Patients' perspectives of ophthalmic management of facial nerve paralysis.

Objective: Facial nerve paralysis (FNP) affects eye muscle function causing lagophthalmos. This leaves the cornea vulnerable to irritation and injury which, if untreated, may cause permanent vision impairment. Decreased eye muscle control impacts facial expressions and quality of life. Although non-surgical interventions such as lubrication are routinely used in standard eyecare, patient perspectives regarding these interventions have not been extensively investigated. This study aims to investigate patients' perspectives of conservative ophthalmic management for FNP.

Methods and analysis: Participants with FNP completed a survey including seven conservative lagophthalmos management interventions: artificial tears, lubricating ointment, taping the eye shut, tape to lift the lower eyelid, scleral contact lens, moisture chamber and manual eye closure. Open-ended questions and Likert scales covered six domains: discomfort, appearance-related concerns, application difficulties, impact on activities of daily living and social activities, and tolerance to outdoor settings. Descriptive, bivariate, correlation and thematic analyses were undertaken.

Results: 49 participants completed the survey (17 males, 32 females; mean age 55 years, SD 14.94). Mean duration of FNP was 8 years, 5 months (range 12 months to 47 years). Artificial tears and lubricating ointments were most frequently used with highest overall satisfaction. Participants were less satisfied with interventions involving the use of tape. Manual eye closure had a small positive impact. Main themes were comfort, vision and appearance.

Conclusions: Functional, social and psychological impairments associated with lagophthalmos are managed using conservative interventions. A better understanding of a patient's capacity, priorities and preferences underpins a collaborative approach when selecting eye-protective interventions and optimises patient outcomes.The main limitation of this study was that participants were recruited from a specialty facial nerve clinic, resulting in an over-representation of individuals with long-standing, complex conditions.