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JM Martinez, J Satorre, T Saleh; Lagophthalmos: An unresolved problem . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1472.
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Purpose: To study the natural history of the lagophthalmos due to facial nerve palsy (FNP) Methods: A series of 126 patients has been studied in order to determine its ethiology and its natural history, the presence of factors of bad prognosis and the recurrences. Results: A Series of 126 patients has been studied: M/F ratio: 57/69. Mean age 49 y. 74 cases had a spontaneous recovery whereas 52 required surgical treatment. The ethiological classification showed: 57 cases of idiopathic facial nerve plasy, 18 post-cerebello angle surgery, 15 post-facial surgery, 11 Ramsay-Hunt syndrome, 11 postraumatic, 8 brain stem disease, 4 ear surgery and 2 other infectious disease. The idiopatic cases recovered spontaneously in 86.0% of the cases and the traumatic cases in a 63.6%, whereas the patients with cerebellopontine angle surgery needed surgery in 94.1% of the cases and the post-facial surgery group in 86.6%. 19.3% of the cases of the idiopathic cause had recurrences in either side of the face. In this series 7 patients under 14 years have been studied: 5 cases were idiopathic facial nerve palsy and 2 postraumatic. All of them recovered spontaneously. We consider bad prognosis factors: no Bell's phenomenon, dry eye, oculomotor cranial nerve palsy, corneal anesthesia and periorbital XRT. These factors are shown mainly in four groups: cerebellopontine angle surgery, facial surgery, brain stem disease, and trauma. The last two have a great percentage of spontaneous recovery whereas the former two required prompt surgery. Conclusion: The severity of lagophthalmos depends mainly on its ethiology as it determines the factors of bad prognosis and the grade of spontaneous recovery. The idiopathic and postraumatic causes have a great percentage of spontaneous recovery whereas post cerebellopontine angle surgery and post-facial surgery cases have a worse prognosis.
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