Title | Parry-Romberg syndrome: a case of lagophthalmos and hemifacial atrophy |
Purpose | To report a case of a 54 year old female patient with nightly pain and dryness of the right eye. She already consulted other ophthalmologists for this problem and asked for a surgical solution. |
Methods | Clinical inspection revealed lagophthalmos with exposure keratopathy, enophthalmos, a deep superior palpebral sulcus and a rounded lateral canthus of the right eye. Further facial inspection showed a protruding cheekbone and fat atrophy at the masseter region on the right side of the face. Orbital imaging (MRI) and advise of the internal medicine team were planned. |
Results | Based on clinical presentation, orbital imaging and assessment of antinuclear antibodies, the diagnosis of Parry-Romberg syndrome was established. Immune suppressive therapy with methylprednisolone and methotrexate was started. Surgical treatment options such as autogenous fat grafting or insertion of an inorganic implant were considered. First a soft therapeutic contact lens was fitted preventing nocturnal corneal exposure. Patient was much more comfortable wearing the contact lens during the night. Surgical treatment was thereby postponed. |
Conclusion | In case of lagophthalmos with exposure keratopathy of unknown cause it is important to look for facial asymmetry and consider the diagnosis of Parry-Romberg syndrome. In these COVID-19 times it is important to ask the patient to remove the mask momentarily for further inspection of the face. Before planning surgery consider fitting a therapeutic soft or scleral contact lens worn nightly. |
Conflict of interest | No |
Details of conflicting interests | - |
Last name | LEYSEN |
Initials | I |
Department | Department of Ophthalmology, Antwerp University Hospital, Belgium |
City | Edegem |
Last name | Verstrepen |
Initials | K |
Department | Belgium Faculty of Medicine and Health Sciences, University of Antwerp, Belgium |
City | Wilrijk |