevation. No children underwent tarsorrhaphy. The CADS Grading Scale scores improved significantly post-treatment in Cornea, Asymmetry, and Dynamic function (P < .05). Vision was maintained in 4 patients (21%) and improved in 11 (58%). Deterioration was seen in 4 cases (21%). Neurotrophic keratopathy improved in 2 children without corneal neurotization.

Corneal involvement was common in children with corneal anesthesia. Upper eyelid skin contracture was a common feature. Lagophthalmos was better addressed by levator recession, platinum segment insertion, correction of MGI, and FTSG, which improved the ocular surface and corneal sensation. Vision improvement was notable without tarsorrhaphy-related field loss. Synkinesis was rare.