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Palpebral spring an option for lagophthalmos due to facial nerve palsy
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LAS VEGAS — Implantation of a palpebral spring can restore lid function in some patients with lagophthalmos, according to a surgeon speaking here.
Hakan Demirci, MD, and colleagues at the University of Michigan reviewed their experience using the device for treating patients with lagophthalmos and exposure keratopathy secondary to facial nerve palsy. Their study included 29 eyes of 28 patients followed for a mean of 83 months. Dr. Demirci presented their results at the American Society of Ophthalmic Plastic and Reconstructive Surgery meeting held after the American Academy of Ophthalmology meeting.
The palpebral spring is a dynamic facial reanimation technique designed to mimic the movement of the upper eyelid. The device lowers the eyelid during primary gaze and allows downward movement of the upper eyelid "without requiring gravity," Dr. Demirci said.
Using a 22-gauge spinal needle, The palpebral spring is inserted through an incision made at the level of the pupil and a lateral orbital incision made just below the hairline. Once inserted, the ends of the spring are bent using pliers and sutured to the periosteum.
Spring tension can then be adjusted based on the desired height and amount of lagophthalmos, Dr. Demirci said.
After surgery, discomfort, inability to close eyes and symptoms of dry eye decreased in all patients. Additionally, 83% of patients became asymptomatic, he said.
Lagophthalmos improved or completely resolved in 79% of patients. Symptoms of keratopathy improved or completely resolved in 87% of patients, and corneal exposure rates decreased, he said.
However, surgeons had to adjust the spring in 27% of eyes, replace it in 33% and remove it in 14% due to extrusion.