A clinical case of complex treatment for paralytic lagophthalmos complicated by neurotrophic keratopathy

Abstract

Introduction. Combined leisure of facial and trigeminal nerves causes paralytic lagophthalmos and severe neurotrophic keratopathy that can lead to significant loss of vision. Material and methods. This article describes a clinical case of step-by-step complex surgical treatment in paralytic lagophthalmos accompanied by neuropathic keratopathy complicated by fistula of corneal graft. Results. The performed three stepped surgeries to improve lagophthalmos and corneal nerve supply resulted in subcompensation of lagophthalmos and restoration of corneal sensitivity up to the low limit. This was accompanied by heeling of long lasting corneal fistula. Conclusion. Pathogenetic treatment of combined paralytic changes, that includes correction of eyelid position and direct corneal neurotization, provides medical and social rehabilitation of patients with paralytic lagophthalmos complicated by neurotrophic keratopathy. Keywords: facial nerve, trigeminal nerve, neuropathic keratopathy, corneal neurotization, corneal fistula