A Simple Guide to Facial Palsy

A Simple Guide to Facial Palsy
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What is Facial Palsy?
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Facial Palsy is the paralysis of the facial nerve from its origin in the brain right to the branches of the nerve in the face.

It is usually temporary.

What are the causes of Facial Palsy?
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Facial Palsy occur as a result of reduced blood supply to or pressure on the facial nerve at 2 areas:

Supranuclear(within the Brain)
1.Cerebral vascular lesions

2.Cerebral tumours

Infranuclear(outside the brain)
1.Bell's palsy - most common with unknown cause, most likely due to viral infection of the facial nerve after the stylomastoid foramen.

2.Trauma- Birth injury,fractured temporal bone, surgery of the ear

3.Tumours- Acoustic neurofibroma, parotid tumours, malinant disease of the ear,
4.Infections- from acute otitis media or chronic otitis media, herpes zoster of the ear, HIV, Lyme's disease

5.Autoimmune disease-Gullian-Barr Syndrome, sarcoidosis,

6.Multiple sclerosis

What are the symptoms and signs of Facial Palsy?
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The onset of facial palsy is usually very sudden.

The most important part of the diagnosis is to distinguish between the supranuclear and infranuclear causes of facial palsy.

Supranuclear symptoms and signs:
1. The movements of the upper part of the face is unaffected because the forehead muscles have bilateral cortical representations

2.Depressed taste ( lesion above chorda tympani)

3.hyperacusis ( lesion above nerve to stapedius)


Infranuclear symptoms and signs:
1.pain and discomfort at the mastoid region(behind the ear) or in the ear.

2.weakness of facial muscle on 1 side, with sagging eyelids, difficulty in closing the eye, drooping of the mouth on 1 side.

3.dribbling of saliva

4.difficulty in speaking

5.loss of taste at the front of the tongue

6.dryness or watering of the affected eye

7.eyeball rolled up and inward on attempted closure of affected eye

8.ectropion or turned out lower eyelid

9.sharp hearing on the affected side

10.Voluntary twitches (called synkinesis) such as the corner of the mouth turning up in a smile when blinking or tears in the eye while eating.

What are the investigations required in Facial Palsy?
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1.Physical examination
a.test muscle movement of the forehead to determine whether cause is
supranuclear(muscle movement present) or
infranuclear( no movement of forehead muscles)

b.test closing of the eye - to test weakness of eyelid muscles

c.ask patient to smile - to check for weakness of the cheek muscles

2.Investigations:
a.Blood for infections, HIV, Lyme's disease

b.MRI of brain to exclude tumours

c.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis

What is the treatment of Facial Palsy?
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1.Start on a course of steroids like prednisolone(about 40-60mg/a day at first, then tapering off the dosage) to hasten rapid recovery.

The steroid usually reduce swelling of the nerve.

2.antiviral drugs such as acyclovir can help recovery especially when the cause is suspected herpes virus

3. Protection of the affected eye (which cannot be closed properly) by wearing glasses or an eyepad.

Use artificial eyedrops during the day to keep the eye moist.

Tape the eye at night to keep it closed.

4.Physiotherapy of the facial muscles -
facial massage,
facial exercises, and
acupuncture may help restore the facial muscle tone.

5.Surgery
Tarsorrhaphy, which narrows the space between the upper and lower eyelids, may improve eye closure.

Plastic surgery may improve permanent facial drooping

What is the prognosis of Facial Palsy?
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80-90% of patient with facial palsy recover spontaneously and completely within three weeks.

The remainder usually takes up to six months to recover.

Very rarely do you get permanent paralysis of the facial nerve.

A Simple Guide to Uveitis

A Simple Guide to Uveitis
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What is Uveitis?
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Uveitis is inflammation of the eye's uvea. The uvea is the eye's middle layer that consists of the iris, ciliary body and choroid.

What are different types of Uveitis?
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Uveitis is classified by the part of the uvea it affects.

1. Anterior uveitis refers to inflammation of the iris alone (called iritis) or the iris and ciliary body. Anterior uveitis is the most common form.

2.Intermediate uveitis refers to inflammation of the ciliary body.

3. Posterior uveitis is inflammation of the choroid.

Diffuse uveitis is inflammation in all areas of the uvea.

What are the dangers of Uveitis?
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Many cases of uveitis are chronic.
They can produce numerous possible complications, including clouding of the lens (cataract) or cornea, elevated intraocular pressure (IOP), glaucoma, and retinal problems (such as swelling of the retina or retinal detachment).
These complications can lead to loss of vision.

Who are affected by Uveitis?
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Uveitis occurs most frequently in people ages 20 to 50.
It is more common in women and more likely to develop with age.

What are the Complications of Uveitis?
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Uveitis complications:
secondary cataracts,
secondary glaucoma,
high intraocular pressure,
retinal detachment

What are the Symptoms and Signs of Uveitis?
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With anterior uveitis, the symptoms usually affect only one eye.
There may be
mild to strong pain
redness and
light sensitivity.
Your vision may also be blurred.
Eye is tender to palpation

Both intermediate and posterior uveitis are usually painless.
Symptoms are blurred vision and floaters, typically in both eyes.

Diffuse uveitis has a combination of symptoms of all types of uveitis.

What Causes Uveitis?
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Uveitis has dozens of causes, including viral, fungal, and bacterial infections.
But, in many cases, the cause is unknown (idiopathic).
Eye doctors can sometimes identify the cause if there has been trauma to the eye, such as from surgery or a blow, or if there is a history of an infectious or immunological systemic disorder.
Some of the many different systemic disorders that can cause uveitis include:
acute posterior multifocal placoid pigment epitheliopathy
ankylosing spondylitis
Behçet's disease
birdshot retinochoroidopathy
brucellosis
herpes simplex
herpes zoster
inflammatory bowel disease
juvenile rheumatoid arthritis
Kawasaki's disease
leptospirosis
Lyme disease
multiple sclerosis
presumed ocular histoplasmosis syndrome
psoriatic arthritis
Reiter's syndrome
sarcoidosis
syphilis
systemic lupus erythematosus
toxocariasis
toxoplasmosis
tuberculosis
Vogt-Koyanagi-Harada syndrome

What is the Treatment of Uveitis?
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Non-drug:
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warm water
pads to cover eyes for rest and avoid sun

Drugs:
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Your doctor will likely prescribe a steroid to reduce the inflammation in your eye.
Whether the steroid is in eye drop, pill, or injection form depends on the type of uveitis you have.
Because anterior uveitis affects the front of the eye, it's easy to treat with eye drops.
Intermediate uveitis can go either way, and
posterior uveitis usually requires tablets or injections.

Steroids and other immunosuppressants can produce many serious side effects:
such as
kidney damage,
high blood sugar,
high blood pressure,
osteoporosis, and
glaucoma.

In April 2005 the drug Retisert was approved by FDA for chronic non-infectious posterior uveitis. Retisert is a drug implant and is the first of its kind for treatment of uveitis. It consists of a drug reservoir that delivers sustained amounts of fluocinolone acetonide, an anti-inflammatory corticosteroid, for about two and a half years. It is implanted into the back of the eye. During clinical trials the incidence of reccurent uveitis fell from 40%-54% to 7%-14%. The most common side effects noted during those studies were cataract progression, increased intraocular pressure, procedural complications, and eye pain.

If you have anterior uveitis, your doctor will likely prescribe, in addition to the steroids, pupil-dilating eye drops to reduce pain.
You may also need eye drops to lower your intraocular pressure if it's elevated.