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Horizontal shortening of the lower eyelid margin in facial nerve palsy

Eye volume 38, pages 205–209 (2024)Cite this article

Subjects

Abstract

Background/Objectives

To determine whether horizontal lower eyelid margin length shortens following facial nerve palsy (FNP).

Subjects/Methods

A single-centre retrospective audit of lower eyelid margin horizontal length, measuring from the lower lacrimal punctum to lateral canthal angle with a straight plastic ruler, with the eyelid on gentle stretch (‘punctum-to-canthus (PC) distance’), recorded in all FNP patients reviewed in July–September 2021. Affected and fellow eyes were compared using parametric testing.

Results

Forty-one patients were reviewed. Seventeen were excluded due to previous surgery that would lengthen (e.g., periosteal flap) or shorten (e.g., lateral tarsal strip) the lower eyelid margin. Of the remaining 24, mean age was 52.5 years (range, 27–79) and 54% were female. Mean PC distance was significantly shorter in affected eyes (26.0 mm, range: 22–34 mm) compared to fellow eyes (27.5 mm, 24–35 mm) (paired t-test, T(23) = 6.06, p < 0.00001). Mean difference between both eyes’ PC distance was 1.5 mm (0–4 mm). Only three patients were still in the ‘paralytic phase’ (i.e., <1 year since FNP onset), and difference in PC distance was 0 mm in all three. A reduction in lower eyelid PC distance was weakly associated with a reduction in upper eyelid lid-margin-to-brow distance (R = 0.4775, p = 0.0286).

Conclusions

The lower eyelid margin appears to shorten horizontally following FNP. This study provides proof-of-concept for the use of measuring PC distance in patients with FNP as an additional tool for the overall assessment of soft tissue contraction following FNP. It may help identify patients in whom further lower eyelid margin shortening should be avoided and in whom eyelid lengthening may be required.

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Fig. 1: PC (punctum-to canthus) distance measurement technique.
Fig. 2: Difference in PC measurement in a patient with facial nerve palsy.
Fig. 3: Facial nerve palsy aetiology.
Fig. 4: Punctum-to-canthus (PC) distances in the affected and fellow eyes.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

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Funding

The study was supported in part by an Unrestricted Grant from Research to Prevent Blindness, Inc., New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah.

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Authors and Affiliations

  1. Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK

    Aaron Jamison & Raman Malhotra

  2. Moran Eye Center, University of Utah, Salt Lake City, UT, USA

    Bhupendra C. K. Patel

Authors
  1. Aaron Jamison
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  2. Bhupendra C. K. Patel
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  3. Raman Malhotra
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Contributions

All authors made substantial contributions to the conception and/or design of the work, and to the acquisition, analysis, and/or interpretation of data for the work. AJ drafted the work and all authors revised it critically for important intellectual content. All authors gave final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Aaron Jamison.

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The authors declare no competing interests.

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Jamison, A., Patel, B.C.K. & Malhotra, R. Horizontal shortening of the lower eyelid margin in facial nerve palsy. Eye 38, 205–209 (2024). https://doi.org/10.1038/s41433-023-02661-2

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