Eye Care for Patients with Ramsay Hunt Syndrome
Many patients with RHS experience a complication of incomplete eye closure due to paralysis of the facial nerve which innervates the muscles responsible for eye closure.This can lead to dry eye and corneal damage if not properly treated.
Ocular Ramsay Hunt syndrome refers to the involvement of the eye and surrounding structures in Ramsay Hunt syndrome (RHS). Ocular complications arise from the facial nerve's role in eye movement and eyelid closure, potentially causing dry eye, corneal damage, and vision problems.
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Symptoms related to the eye
The facial nerve controls the muscles that close the eyelid. In RHS, facial paralysis can make it difficult or impossible to fully close the eye on the affected side. This is referred to as lagopthalmos or the inability to fully close one's eyelids.
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Dry Eye
When the eyelid doesn't close properly, the eye's surface can dry out, leading to dryness, irritation, discomfort, and blurred vision. The facial nerve also controls the lacrimal gland in the corner of the eye, which is responsible for tear production.​​
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Corneal Damage
Prolonged exposure to air, due to the inability to blink, can cause the cornea (the clear front part of the eye) to become damaged, potentially leading to corneal ulcers, infections, and even temporary or more permanent vision loss. There is a danger of scratching the cornea as well, with eye closure impairment, especially while asleep.
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Excessive Tearing
In some cases, the affected eye may also experience excessive tearing, potentially due to irritation or nerve involvement. Sometimes, the body can also sense that the eye is dry and produce too much of the watery tear component to try to compensate for the dryness. This can be why your eyes feel dry, but there is water running down your cheek from tears.​
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Eye Lubrication
Artificial tears and lubricating ointments are often recommended to keep the eye surface moist and prevent drying. There are many different over the counter artificial tears, almost any of them will be ok, but ones that are preservative free are generally tolerated the best. Also, avoid using anything that says it removes redness like Visine. ​
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Prescription Dry Eye Treatments
In addition to many over the counter (OTC) dry eye treatments, there are several prescription medications that can be used to help treat dry eyes as well. There are topical drops, a nasal spray, as well as some oral medications that can sometimes be beneficial. There are also in office treatments like Lipiflow or IPL that can be beneficial for dryness in general, but may not be as useful for RHS patients. Another temporary solution to address dry eyes is a punctal plug that is inserted into the bottom tear duct (and sometimes the top as well). Also a scleral lens is a special lens that addresses dry eye by protecting the cornea in cases of full or partial blink impairment.
For people with corrective lenses for myopia while dealing with facial palsy, there are prescription products that can be purchased: prescription swim goggles, prescription moisture chamber glasses, prescription motorcycle glasses and sports glasses that can provide eye protection while also helping a person to see normally if they have near-sightedness.
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Prescription Dry Eye Treatments
In addition to many over the counter (OTC) dry eye treatments, there are several prescription medications that can be used to help treat dry eyes as well. There are topical drops, a nasal spray, as well as some oral medications that can sometimes be beneficial. There are also in office treatments like Lipiflow or IPL that can be beneficial for dryness in general, but may not be as useful for RHS patients. Another temporary solution to address dry eyes is a punctal plug that is inserted into the bottom tear duct (and sometimes the top as well). Also a scleral lens is a special lens that addresses dry eye by protecting the cornea in cases of full or partial blink impairment.
For people with corrective lenses for myopia while dealing with facial palsy, there are prescription products that can be purchased: prescription swim goggles, prescription moisture chamber glasses, prescription motorcycle glasses and sports glasses that can provide eye protection while also helping a person to see normally if they have near-sightedness.
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Eye Patching
Taping the eye shut at night can help protect the cornea and prevent further dryness. As an alternative, you can also use a sleep mask to cover the eyes at night. There are even artificial tear ointments that are for PM use and can help with overnight evaporation problems. It's also a good idea to make sure you don't have excessive air blowing on your face at night from a fan above your bed or a ceiling vent. Using pirate patch or eye mask without securing the upper eyelid could cause corneal abrasion if they move while asleep. One alternative that some people have used instead of using medical tape is Glad Press N Seal to keep the eyelid down at night.
For instance: the Ortolux eye bubble moisture chamber - Link
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More permanent solutions
Surgical options for dryness can also be addressed if needed. They won't necessarily target the dryness as much as the lid not being able to blink as easily. Surgery can be done to lower the upper lid to help cover the eye more throughout the day and sometimes a small weight can be inserted into the lid to help it close. Generally, surgical options are a last result if other options have been tried and were not sufficient.
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Treatment of Underlying RHS
Prompt treatment with antiviral medications and corticosteroids is crucial to reduce inflammation and nerve damage. ​
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Importance of early intervention
Early diagnosis and treatment of RHS are essential for minimizing the risk of long-term complications, including permanent facial paralysis and eye damage. If you experience any symptoms of RHS, including facial paralysis, ear pain, or a rash around the ear, seek medical attention immediately.
Provided by Dr. Scott Sikes, O,D
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