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Periocular clinical differences between primary and postparalytic hemifacial spasm: A retrospective comparative
Ali Ahmed1, Naif Alsulaiman2, Mostafa M Diab3,4
1Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Indian Journal of Ophthalmology
|September 25, 2025
Summary
Postparalytic facial spasm (PFS) patients show narrower palpebral fissures and ptosis, unlike hemifacial spasm (HFS) patients who exhibit the "other Babinski sign." These findings help differentiate between these facial spasm types.
Area of Science:
- Ophthalmology
- Neurology
- Facial Nerve Disorders
Background:
- Facial spasms, including hemifacial spasm (HFS) and postparalytic facial spasm (PFS), present with distinct clinical characteristics.
- Differentiating between HFS and PFS is crucial for accurate diagnosis and treatment planning.
- Periocular features offer valuable insights into the underlying pathophysiology of these conditions.
Purpose of the Study:
- To investigate and compare the specific periocular features observed in patients diagnosed with primary hemifacial spasm (HFS) versus postparalytic facial spasm (PFS).
- To identify key clinical markers that can aid in distinguishing HFS from PFS.
- To enhance the understanding of the anatomical and functional differences between these two types of facial spasms.
Main Methods:
- A retrospective analysis of electronic medical records from patients diagnosed with HFS and PFS at two tertiary-care eye centers in Saudi Arabia.
- Data collection included demographic information and specific periocular measurements such as margin reflex distances (MRD1, MRD2), vertical palpebral fissure height (VPF), and brow height.
- Assessment of clinical signs including Babinski signs, forehead furrow status, and presence of synkinesis.
Main Results:
- Sixty-seven patients (33 HFS, 34 PFS) were analyzed. HFS patients exhibited significantly higher MRD1 and MRD2 compared to PFS patients.
- PFS patients presented with significantly narrower vertical palpebral fissure height (VPF) and a higher prevalence of oro-ocular synkinesis.
- The
- other Babinski sign
- was more common in HFS, whereas brow ptosis and synkinesis were more frequent in PFS.
Conclusions:
- Postparalytic facial spasm (PFS) is characterized by narrower palpebral fissures, upper eyelid ptosis, reverse ptosis, and brow ptosis.
- Hemifacial spasm (HFS) is more frequently associated with the "other Babinski sign" and prominent forehead furrows.
- These distinct periocular findings provide valuable clinical indicators for differentiating between PFS and HFS.
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