Facial Nerve Paralysis: An Unrecognized Cause of Lower Eyelid Entropion in the Pediatric Population

We describe the management of the congenital entropion with tarsal kink in a case of mobius syndrome. Mobius syndrome is extremely rare congenital neurological disorder results from the underdevelopment of the sixth and seventh cranial nerves which causes facial paralysis and inability to move the eyes from side to side. A congenital malformation of the tarsus known as tarsal kink was the associated eyelid anomaly which caused upperlid entropion. A two year old girl presented with both eyelids entropion of left eye which was corrected by upper lid tarsotomy, marginal rotation and levator suturing with tarsal plate and lower lid retractors were strengthened by their advancement to the tarsal plate.

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“…The lower lid entropion can be due to imbalance between orbicularis oculi and lower lid retractors due to facial palsy. 12…”

Section: Discussionmentioning

confidence: 99%

Combined Mobius Syndrome and Tarsal Kink Syndrome- A Unique Presentation.

et al. 2017

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“…Lower eyelid entropion has been described previously in a small group of children with FNP and craniofacial abnormalities. 3 Our report shows that entropion is also a frequent observation in children with diverse causes of isolated, unilateral FNP without craniofacial syndromes. The mechanism of lower eyelid changes observed in this study was not clear, although the presence of tight medial and lateral canthal tendons in children might combine with a loss in the balance between the orbicularis oculi and lower eyelid retractors in patients with FNP to contribute to the development of lower eyelid entropion and lid retraction.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism of lower eyelid changes observed in this study was not clear, although the presence of tight medial and lateral canthal tendons in children might combine with a loss in the balance between the orbicularis oculi and lower eyelid retractors in patients with FNP to contribute to the development of lower eyelid entropion and lid retraction. 3,12 Alternatively, maldevelopment or repair of the peripheral facial nerve injury might lead to subclinical hyperactivity of previously paralyzed periocular muscles.…”

Section: Discussionmentioning

confidence: 99%

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Entropion in children with isolated peripheral facial nerve paresis

Alsuhaibani¹,

Bosley²,

Goldberg³

et al. 2012

Eye

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Purpose Adults with facial nerve paresis (FNP) generally develop ectropion, but a recent report of children with syndromatic FNPs implies that entropion may be more common in this setting than ectropion. This study evaluates eyelid position and other periorbital changes in children with isolated, non-syndromatic FNP. Methods Charts were reviewed of 10 sequential children who presented to a major national eye referral centre with isolated FNP of variable aetiology. Severity of FNP was assessed according to the House-Brackmann scale. Results All 10 patients (4 males and 6 females; mean age at presentation, 4 years) had unilateral, isolated FNP. Mild lowereyelid entropion was present in four patients, and severe lower-eyelid entropion required surgical correction in three patients. All patients had lower eyelid retraction (mean 2.3 mm) and lagophthalmos (mean 2.9 mm). None had enophthalmos, lower eyelid ectropion, or brow ptosis. Conclusion Unlike adults, children with isolated FNP seem prone to develop entropion rather than ectropion. Entropion reported previously in five syndromic children with FNP seems more likely related to patients' age than to their congenital syndromes.

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“…Tearing and synkinetic facial movements secondary to aberrant regeneration are other common complaints of patients with a history of FNP. Children with FNP may present with lower eyelid entropion 22 [ Figure 1 ].…”

Section: Clinical Evaluationmentioning

confidence: 99%

Facial nerve palsy: Providing eye comfort and cosmesis

Alsuhaibani

2010

Middle East Afr J Ophthalmol

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Development of facial nerve palsy (FNP) may lead to dramatic change in the patient's facial function, expression, and emotions. The ophthalmologist may play an important role in the initial evaluation, and the long-term management of patients with new-onset of FNP. In patients with expected temporary facial weakness, no efforts should be wasted to ensure proper corneal protection. Patients with permanent functional deficit may require combination of surgical procedures tailored to the patient's clinical findings that may require good eye comfort and cosmesis.

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Facial Nerve Paralysis: An Unrecognized Cause of Lower Eyelid Entropion in the Pediatric Population

Abstract: To the best of our knowledge, this is the first report linking facial nerve paralysis with entropion in the pediatric population. Ophthalmologists and pediatricians should consider this in the evaluation of children with craniofacial abnormalities and facial nerve paralysis.

Cited by 7 publications

References 10 publications

Combined Mobius Syndrome and Tarsal Kink Syndrome- A Unique Presentation.

Combined Mobius Syndrome and Tarsal Kink Syndrome- A Unique Presentation.

Entropion in children with isolated peripheral facial nerve paresis

Facial nerve palsy: Providing eye comfort and cosmesis

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