Bilateral Facial Nerve Palsy After Covid-19 Infection Has Lead To Corneal Perforation: A Case Report

To present a rare case of bilateral facial nerve palsy after covid-19 infection and the devastating results that the condition had on the patient’s left eye. To our knowledge there are very few cases of bilateral facial nerve palsy reported due to covid-19 and we will present to you the rapidity in which this situation affected the eyes of the patients and how serious and difficult the case was  to treat.

Α 61 years old patient has visited the emergency room of our hospital with inability to close the upper eyelid of both eyes and blurry vision that has been deteriorating the last days especially at the left eye. The medical history of the patient revealed a 38 days hospitalization in a covid-19 clinic due to pneumonia. A month after the patient exited the clinic she suffered a facial nerve palsy on both sides, so she entered a neurology clinic for treatment and rehabilitation

One week after she exited the neurology clinic she visited an ophthalmologist because of irritation in her left eye and after the examination she was diagnosed with corneal ulcer, so she received treatment with drops of ofloxacin , dexamethasone and artificial tears. The clinical examination revealed very low visual acuity, light perception and at the slit lamb examination corneal melting was extended with corneal perforation at the center of it. The iris was tamponading the perforation and the anterior chamber was swallow whereas the lens was not visible. The right eye had visual acuity 2/10 and punctate keratitis with corneal thinning temporalily. Bell’s sign was positive in both eyes and the cornea sensitivity was also low in both eyes. 

We decided the immediate surgical reformation of the anterior chamber and the preparation of the perforation boundaries to be closed with a plastic patch and cyanoacrylate glue regarding the left eye. Topical treatment was initiated in both eyes after the surgery of left eye.

Bilateral facial nerve palsy is an extremely rare condition that has been described as a result of an infection especially from Eptein-Barr virous and in lyme’s disease. In our case report it was covid-19 that has caused the bilateral palsy, a very rare complication of covid-19 infection, described in verry little cases and the result of this complication was extremely severe for our patient’s left eye.