Relative exophthalmos in facial nerve palsy.

OBJECTIVE: While ocular manifestations of facial nerve palsy, such as lagophthalmos are well known, there is limited knowledge on whether CN 7 palsy impacts globe positioning and its implications on symptoms and management. We hypothesize that CN 7 palsy is associated with ipsilateral exophthalmos. METHODS: A retrospective analysis of 500 patients diagnosed with facial nerve disorders, identified by ICD codes G51.0-G51.9, was conducted at a tertiary health care facility from January to November 2023. Patients were included if they had a diagnosis of unilateral facial nerve (CN 7) palsy and available computed tomography (CT) imaging after diagnosis. Patients under 18 years, those with bilateral CN 7 palsy, or with CT images of poor resolution were excluded. Axial position of the globe was measured on CT scans using 2 methods, both previously shown to correlate with Hertel exophthalmometry. RESULTS: Of the 500 charts reviewed, 55 patients met inclusion criteria. 55% (n = 30) of patients were male, and 58% (n = 32) had right-sided CN 7 palsy. The predominant etiology was acute Bell's palsy 76% (n = 42). CT measurements revealed a statistically significant relative exophthalmos on the side affected by CN 7 palsy, measuring an average of 0.89 mm (Method 1) and 0.92 mm (Method 2) (both methods p < .001). CONCLUSIONS: Our study is the first to highlight changes in ocular globe position in CN 7 palsies. The observed exophthalmos highlights the importance of assessing globe position in ophthalmologic management of the disorder.

Duke Scholars

Author Christopher Robert Dermarkarian Ophthalmology, Comprehensive Ophthalmology

Author Julie Ann Woodward Ophthalmology, Oculofacial Surgery

Author Sandra Sue Stinnett Biostatistics & Bioinformatics, Division of Biostatistics