Leprosy Mailing List – May 3rd, 2007
Ref.:
How to treat early lagophtalmus?
From: Theuvenet W., Apeldoorn, The
Netherlands
Dear Salvatore,
Thank you for sharing this patient!
A lagophthalmos with a lid gap of 2
mm in the presence of corneal sensation should not present a risk to
the cornea as the patient, as you mention, is capable of
completely closing the eyes while he will turn away the cornea when
asleep. Your dosage of
Prednison seems adequate though depending on the body weight can
perhaps be increased to 60 mg in a single dose, in combination with
antacids to protect the gastric wall.
When you opt for a surgical correction at a later stage and
are still faced with a lid gap of only 2(-4)mm, one may choose
between a facial sling for the lower eye lid (in elderly patients with
a lax tarsal plate) or a combination of a lateral suspension plasty
and a medial canthoplasty (in younger patients)? A lateral+medial
tarsorrhaphy should be avoided if possible because of the poor
cosmetic outcome.
Physiotherapy may help as suggested by Paul but the problem
may not be as much muscle weakness as well as lack of nerve function. Hope that your patient will be
OK; otherwise I’ll be happy to come over and assist you in surgery.
Success!
Best regards,
Wim Theuvenet,
Plast. Rec. Surgeon
