Nictavi Tarsus Patch for Managing Lagophthalmos

Lagophthalmos is the inability to completely close the eyelids, which can be caused by conditions such as facial nerve dysfunction and eyelid scarring. Lagophthalmos causes evaporation of the tears, which in turn can lead to damage to the eye and permanent vision loss. Surgical interventions such as tarsorrhaphy or gold/platinum weight implantation can improve lagophthalmos, but these are invasive procedures that are not easily reversible. Temporary methods for treating lagophthalmos are also available, such as the use of medical tape or commercial eyelid closure devices. In the investigators' clinical experience, however, these methods are not well-tolerated by patients due to discomfort, especially due to the device sticking to the eyelashes. As a result, patients are at greater risk of non-compliance and subsequently experiencing ocular complications.

The Nictavi Tarsus Patch is a new medical device that uses a flexible material that conforms to the upper eyelid curvature while maintaining sufficient rigidity to keep the upper eyelid in a closed position. It also is designed to be placed above the eyelash line, which allows for enhanced comfort. There has been no study to date evaluating the Tarsus Patch for its effectiveness, safety, or tolerability.

The purpose of this study is to determine the effectiveness, safety, and tolerability of the Tarsus Patch in managing lagophthalmos in children and adolescents overnight. The investigators hypothesize that there will be a significant improvement in eyelid closure when using the Tarsus Patch when compared to not using any device and that over 90% of subjects will achieve complete eyelid closure with its use. The investigators also hypothesize there will be no complications related to the use of the Tarsus Patch, and that it will be considered by patients and parents to be comfortable, easy to use, and, overall, preferable to other available methods of nocturnal eyelid closure.

The investigators plan to recruit 20 children and adolescents (ages 0 to 17 years, inclusive) from the Children's Hospital Los Angeles (CHLA) ophthalmology clinics who have lagophthalmos affecting one or both eyes and have been recommended to use medical tape or other eyelid closure device to help keep their eyelids closed. The aims are to 1) objectively measure the improvement in lagophthalmos from baseline while using the Tarsus Patch, and 2) evaluate patients' and parents' experience with survey questions related to complications, comfort, ease of use, and preference for using the about the Tarsus Patch.

PROCEDURES INVOLVED

* Study visit (Day 1 of study, 60 minute commitment):

  * At the study visit, informed consent will be obtained by the study coordinator or investigator.
  * Once consent is obtained, the enrolled subject then undergoes an ophthalmic history and examination, including dilated examination if deemed necessary for their usual ophthalmic care. The history will include usual questions asked at a follow-up visit about ocular health and will also include details about how often, in which eye, and with what method they close their eyelids at night.
  * The examination will include standard measures of vision, ocular surface health, and eyelid position and function.
  * If the subject has unilateral lagophthalmos, then the involved eye will be designated as the study eye. If the subject has bilateral lagophthalmos, then the eye with more severe lagophthalmos will be designated as the study eye.
  * The parent will receive an explanation about the procedures of the study.
  * The study investigator will choose which Tarsus Patch size (pediatric or adult) will fit best on the child's eyelid. With the proper size, the parent will then be shown how to properly place the Tarsus Patch on the study eye, and questions will be answered about how to properly place the patch on the eye.
  * The parent will then be given the following items to take home: 6 patches (this includes a few extra patches in case they are needed), and a copy of the study consent form including email and phone number to reach the study team should they have any questions
  * To minimize risk, the parent will be informed that if the subject has any discomfort with an of the study protocols, they should stop the use of the Patch call the study team to discuss how to address the issue.
* At home portion (Day 1-3 of study):

  - Each night for 3 nights, the parent should place a new Tarsus Patch on the subject's study eye and then place a ½ cm strip of ophthalmic ointment or gel into the study eye. The parent should then help remove the patch the next morning and throw it away.
* Phone survey (Day 4):

  * A study investigator will call the parents to have them respond to the Parent Survey over the phone in the absence of the study subject.
  * If the subject is 10 years of age or older and cognitively able to answer the survey questions, then they will be asked to answer the Subject Survey over the phone with the help of the parent.

Eligibility Criteria:
Inclusion Criteria:

* Patient subjects:

  * Between 0 and 17 years old (inclusive)
  * Diagnosis of unilateral or bilateral lagophthalmos based upon an eye examination since Jan 1, 2019
  * Previously recommended to use an eyelid closure method (such as using medical tape, steristrips, moisture chambers, temporary tarsorrhaphy, etc).
  * English-speaking
  * Able to participate in an age-appropriate manner for the eye examination
* Parent subjects:

  * 18 years or older
  * English-speaking

Exclusion Criteria:

* Patient subjects:

  * Presence of corneal abrasion or corneal ulcer on the study eye
  * Active use of bandage contact lens in the study eye
  * Active dermatitis affecting the eyelids
  * Inability to tolerate the Tarsus Patch in clinic
  * Inability for complete mechanical closure of the eyelid by any means
  * Allergy to adhesive
* Parent subjects:

  * Prisoners