CADS grading scale: towards better grading of ophthalmic involvement in facial nerve paralysis

Malhotra, Raman; Ziahosseini, Kimia; Litwin, Andre; Nduka, Charles; El-Shammah, Nora

doi:10.1136/bjophthalmol-2015-307167

Cited by 31 publications

(20 citation statements)

References 24 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Data collection included patient demographics, preoperative and postoperative clinical measurements such as lagophthalmos measurements, and details of revision surgery or adverse event(s), if any. CADS grading scale was recently introduced to better classify the periorbital involvement in patients with facial nerve palsy: corneal involvement, resting or static asymmetry in the periorbital region, dynamic function of periorbital muscles and synkinesis 20. The D-scores in the CADS grading scale are as follows: D 0 =no blink lagophthalmos; D 1 =lagophthalmos on blink <5 mm; D 2 =lagophthalmos on blink ≥5 mm and/or lagophthalmos on gentle closure ≤5 mm; D 3 =lagophthalmos on gentle closure >5 mm and/or lagophthalmos on forced closure >2 mm.…”

Section: Methodsmentioning

confidence: 99%

Late outcomes of gold weights and platinum chains for upper eyelid loading

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

Late outcomes of gold weights and platinum chains for upper eyelid loading

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, ophthalmologic assessment in this system is limited to whether there is a complete or incomplete eyelid closure and thus, provides an inaccurate picture of eye involvement. The CADS scale [12], combined with standard dry eye evaluation tests, can measure the eye sequelae more effectively.…”

Section: Discussionmentioning

confidence: 99%

“…before surgical correction. The severity of facial nerve palsy was assessed according to the CADS (cornea, static asymmetry, dynamic function, and synkinesis) grading scale reported by Malhotra et al [12]. As corneal staining was evaluated using another grading system described later, the cornea (C) grading system was not used in this study.…”

Section: Methodsmentioning

confidence: 99%

Relationship Between Eyelid Pressure and Lacrimal Status in Mild Facial Nerve Palsy

Lee¹,

Vaidya²,

Kono³

et al. 2021

Cureus

View full text Add to dashboard Cite

Purpose: Facial nerve palsy is frequently associated with both epiphora and dry eye, and orbicularis oculi muscle weakness or paralysis is the main cause of these symptoms. Eyelid pressure is a quantitatively measurable parameter for evaluating the tone and function of the orbicularis oculi muscle. The aim of this study was to examine the relationship between eyelid pressure and lacrimal status in patients with mild facial nerve palsy. Methods: This prospective, interventional study included 10 patients with unilateral facial nerve palsy. The severity of facial nerve palsy was determined using the CADS scale (cornea, static asymmetry, dynamic function, and synkinesis). Eyelid pressure was measured using a blepharo-tensiometer. Lacrimal status was quantified through tear meniscus height (TMH), clinical assessment of meibomian gland dysfunction (MGD) (eyelid margin abnormalities, Marx line, meibum expression, and loss of meibomian glands), corneal fluorescein staining, tear break-up time, and Schirmer test I results. Results: All 10 patients suffered from mild facial nerve palsy without eyelid ectropion or entropion, or gustatory epiphora. Lower eyelid pressure during forceful eye closure was significantly decreased in affected eyes (P = 0.007), but upper eyelid pressure during forceful eye closure and static upper and lower eyelid pressure were not significantly different between the affected and unaffected sides (P > 0.050). The TMH, MGD, and dry eye measurements showed no significant difference between the affected and unaffected eyes (P > 0.050). Conclusions: Mild facial nerve palsy is associated with decreased lower eyelid pressure during forceful eye closure. However, no other differences in upper eyelid pressure during forceful eye closure, static eyelid pressure, TMH, MGD, or dry eye disease symptoms were noted. These results imply that eyelid pressure slightly decreases due to mild facial nerve palsy, but this change may be clinically negligible.

show abstract

“…In our patients, however, the subgroup analysis comparing patients with and without additional lateral tarsorrhaphy showed almost identical reduction of lagophthalmos, MRD-1, and corneal staining scores. Finally, we have reported the severity of facial palsy using House–Brackmann score, 5 while the use of another classification system named CADS (Cornea, Asymmetry, Dynamic function, Synkinesis) grading, 12 which is more specific for periorbital involvement, could have better encompassed the ophthalmic sequelae of facial palsy. In conclusion, this study showed recession of levator aponeurosis to be an appropriate procedure for addressing paralytic lagophthalmos and exposure keratopathy.…”

Section: Discussionmentioning

confidence: 99%

Levator recession and minimal lateral tarsorrhaphy for the management of lagophthalmos and corneal exposure in facial palsy

Eshraghi

Ghadimi

Nikdel

2019

European Journal of Ophthalmology

View full text Add to dashboard Cite

Purpose: Recession of levator muscle can potentially decrease the severity of corneal exposure by reducing margin-reflex distance 1. The purpose of this study is evaluation of effects of levator recession on lagophthalmos in facial palsy. Materials and methods: In a non-comparative case series of consecutive patients with exposure keratopathy due to facial paralysis between 2012 and 2017, levator recession was performed through lid crease incision. Small-size (⩽3 mm) lateral tarsorrhaphy was performed on a case-by-case basis for those with moderate-to-severe keratopathy. Preoperative and postoperative measurements of margin-reflex distance 1 and lagophthalmos were compared using paired t-test. Results: Thirty-four patients (14 men and 20 women) were enrolled with an average age of 52.3 years. Mean follow-up was 13.3 months (range, 6–36 months). The most common etiology of facial paralysis was Bell’s palsy (22 cases), followed by motor vehicle accident (8), parotid surgery (3), and brain tumor surgery (1). No additional procedure was performed for eight patients, while lateral tarsorrhaphy was performed in 26 cases. Mean margin-reflex distance 1 decreased from 5.0 ± 0.4 mm to 4.0 ± 0.5 mm ( p < 0.001) and mean lagophthalmos decreased from 3.3 ± 0.9 mm to 1.8 ± 0.9 mm ( p < 0.001). Subgroups of patients with additional lateral tarsorrhaphy and without tarsorrhaphy experienced the same amount of reduction in margin-reflex distance 1 and lagophthalmos. Conclusion: Recession of levator muscle was effective in reduction of margin-reflex distance 1 and lagophthalmos in facial palsy patients. This procedure can be added to the surgical armamentarium for management of patients with facial palsy and lagophthalmos.

show abstract

CADS grading scale: towards better grading of ophthalmic involvement in facial nerve paralysis

Abstract: We present a validation study of an FNGI specifically designed for ophthalmic involvement of FNP. Objective and subjective parameters helped standardise grading and management planning.

Cited by 31 publications

References 24 publications

Late outcomes of gold weights and platinum chains for upper eyelid loading

Late outcomes of gold weights and platinum chains for upper eyelid loading

Relationship Between Eyelid Pressure and Lacrimal Status in Mild Facial Nerve Palsy

Levator recession and minimal lateral tarsorrhaphy for the management of lagophthalmos and corneal exposure in facial palsy

Contact Info

Product

Resources

About