by Jay Stockman,
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UNITED STATES, Oct 22 — Underdevelopment of the VI and VII cranial nerves which control lateral eye movement and facial expression. As a result, these people suffer from facial paralysis and an inability to move their eyes from side to side.As a result of this paralysis many of these folks have a retracted upper lid due to muscle atrophy.
Surgery such as tarsorraphy, muscle transfer grafts and “smile surgery” are done on a as needed basis
U
nderdevelopment of the VI and VII cranial nerves which control lateral eye movement and facial expression. As a result, these people suffer from facial paralysis and an inability to move their eyes from side to side.
As a result of this paralysis many of these folks have a retracted upper lid due to muscle atrophy. These facial anomalies give the patient a mask like appearance devoid of any expression. They are therefore often perceived as not being friendly, but that is not the case. Intelligence is not affected by this condition, but because of the lack of facial movement these individuals are thought to have social issues.
The lack of lateral ocular movements result in greater head turns in order to see to the sides. Additionally, there is a reduction in the blinking mechanism which causes dry eyes and an increase in the frequency of eye infections. Furthermore, because of the cranial nerve anomaly there is also a decrease in tear production and an increase in blepharitis. Often these patients experience a decrease in vision because of the dry eye condition and greater frequency of corneal erosions.
Other physical findings include limb abnormalities such as clubbed feet and missing toes and fingers, Poland syndrome which is a chest wall changes, difficulties in breathing and swallowing and on occasion the need for prosthetic limbs since the natural ones are non functional.
Treatment for these patients is limited to support and comfort since the abnormalities are permanent. With regard to the eyes artificial tears, punctal occlusion and ophthalmic eye drops as needed as well as protective eye wear that must be worn. Bandage contact lenses are used when the corneal exposure results in discomfort, and risks damage and scarring.
Surgery such as tarsorraphy, muscle transfer grafts and “smile surgery” are done on a as needed basis. Fortunately, this condition is rare, but practitioners must be aware of the care required to comfort these patients since it is a life long marathon.
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