Pediatric facial nerve palsy study finds alternatives to tarsorrhaphy

Children with facial nerve palsy, tailored periocular surgical procedures can effectively protect the cornea and improve vision outcomes without the need for tarsorrhaphy, thereby avoiding its associated visual field loss, according to a study.

The study reviewed records of 26 pediatric patients (29 affected eyes), identifying corneal anesthesia and upper eyelid skin contracture as common findings. Three children developed neurotrophic keratopathy. Surgical interventions included levator recession, platinum segment insertion, correction of meibomian gland inversion, full-thickness skin grafts, and lower eyelid elevation, none of which involved tarsorrhaphy.

Post-treatment, CADS grading scores significantly improved in corneal health, facial symmetry, and eyelid function. Vision improved in over half of patients (58%) and was maintained in 21%, though deterioration occurred in 21%. Two children showed improvement in neurotrophic keratopathy without corneal neurotization.

Reference
Lim CS, Neville C, Nduka C, et al. Periocular Management of Pediatric Facial Nerve Palsy. Am J Ophthalmol. 2025;278:292-304. doi: 10.1016/j.ajo.2025.06.038. Epub 2025 Jun 20. PMID: 40545019.