This study assesses the use of intramuscular bupivicaine to treat lid retraction and lagophthalmos in facial palsy. It is a prospective non-comparative interventional series of 10 patients with Bell’s palsy (House-Brackman grade IV or V) who each received three serial injections of 5ml of 0.75% bupivicaine. All patients had been diagnosed at least a year before treatment, and had previously shown some recovery. All had stable lid positions for six months and none had undergone prior lid surgery. The bupivicaine was injected into the upper and lower lid preseptal and pretarsal orbicularis oculi muscle and the pre-injection lid positions were compared with those at one, three and six months post-injection. They found a significant decrease in lagophthalmos from an average of 3.9mm pre-injection to 2.3mm at six months. The vertical palpebral aperture decreased significantly from 11.2mm to 9.4mm, with improvement in both upper and lower lid retraction. Similarly, corneal exposure and scleral show in shut eyes also improved significantly. There were no complications and all patients also reported a reduction of epiphora and foreign body sensation. The main weaknesses of the study are the small numbers and lack of longer-term follow-up or a control group. Given that bupivicaine causes myotoxicity which subsequently leads to regeneration, it would have been interesting to see if there was an initial worsening of the facial palsy parameters before the later improvement. Unfortunately the one and three month data are not provided. Despite these drawbacks this is an interesting and original pilot study with impressive results which merits further investigation. 

Bupivicaine injection for management of lagophthalmos due to long-standing idiopathic facial nerve palsy.
Rajabi MT, Shadravan M, Mazloumi M, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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