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 with Bell’s palsy have 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, or breathing through one nostril, but mostly they experience irritating or painful problems with their eye.
One of the most common problems of facial paralysis is an inability to close the eyelid, leading to inflammation of the cornea, or exposure keratitis. Inflammation of the cornea is often a result of a combination of issues. The patient’s inability to close the eye, or lagophthalmos, leaves the eye open and susceptible to irritants. Due to muscle weakness in the eye area, the patient may have upper lid retraction and/or paralytic ectropion. Ectropion is when the eyelid is turned outward, which again leaves the patient with an extremely uncomfortable eye.
Topical lubricants may help alleviate some of the symptoms of dry eye. When the problem is very severe and medical management fails, surgical intervention may become necessary. Surgical options include:
- Placement of a gold weight inside the upper eyelid to help it close.
- Raising the eyebrow back to its normal position.
- Cheek and mouth lift to achieve better symmetry with the unaffected side.
- Ectropion repair to tighten the lower (and possibly upper) eyelid, with or without grafts or implants.
- Spring implants to help the upper lid close.