Facial paralysis can be the result of several medical causes, but
most commonly the cause is unknown. This is referred to as Bell’s
palsy. Patients often present with visible drooping of one side
of the face involving, but not limited to, the brow, eye, cheek,
and mouth area. They may have trouble winking, whistling, breathing
through one nostril, but mostly irritating or painful problems with
their eye. Exposure keratitis (inflammation of the cornea) due to
lagophthalmos (inability to close the eye) is one of the most problematic
symptoms of facial paralysis, as well as upper lid retraction and/or
paralytic ectropion (eyelid turning outward). Due to the muscle
weakness, the eyelid turns outward causing ectropion, leaving the
patient with an extremely uncomfortable eye. Topical lubricants
may help alleviate some of the patient’s symptoms. The upper lid
may lack the ability to close by itself. When severe enough and
medical management fails, surgical intervention may become necessary.
Surgical options include:
- Gold weight placement helps the lid to close.
- Raising the eyebrow back to its normal position.
- Cheek and mouth lift to achieve better symmetry with the normal
- Ectropion repair to tighten the lower (and possibly upper)
eyelid, with or without grafts or implants.
- Spring implants to help the upper lid close.