Download PDF
Semin Plast Surg 2004; 18(1): 31-38
DOI: 10.1055/s-2004-823121
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Ophthalmic Management of the Facial Palsy Patient

Philip L. Custer1
  • 1Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, MO
Further Information

Publication History

Publication Date:
20 April 2004 (online)

    Permissions and Reprints

The management of the ocular sequelae of facial palsy should be individualized for each patient. The patient's age, ocular motility, tear production, and corneal sensation are considered when developing a treatment plan. Individuals with transient weakness often require only therapy with topical lubricants. Permanent or chronic facial paralysis is usually associated with lagophthalmos, ectropion, and exposure keratitis. Both “static” and “dynamic” procedures can be performed to improve these conditions. Combined eyelid surgery and suspension of the midface often provides the best result. However, patients with permanent facial palsy usually suffer chronic ocular symptoms, requiring long-term follow-up and continued topical therapy.

KEYWORDS

Lagophthalmos - paralytic ectropion - exposure keratopathy

REFERENCES

  • 1 Leatherbarrow B, Collin J RO. Eyelid surgery in facial palsy.  Eye. 1991;  5 585-590
    CrossrefPubMedGoogle Scholar
  • 2 Tenzel R R, Buffam F V, Miller G R. The use of the “lateral canthal sling” in ectropion repair.  Can J Ophthalmol. 1977;  12 199-202
    PubMedGoogle Scholar
  • 3 Anderson R L, Gordy D D. The tarsal strip procedure.  Arch Ophthalmol. 1979;  97 2192-2196
    CrossrefPubMedGoogle Scholar
  • 4 Oliver J M. Raising the suborbicularis oculi fat (SOOF): its role in chronic facial palsy.  Br J Ophthalmol. 2000;  84 1401-1406
    CrossrefPubMedGoogle Scholar
  • 5 May M, Hoffmann D F, Buerger G F, Soll D B. Management of the paralyzed lower eyelid by implanting auricular cartilage.  Arch Otolaryngol Head Neck Surg. 1990;  116 786-788
    Google Scholar
  • 6 Morel-Fatio D, Lalardrie J P. Palliative surgical treatment of facial paralysis. The palpebral spring.  Plast Reconstr Surg. 1964;  33 446-456
    CrossrefPubMedGoogle Scholar
  • 7 May M. Gold weight and wire spring implants as alternatives to tarsorrhaphy.  Arch Otolaryngol Head Neck Surg. 1987;  113 656-660
    CrossrefPubMedGoogle Scholar
  • 8 May M. Paralyzed eyelids reanimated with a closed-eyelid spring.  Laryngoscope. 1988;  98 382-385
    PubMedGoogle Scholar
  • 9 McNeill J I, Oh Y. An improved palpebral spring for the management of paralytic lagophthalmos.  Ophthalmology. 1991;  98 715-719
    PubMedGoogle Scholar
  • 10 Arion H G. Dynamic closure of the lids in paralysis of the orbicularis muscle.  Int Surg. 1972;  57 48-50
    PubMedGoogle Scholar
  • 11 Gilliland G D, Wobig J L, Dailey R A. A modified surgical technique in the treatment of facial nerve palsies.  Ophthal Plast Reconstr Surg. 1998;  14 94-98
    PubMedGoogle Scholar
  • 12 Wiggs E O, Guibor P, Hecht S D, Wolfley D E. Surgical treatment of the denervated or sagging lower lid.  Ophthalmology. 1982;  89 428-432
    PubMedGoogle Scholar
  • 13 Ueda K, Harii K, Yamada A, Asato H. A comparison of temporal muscle transfer and lid loading in the treatment of paralytic lagophthalmos.  Scand J Plast Reconstr Surg Hand Surg. 1995;  29 45-49
    CrossrefPubMedGoogle Scholar
  • 14 Smellie G D. Restoration of the blinking reflex in facial palsy by a simple lid-load operation.  Br J Plast Surg. 1966;  19 279-283
    Google Scholar
  • 15 Jobe R. Gold lid loads.  Plast Reconstr Surg. 1993;  91 563-564
    PubMedGoogle Scholar
  • 16 Harrisberg B P, Singh R P, Croxson G R, Taylor R F, McCluskey P J. Long-term outcome of gold eyelid weights in patients with facial nerve palsy.  Otol Neurotol. 2001;  22 397-400
    PubMedGoogle Scholar
  • 17 Misra A, Grover R, Withey S, Grobbelaar A O, Harrison D H. Reducing postoperative morbidity after the insertion of gold weights to treat lagophthalmos.  Ann Plast Surg. 2000;  45 623-628
    PubMedGoogle Scholar
  • 18 Pickford M A, Scamp T, Harrison D H. Morbidity after gold weight insertion into the upper eyelid in facial palsy.  Br J Plast Surg. 1992;  45 460-464
    CrossrefPubMedGoogle Scholar
  • 19 Chepeha D B, Yoo J, Birt C et al.. Prospective evaluation of eyelid function with gold weight implant and lower eyelid shortening for facial paralysis.  Arch Otolaryngol Head Neck Surg. 2001;  127 299-303
    PubMedGoogle Scholar
  • 20 Bair R L, Harris G J, Lyon D B, Komorowski R A. Noninfectious inflammatory response to gold weight eyelid implants.  Ophthal Plast Reconstr Surg. 1995;  11 209-214
    CrossrefPubMedGoogle Scholar
  • 21 Seiff S R, Sullivan J H, Freeman N, Ahn J. Pretarsal fixation of gold weights in facial nerve palsy.  Ophthal Plast Reconstr Surg. 1989;  5 104-109
    CrossrefPubMedGoogle Scholar
  • 22 Canady J W, Meine J, Thompson S A, Yuh W TC. Effects of magnetic resonance imaging fields on gold eyelid loads.  Ann Plast Surg. 1993;  31 76-77
    PubMedGoogle Scholar
  • 23 Lisman R D, Smith B, Baker D, Arthurs B. Efficacy of surgical treatment for paralytic ectropion.  Ophthalmology. 1987;  94 671-681
    PubMedGoogle Scholar
  • 24 Hofmann R J. Treatment of Frey's syndrome (gustatory sweating) and ‘crocodile tears’ (gustatory epiphora) with purified botulinum toxin.  Ophthal Plast Reconstr Surg. 2000;  16 289-291
    CrossrefPubMedGoogle Scholar
  • 25 Lee O S. An operation for the correction of everted lacrimal puncta.  Am J Ophthalmol. 1951;  34 575-578
    PubMedGoogle Scholar
  • 26 Hontanilla B. Weight measurement of upper eyelid gold implants for lagophthalmos in facial paralysis.  Plast Reconstr Surg. 2001;  108 1539-1543
    CrossrefPubMedGoogle Scholar

Philip L CusterM.D. 

Department of Ophthalmology, Washington University School of Medicine

660 S. Euclid Avenue, Box 8096

St. Louis, MO 63110

      >