Lagophthalmos: An etiological lookout to frame the decision for management.

Purpose: To describe the etiology, clinical profile, duration of lagophthalmos cases and thereby, framing a decision for the management based on the severity of Exposure keratitis (EK), Facial palsy (FP) with each etiology and to describe the outcome of the management options. Methods: The method was a prospective review of 120 lagophthalmos cases treated at a single tertiary center from January 2018 to January 2019. The main outcome measures were analysing the association between age, etiology, duration and management of lagophthalmos. Results: Of the 120 patients studied, paralytic etiology was noted in 86 and eyelid etiology in 34 patients. The percentage of various lagophthalmos etiology documented were Bell's palsy (35.83%), lagophthalmos in ICU patients (15%), traumatic facial palsy(FP) (10.80%), stroke associated FP (6.67%), infection associated FP (6.67%), iatrogenic FP, cicatricial lagophthalmos (5%), lagophthalmos post eyelid surgeries (5%), neoplastic FP(3.33%), congenital FP (1.67%), proptosis induced lagophthalmos (1.67%), floppy eyelid syndrome induced lagophthalmos (0.83%) and lid coloboma associated lagophthalmos (0.83%). A statistically significant correlation was noted between exposure keratitis and age, with an increased prevalence age advances. The management showed significant variation with individual etiology, with some etiologies unquestionably requiring surgical management. Surgical management is crucial as the duration of lagophthalmos increases more than 6 weeks, EK involving pupillary axis and poor FP recovery. Conclusion: This study concludes that the conservative management was sufficient in all cases when the duration is less than 1 week, Exposure keratitis not involving the pupillary axis (EK< Grade II) and FP with good functional recovery ( FP < Grade III). The predominant causes being Bell's palsy, lagophthalmos in ICU patients and vascular FP. Whereas, cases with poor functional recovery of facial palsy(FP) and permanent eyelid deformation require definitive surgical management like Traumatic FP & cicatricial lagophthalmos.

4-Amino-pyridinium picrate.

In the title compound, C(5)H(7)N(2) (+)·C(6)H(2)N(3)O(7) (-), the 4-amino-pyridinium cation is essentially planar (r.m.s. deviation = 0.002 Å). The three nitro groups in the picrate anion are twisted away from the attached benzene ring [dihedral angles = 24.1 (1), 9.3 (3) and 21.4 (1)°]. In the crystal structure, the ions are linked into a three-dimensional network by N-H⋯O and C-H⋯O hydrogen bonds.

4-tert-Butyl-pyridinium picrate.

In the title compound, C(9)H(14)N(+)·C(6)H(2)N(3)O(7) (-), the three nitro groups of the picrate anion are twisted out of the plane of the attached benzene ring; the dihedral angles are 32.8 (2), 10.5 (4) and 12.3 (4)°. The pyridinium cations and picrate anions are linked via bifurcated N-H⋯(O,O) hydrogen bonds. The ionic pairs are linked into a ribbon-like structure along [101] by C-H⋯O hydrogen bonds.