An Audit of Eye-Protection Practices in ENT-Related Facial Nerve Palsy: A Retrospective Review of Discharge Summaries

Background and objective Facial nerve palsy (FNP) secondary to ENT-related conditions can lead to lagophthalmos and exposure keratopathy, putting patients at risk of vision-threatening complications. Proper documentation of eye-protection measures in discharge summaries is critical for continuity of care and patient safety. This study aimed to evaluate the quality and completeness of eye-care instructions in discharge summaries of ENT-related FNP patients. Materials and methods A retrospective review was conducted on 104 discharge summaries from the Department of ENT - Head and Neck Surgery, Pakistan Institute of Medical Sciences, Islamabad, over a 32-month period (from January 2023 to August 2025). Patients included had FNP due to ENT-related causes, while non-ENT etiologies and incomplete records were excluded. A checklist based on ENT UK, National Institute for Health and Care Excellence (NICE), and Royal College of Ophthalmology guidelines was used to assess documentation of eye-protection measures. Discharge summaries were scored from 0 to 6 and classified as poor (0-1), fair (2-3), good (4-5), or excellent (6). Statistical analysis was performed using SPSS v27 (IBM Corp., Armonk, NY). Results The mean patient age was 46 ± 13.5 years; 67 (64.4%) were male. The most common etiologies were chronic suppurative otitis media with cholesteatoma (40.5%), head and neck cancer (22.1%), and trauma (16.3%). Documented eye-care measures included daytime lubricating drops (96.2%), eyelid taping (84.6%), follow-up instructions (74.0%), night-time ointment (66.3%), ophthalmology referral (38.5%), and corneal status/lagophthalmos (24.0%). Overall discharge summary quality was excellent in 8.7%, good in 30.8%, fair in 58.7%, and poor in 1.9%. Collapsing the ratings into adequate and inadequate showed that 41 summaries (39.4%) were adequate, and 63 (60.6%) were inadequate. Conclusion While basic eye-care instructions were frequently documented, critical elements such as corneal assessment and ophthalmology referral were often missing. Several discharge summaries were inadequate, emphasizing the need for standardized, comprehensive documentation to improve patient safety and reduce preventable ocular morbidity in ENT-related FNP.