Facial Palsy and the eyes: Epidemiology, Tear Film, and Meibomian gland dysfunction; a comparative analysis

Purpose To describe the correlation between facial palsy of any etiology and Meibomian gland dysfunction and to report the tear film parameters found in patients with facial palsy diagnosis. Design Observational, longitudinal, and comparative study. Methods A sample of 20 patients with unilateral facial palsy was obtained its severity was staged using the House-Brackmann scale. A dry eye evaluation using an Oculus 5M keratograph was performed, which included infrared meibography, tear breakup time, and a dry eye questionnaire. Meibographies were analyzed using ImageJ software to determine the affected area. Results 11 patients (55%) were female, mean age of diagnosis was 57.80 ± 18.28 (range of 22-80), 10 (50%) cases were due to Bell’s palsy. Tear breakup time was markedly reduced in the affected side but was statistically insignificant (p=0.2167) and tear meniscus height was much greater in the non-affected side (p=0.0199). Finally, Meibomian gland alterations were more evident in the affected side, with upper Meibomian glands having a loss of 29.55 ± 13.31 percent (p=0.0374) and lower glands presenting a loss 44.44 ± 16.9 percent (p=<0.001). Conclusions A clear difference in Meibomian gland and tear film dynamics can be observed in paretic vs non paretic sides in the same patients. Multiple mechanisms contribute to this ailment, such as an incomplete blinking pattern and Meibomian gland dysfunction due to orbicularis oculi weakness. Software based analysis also showed a greater glandular area loss when compared to clinician’s analysis, which may help aide in therapeutic decisions for patients with meibomian gland dysfunction.