Risk Assessment and Prevention of Corneal Complications after Lateral Skull Base Surgery

Objective: To analyze the rate of corneal complications after lateral skull base surgery, and the relative risk of each potential contributing factor. Study Design: Retrospective cohort study. Setting: Tertiary care center. Patients: Adult patients who had undergone lateral skull base surgery involving an otolaryngologist at our institution from 2007 to 2015. Intervention: None. Main Outcome Measure: Relative risk (RR) for each potential contributing factor to corneal complications. Results: Four hundred sixty nine patients met inclusion criteria. Of those, 35 developed mild exposure keratopathy, 13 developed moderate exposure keratopathy, and 5 developed severe exposure keratopathy. Age, sex, previous eye surgery, tumor side, and pathology were not significant predictors of keratopathy. Tumor size greater than 30 mm (RR 4.75), postoperative trigeminal palsy (RR 3.42), postoperative abducens palsy (RR 9.08), House-Brackman score 5-6 (RR 4.77), lagophthalmos (RR 11.85), ectropion (RR 4.29), and previous eye disease (RR 1.83) were all significantly associated with the development of corneal complications. On multivariate analysis, lagophthalmos, abducens palsy, and tumor size were independent predictors of keratopathy. Conclusions: There are several important risk factors for exposure keratopathy after lateral skull base surgery, and knowledge of these risk factors can help identify high-risk patients in whom early, aggressive preventative therapy is warranted.