Facial Paralysis

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 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 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.