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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	-

Authors 1

Last name	LEYSEN
Initials	I
Department	Department of Ophthalmology, Antwerp University Hospital, Belgium
City	Edegem

Authors 2

Last name	Verstrepen
Initials	K
Department	Belgium Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
City	Wilrijk