ArticleCase reports in ophthalmology
Eyelid Elevation and Ocular Surface Rehabilitation Using Quadrant-Asymmetric Scleral Contact Lenses in Facial Nerve Palsy with Keratoconus: A 2-Case Series.
Article in Case reports in ophthalmology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Facial nerve palsy (FNP) with associated ptosis and keratoconus (KC) presents a combined challenge of visual dysfunction, ocular-surface disease, and cosmetic impairment. While surgical procedures are frequently performed, scleral contact lenses can offer both ocular-surface protection and mechanical eyelid support. While scleral lenses have previously been described for exposure keratopathy and irregular corneal astigmatism, the present 2-case series provides objective margin reflex distance-1 (MRD1) documentation of eyelid elevation achieved through quadrant-asymmetric scleral contact lens (QASCL) fitting in elderly patients with concurrent FNP and KC requiring simultaneous KC rehabilitation - an outcome combination not previously reported in this population. Case Presentation: Two elderly patients with KC and FNP were fitted with QASCL after poor tolerance of soft lenses. A 71-year-old man with severe lagophthalmos and brow ptosis showed MRD1 improvement from 1.0 mm to 3.5 mm and best-corrected visual acuity (BCVA) from 1.3 logMAR to 0.1 logMAR. His Ocular Surface Disease Index (OSDI) score decreased from 79.16 to 33.33 after 3 months, and the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) score was 11. A 74-year-old man with mild synkinesis had MRD1 increase from 0.5 mm to 3.0 mm and BCVA from 1.0 logMAR to 0.02 logMAR. His OSDI decreased from 91.66 to 45.83 after 3 months, and CLDEQ-8 was 16. Both patients exhibited reduced ocular-surface staining, improved meibomian gland function, and decreased conjunctival hyperemia over follow-up. Conclusion: QASCL fitting was associated with clinically meaningful improvements in eyelid elevation, visual acuity, and ocular-surface integrity, together with reductions in symptom severity as measured by OSDI and CLDEQ-8. In these two elderly patients with FNP and KC, QASCLs appeared safe, effective, and reversible nonsurgical option, providing sustained functional and anatomical benefit during long-term follow-up.
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