Periocular clinical differences between primary and postparalytic hemifacial spasm: A retrospective comparative study

This study aims to investigate the differences in periocular features between patients with primary hemifacial spasm (HFS) and postparalytic facial spasm (PFS).

A retrospective study was conducted at two tertiary-care eye centers in Riyadh, Saudi Arabia. Electronic medical records for patients diagnosed with HFS and PFS who were treated at these facilities were reviewed. Data collected included demographics, margin reflex distances (MRD1, MRD2), vertical palpebral fissure height (VPF), brow height, other Babinski signs, forehead furrow status, and synkinesis.

Sixty-seven hemifacial spasm patients (mean age 47.5 ± 10.01 years; 73.1% female) were included: 33 with HFS and 34 with PFS. MRD1 was significantly higher in HFS compared to PFS (3.5 ± 0.35 mm vs. 2.0 ± 0.26 mm, P < 0.001). Similarly, MRD2 was significantly higher in HFS compared to PFS (4.5 ± 0.75 mm vs. 3.0 ± 0.21 mm, P < 0.001). VPF was significantly narrower in PFS compared to HFS (5.0 ± 0.33 mm vs. 8.0 ± 0.83 mm, P < 0.001). Oro-ocular synkinesis was significantly more prevalent in PFS compared to HFS (94.1% vs. 15.2%, P < 0.001). The other Babinski sign was more common in HFS (63.6% vs. 14.7%, P < 0.001), while brow ptosis (82.4%, P < 0.001) and synkinesis (94.1% vs. 15.2%, P < 0.001) were more frequent in PFS.

Patients with PFS typically exhibit significantly narrower palpebral fissures, upper eyelid ptosis, reverse ptosis, and brow ptosis. In contrast, those with HFS are more likely to display the "other Babinski sign" and prominent forehead furrows.