Management of the eye in facial paralysis.

Facial nerve palsy, whether the cause is idiopathic, or following such insults as surgery, trauma, or malignancy, places the health of the ocular surface at risk. Reduced or absent orbicularis oculi function results in lagophthalmos and exposure of the cornea, which is exacerbated by eyelid malposition. Management of the exposure keratopathy is paramount to prevent corneal breakdown, scarring, and permanent vision loss. Significant exposure keratopathy can be complicated by loss of corneal sensation, leading to a neurotrophic corneal ulcer. Initial management consists of artificial tear drops and ointment for corneal lubrication and strategies to address the lagophthalmos. Once the condition of the ocular surface has been stabilized, a variety of surgical treatment options are available depending on the severity and persistence of eyelid and ocular findings. The most common surgical options include temporary or permanent tarsorrhaphy for lagophthalmos, upper eyelid weight placement for retraction, and lateral canthoplasty with or without a middle lamellar spacer for lower eyelid retraction. External eyelid loading is a good option in patients who are poor surgical candidates or who have a known temporary palsy of short duration. The goal of all such procedures must be protection of the ocular surface through optimization of eyelid position.

Descemet stripping endothelial keratoplasty for the treatment of combined fuchs corneal endothelial dystrophy and keratoconus.

PURPOSE: To report the first case series of patients with Fuchs corneal endothelial dystrophy (FCD) and keratoconus (KCN) who underwent Descemet stripping endothelial keratoplasty (DSEK). METHODS: This is a retrospective case series of 6 eyes of 4 patients with combined FCD and KCN who underwent DSEK at 3 different centers. Clinical information collected included corneal topography measurements, central corneal thickness, and endothelial cell count. Visual outcomes and change in keratometric measurements were evaluated. RESULTS: The follow-up for patients ranged from 10 to 72 months. The best-corrected visual acuity was 20/40 or better in all 6 eyes. The mean keratometric measurements decreased in all cases (range of 0.5-5.8 diopters); however, topography still demonstrated an inferior steepening in each case. CONCLUSIONS: Patients with FCD and KCN have been previously reported as being managed with penetrating keratoplasty. We present 6 eyes of 4 patients who were managed with DSEK for the FCD. Topographically, the characteristic inferior steepening of KCN did not change; however, all patients with DSEK had flatter postoperative keratometric measurements with improved visual acuity. If a DSEK is performed for FCD before apical corneal scarring from KCN, a good visual outcome may be achieved.