Neuro Ophtho · Seventh nerve palsy

Impending corneal perforation with lagophthalmos

Managed by tarsorraphy (image below) using bolsters. Indications: Corneal exposure secondary to: Lagophthalmos due to facial nerve palsies (neurogenic exposure keratopathy), cicatricial damage to the eyelids, anorexia nervosa, leprosy, Ramsay Hunt Syndrome Type 2, orbital tumors, and thyroid eye disease Proptotic exposure secondary to thyroid eye disease or other inflammatory orbital disease, and orbital tumors Eyelid malposition secondary to trauma, surgery, scaring, and floppy eyelid syndrome Inadequate blinking secondary to reduced corneal sensation, Riley Day Syndrome/Familial Dysautonomia, severe brain injury, or prolonged sedation Non-healing corneal defects or pathology: Non-healing epithelial defects Neurotrophic corneal ulceration (CN V deficit, herpes simplex virus (HSV) or varicella zoster virus (VZV) keratitis) Recalcitrant dry eye Progressive corneal thinning or descemetocele Limbal stem cell deficiency Palytoxin keratitis/keratoconjunctivitis/coral keratitis In conjunction with other surgeries: To prevent conjunctival swelling (chemosis) and exposure after ocular surgery To retain a prosthesis, Boston Keratoprosthesis, or other device in patients with anophthalmia or after evisceration or enucleation Tarsal kink repair In conjunction with globe reconstruction in repair of traumatic globe luxation In ocular graft versus host disease in combination with amniotic membrane

Contributed byDr. Mohammed Arif KaderiResident, JNMC, Wardha

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