Evaluation of the corneal morphologic and topographic alterations in patients with Bell’s palsy

Abstract

Purpose: To evaluate the effects of ocular surface changes that may develop due to Bell’s palsy (BP) on dry eye parameters, corneal densitometry values, and aberrations in patients with unilateral BP and compare them with sound eyes.
Materials and methods: A total of 33 eyes of 33 patients diagnosed with unilateral BP and 33 sound fellow eyes of the patients were enrolled in this study. A complete ophthalmologic examination including best-corrected visual acuity (BCVA), intraocular pressure measurement, slit-lamp biomicroscopy to observe superficial punctate keratopathy (SPK), tear break-up time (TBUT) test, and detailed fundoscopic examination was performed for all patients. The corneal topographic, densitometric, and aberrometric measurements were performed using the Pentacam Scheimpflug imaging system.
Results: The mean age of 33 patients was 54.9±14.7 years of whom 19 (57.6%) were female; 14 (42.4%) were male. According to the House-Brackmann scale, the majority of the patients had grade II facial nerve palsy. The BCVA in the affected eye was lower and 0.74±0.23 compared to 0.87±0.21 in sound eyes (p=0.029). The mean TBUT was lower and 6.0±4.7 in eyes affected by BP compared to 8.7±4.0 in sound eyes (p=0.014). The SPK was present in 23 (69.7%) patients. The comparison of the corneal densitometry values revealed that the densitometry measurements in anterior concentric zones were slightly higher in affected eyes. Corneal aberrometric values were also slightly higher in affected eyes. No significant difference was observed between affected and sound eyes in terms of corneal keratometric, densitometric, and aberrometric values (p>0.05, for all).
Conclusions: Corneal exposure leading to visual complications, and lowering of the tear production may lead to dry eye in BP patients. The examination of the ocular surface to observe the ocular findings of BP is essential. The main priority of the ophthalmologist is to ensure adequate corneal protection to prevent undesired ocular outcomes. 

Keywords

• Bell palsy
• dry eye
• lagophthalmos
• densitometry
• aberration

Bell paralizili hastalarda korneal morfolojik ve topografik değişikliklerin değerlendirilmesi

Abstract

Amaç: Tek taraflı Bell paralizili (BP) hastalarda BP’ye bağlı gelişebilecek oküler yüzey değişikliklerinin kuru göz parametreleri, korneal dansitometri değerleri ve aberasyonlar üzerindeki etkilerini değerlendirmek ve sağlıklı gözleriyle karşılaştırmak.
Gereç ve yöntem: Bu çalışmaya tek taraflı BP tanısı konan 33 hastanın 33 gözü ve 33 sağlıklı diğer gözü dahil edildi. Tüm hastalara en iyi düzeltilmiş görme keskinliği (EİDGK), göz içi basıncı ölçümü, yüzeyel punktat keratopatiyi (YPK) gözlemlemek için biyomikroskopi, gözyaşı kırılma zamanı (GKZ) testi ve detaylı fundoskopik muayeneyi içeren tam bir oftalmolojik muayene yapıldı. Korneal topografik, dansitometrik ve aberrometrik ölçümler Pentacam Scheimpflug görüntüleme sistemi kullanılarak ölçüldü.
Bulgular: Çalışmaya katılan hastaların 19'u (%57,6) kadın, 14'ü (%42,4) erkekti ve 33 hastanın yaş ortalaması 54,9±14,7 yıldı. House-Brackmann skalasına göre hastaların büyük çoğunluğunda II. derece fasiyal sinir paralizisi vardı. Etkilenen gözdeki EİDGK 0,74±0,23 olup sağlıklı gözlere (0,87±0,21) kıyasla daha düşüktü (p=0,029). Paralizi tarafındaki gözlerde ortalama GKZ 6,0±4,7 olup, sağlam gözlere (8,7±4,0) kıyasla daha düşüktü (p=0,014). Yüzeyel punktat keratopati 23 (%69,7) hastada mevcuttu. Korneal dansitometri değerleri karşılaştırıldığında, etkilenen gözlerde anterior konsantrik zonlardaki dansitometri ölçümlerinin göreceli daha yüksek olduğu izlendi. Korneal aberometrik değerler de etkilenen gözlerde göreceli daha yüksekti. Korneal keratometrik, dansitometrik ve aberrometrik değerler açısından etkilenen ve sağlam gözler arasında anlamlı bir fark gözlenmedi (tümü için p>0,05).
Sonuç: Bell paralizili hastalarda korneal ekspojur görsel komplikasyonlara ve gözyaşı üretiminin azalmasına neden olabilir. Bell paralizisinin oküler bulgularını gözlemlemek için oküler yüzeyin incelenmesi esastır. Göz hekiminin temel önceliği, istenmeyen oküler sonuçları önlemek için yeterli kornea korumasını sağlamaktır.

Keywords

• Bell paralizisi
• kuru göz
• lagoftalmi
• dansitometri
• aberasyon

References

1. Referans1. De Diego-Sastre JI, Prim-Espada MP, Fernández-García F. The epidemiology of Bell's palsy. Rev Neurol. 2005;41(5):287-290.
2. Referans2. Turriziani O, Falasca F, Maida P, et al. Early collection of saliva specimens from Bell's palsy patients: quantitative analysis of HHV-6, HSV-1, and VZV. J Med Virol. 2014;86(10):1752-1758. https://doi.org/10.1002/jmv.23917
3. Referans3. Jeong J, Yoon SR, Lim H, Oh J, Choi HS. Risk factors for Bell's palsy based on the Korean National Health Insurance Service National Sample Cohort data. Sci Rep. 2021;11(1):23387. https://doi.org/10.1038/s41598-021-02816-9
4. Referans4. Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med. 2007;357(16):1598-1607. https://doi.org/10.1056/NEJMoa072006
5. Referans5. Rahman I, Sadiq SA. Ophthalmic management of facial nerve palsy: a review. Surv Ophthalmol. 2007;52(2):121-144. https://doi.org/10.1016/j.survophthal.2006.12.009
6. Referans6. Custer PL. Ophthalmic management of the facial palsy patient. Semin Plast Surg. 2004;18(1):31-38. https://doi.org/10.1055/s-2004-823121
7. Referans7. Sohrab M, Abugo U, Grant M, Merbs S. Management of the eye in facial paralysis. Facial Plast Surg. 2015;31(2):140-144. https://doi.org/10.1055/s-0035-1549292
8. Referans8. Cerviño A, Hosking SL, Montes-Mico R, Bates K. Clinical ocular wavefront analyzers. J Refract Surg. 2007;23(6):603-616. https://doi.org/10.3928/1081-597X-20070601-12

9. Referans9. Otri AM, Fares U, Al-Aqaba MA, Dua HS. Corneal densitometry as an indicator of corneal health. Ophthalmology. 2012;119(3):501-508. https://doi.org/10.1016/j.ophtha.2011.08.024
10. Referans10. Koh S, Maeda N, Ikeda C, et al. Ocular forward light scattering and corneal backward light scattering in patients with dry eye. Invest Ophthalmol Vis Sci. 2014;55(10):6601-6606. https://doi.org/10.1167/iovs.14-15125
11. Referans11. Anayol MA, Bostancı B, Şekeroğlu MA, Şimşek M, Günaydın S, Yılmazbaş P. Assessment of Corneal Densitometry in Rheumatoid Arthritis Patients. Turk J Ophthalmol. 2017;47(3):125-129. https://doi.org/10.4274/tjo.89577
12. Referans12. Yildirim Y, Ozsaygili C, Kucuk B. The short term effect of trehalose and different doses of sodium hyaluronate on anterior corneal aberrations in dry eye patients. Cutan Ocul Toxicol. 2021;40(1):14-20. https://doi.org/10.1080/15569527.2020.1861001
13. Referans13. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146-147. https://doi.org/10.1177/019459988509300202
14. Referans14. Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5(2):108-152.
15. Referans15. Tekin K, Sekeroglu MA, Kiziltoprak H, Yilmazbas P. Corneal Densitometry in Healthy Corneas and Its Correlation With Endothelial Morphometry. Cornea. 2017;36(11):1336-1342. https://doi.org/10.1097/ICO.0000000000001363
16. Referans16. Yilmaz M, Tarakcioglu M, Bayazit N, Bayazit YA, Namiduru M, Kanlikama M. Serum cytokine levels in Bell's palsy. J Neurol Sci. 2002;197(1-2):69-72. https://doi.org/10.1016/s0022-510x(02)00049-7
17. Referans17. Bucak A, Ulu S, Oruc S, et al. Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy. Laryngoscope. 2014;124(7):1678-1681. https://doi.org/10.1002/lary.24551
18. Referans18. Kınar A, Ulu Ş, Bucak A, Kazan E. Can Systemic Immune-Inflammation Index (SII) be a prognostic factor of Bell's palsy patients? Neurol Sci. 2021;42(8):3197-3201. https://doi.org/10.1007/s10072-020-04921-5
19. Referans19. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283. https://doi.org/10.1016/j.jtos.2017.05.008
20. Referans20. Shah CT, Blount AL, Nguyen EV, Hassan AS. Cranial nerve seven palsy and its influence on meibomian gland function. Ophthalmic Plast Reconstr Surg. 2012;28(3):166-168. https://doi.org/10.1097/IOP.0b013e31823f2f82
21. Referans21. Bergeron CM, Moe KS. The evaluation and treatment of upper eyelid paralysis. Facial Plast Surg. 2008;24(2):220-230. https://doi.org/10.1055/s-2008-1075838
22. Referans22. Ekın MA, Ugurlu SK, Imre SS, Kahraman HG. The role of meibomian gland dysfunction on the development of dry eye disease in patients with facial nerve palsy. Arq Bras Oftalmol. 2021;85(2):128-135. https://doi.org/10.5935/0004-2749.20220021
23. Referans23. Takahashi Y, Kakizaki H. Meibomian Gland Dysfunction in Cranial Nerve VII Palsy. Ophthalmic Plast Reconstr Surg. 2015;31(3):179-181. https://doi.org/10.1097/IOP.0000000000000235
24. Referans24. Allen RC. Management of the Eye in the Setting of Facial Nerve Paralysis. In: Gidley PW, DeMonte F, ed. Temporal Bone Cancer. Springer International Publishing: 2018;335-345.
25. Referans25. Doğan A, Gürdal C. Does Dry Eye Affect Repeatability of Corneal Topography Measurements? Turk J Ophthalmol. 2018;48(2):57-60. https://doi.org/10.4274/tjo.10179
26. Referans26. Jensen MN, Søndergaard AP, Pommerencke C, Møller F. Variations in keratometric values (K-value) after administration of three different eye drops - effects on the intraocular lens calculations in relation to cataract surgery. Acta Ophthalmol. 2020;98(6):613-617. https://doi.org/10.1111/aos.14408
27. Referans27. Röggla V, Leydolt C, Schartmüller D, et al. Influence of Artificial Tears on Keratometric Measurements in Cataract Patients. Am J Ophthalmol. 2021;221:1-8. https://doi.org/10.1016/j.ajo.2020.08.024
28. Referans28. Buehren T, Collins MJ, Carney L. Corneal aberrations and reading. Optom Vis Sci. 2003;80(2):159-166. https://doi.org/10.1097/00006324-200302000-00012