Efficacy of Insulin Eye Drops in the Treatment of Corneal Ulcers in Patients with Facial Nerve Palsy and Lagophthalmos: A Retrospective Case-Control Study.

Background and

Objectives

Corneal ulcers in patients with lagophthalmos due to facial nerve palsy pose a significant therapeutic challenge. Topical insulin has emerged as a promising adjuvant therapy for enhancing corneal re-epithelialization. The aim of this study is to evaluate the efficacy of insulin drops compared with lipid-based artificial tears, and to compare the corneal healing rate in achieving complete epithelialization within 30 days in diabetic patients. Materials and

Methods

This retrospective case-control study included 32 patients with facial nerve palsy and lagophthalmos who developed an exposed corneal ulcer, of whom 20 received topical insulin and 12 received lipid-based artificial tears. The primary outcome was complete epithelialization at day 30. Additional variables included age, sex, and baseline defect characteristics.

Results

By day 30, complete epithelialization was achieved in 18 of 20 patients (90%) in the insulin group compared with 5 of 12 (41.7%) in the control group. Binary logistic regression analysis confirmed significantly higher odds of healing with insulin treatment (OR = 10.8; 95% CI 1.8-63.9). No systemic adverse events or signs of hypoglycemia were observed.

Conclusions

Topical insulin significantly accelerates corneal epithelialization in patients with facial nerve palsy and exposed ulcers, offering safe and effective adjuvant therapy for a high-risk population. Despite promising results, the study's limitations-including small sample size, single-center design, and retrospective nature-highlight the need for larger, multicenter prospective studies to confirm efficacy, optimize dosing, and further evaluate long-term safety.