BMJ Case Reports 2014; doi:10.1136/bcr-2014-205372

Eyelid reanimation, neurotisation, and transplantation of the cornea in a patient with facial palsy

  1. Federico Biglioli1
  1. 1Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
  2. 2Department of Ophthalmology, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
  1. Correspondence to Dr Fabiana Allevi, fabiana.allevi{at}
  • Accepted 27 July 2014
  • Published 19 August 2014


Patients affected by facial palsy suffer from failure to fully close the eyelids; the resulting eye exposure can lead to dry eye syndrome, loss of epithelial integrity, corneal ulceration and infections. Corneal anaesthesia exacerbates risk of corneal damage in these patients. Eyelid paralysis-associated corneal lesions may induce severe visual impairment, for which the ideal treatment is corneal transplantation, a procedure contraindicated in patients with corneal sensitivity and inadequate eyelid closure. We present the case of a patient affected by unilateral facial palsy associated with corneal anaesthesia, due to seventh and fifth cranial nerve damage following homolateral eighth cranial nerve surgery. The patient underwent surgery to re-establish eyelid and corneal competence, and then received a corneal graft with consequent amelioration of visual acuity. This is the first case of associated corneal anaesthesia and facial palsy that was comprehensively treated with a set of surgical procedures, including a corneal transplant.

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