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

Year 2022, Volume: 15 Issue: 4, 780 - 787, 01.10.2022

Erman Bozali , Duygu Yalınbaş Yeter , Merve Çiftçi , Adem Bora

https://doi.org/10.31362/patd.1109669

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

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