Management of the Eye in Facial Paralysis

Abstract

Facial nerve palsy, whether the cause is idiopathic, or following such insults as surgery, trauma, or malignancy, places the health of the ocular surface at risk. Reduced or absent orbicularis oculi function results in lagophthalmos and exposure of the cornea, which is exacerbated by eyelid malposition. Management of the exposure keratopathy is paramount to prevent corneal breakdown, scarring, and permanent vision loss. Significant exposure keratopathy can be complicated by loss of corneal sensation, leading to a neurotrophic corneal ulcer. Initial management consists of artificial tear drops and ointment for corneal lubrication and strategies to address the lagophthalmos. Once the condition of the ocular surface has been stabilized, a variety of surgical treatment options are available depending on the severity and persistence of eyelid and ocular findings. The most common surgical options include temporary or permanent tarsorrhaphy for lagophthalmos, upper eyelid weight placement for retraction, and lateral canthoplasty with or without a middle lamellar spacer for lower eyelid retraction. External eyelid loading is a good option in patients who are poor surgical candidates or who have a known temporary palsy of short duration. The goal of all such procedures must be protection of the ocular surface through optimization of eyelid position.

A non-surgical approach to the management of exposure keratitis due to facial palsy by using mini-scleral lenses

“…[ 3 ] The weight of the implant pulls the lid down to cover part of the cornea. Lateral tarsorrhaphy [ 4 ] can also be performed to protect the cornea. This procedure is performed by stitching the lateral thirds of the lids together, which leaves a smaller portion of the cornea uncovered.…”

Rekonstruksjon ved facialisparese

“…Vårt førstevalg er lateral kantoplastikk, som er en operasjon der vi forkorter og strammer opp nedre øyelokk. Dette utføres ofte i kombinasjon med innleggelse av en liten tynn plate (Medpor) under muskelen i nedre øyelokk som gir støtte og stivhet (tarsalplatestøtte) (12).…”

Using Eye Aspect Ratio to Enhance Fast and Objective Assessment of Facial Paralysis

“…Facial paralysis may cause enlarged ocular fissures and an inability to close the eyes or blink. In particular, prolonged exposure of the cornea during sleep can cause dryness of the cornea, which can easily lead to eye infection and damaged vision in severe cases [6]. Studies of the objective and rapid assessment of eye motor function of facial paralysis patients are needed to develop optimal treatment regimens for facial paralysis patients to help them recover as quickly as possible.…”