Case reports in ophthalmology · 2026
Eyelid Elevation and Ocular Surface Rehabilitation Using Quadrant-Asymmetric Scleral Contact Lenses in Facial Nerve Palsy with Keratoconus: A 2-Case Series.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Erdinest Nir, Gur Zvi, Tabi Michael, Blum Noam, Shemesh Nadav, Yahalom Claudia, Lavy Itay
Аннотация
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.
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.