Christopher R. G. Arthur, Ahmed Sadiq, Chuen Yen Hong
Purpose: Currently there is no agreed grading tool for the ocular sequelae of facial nerve palsy. The House Brackman Scale only considers lagophthalmos and may not be adequate to assess ocular morbidity from facial nerve palsy. Our aim was to create a scoring system to help quantify ocular morbidity from facial nerve palsy, to aid in decision making regarding the need for eyelid reanimation.
Method: The notes of all patients who attended the spe- cialist facial palsy clinic in Manchester UK between March 2002 and October 2017 were reviewed, totalling 606 patients. Retrospective multivariate analysis identi- fied clinical predictors for patients that required eyelid reanimation. β coefficients generated in the multivariate analysis helped formulate a probability equation for requiring eyelid reanimation and a scoring system to quantify ocular morbidity.
Results: The House Brackman Scale, corneal lagophthalmos and loss of corneal sensation all proved independent predic- tive factors for patients requiring eyelid reanimation. Valida- tion studies conducted through our patient population proves the probability equation and scoring system are accurate and repeatable. The area under the receiver operating characteris- tic curve for the multivariate prediction model was 0.769 (0.726, 0.811). A score of 5 points out of a possible 8 was the best cut off score to recommend eyelid reanimation, giving a sensitivity of 0.750 and a specificity of 0.671.
Conclusion: We have demonstrated that corneal lagophthalmos, corneal sensation and the House Brackman Scale are important in predicting the need for eyelid reanimation. The scoring system provides an important clinical decision making tool for other ophthalmologists