The Evaluation and Treatment of Lower Eyelid Paralysis

Abstract

The lower eyelid conforms precisely across its length to the complex topography of the cornea, conjunctiva, and globe. Along with the upper eyelid, it protects the eye from foreign bodies, prevents desiccation, and helps circulate the tear film from its origin in the lacrimal gland to its drainage at the lacrimal puncta. Paralysis of the lower eyelid may result in ectropion, lid laxity, epiphora, and lagophthalmos. This article presents a structural approach to the evaluation and treatment of lower eyelid paralysis and describes the surgical procedures designed to correct the three-dimensional anatomic abnormalities underlying this disorder. These procedures are frequently performed in conjunction with upper lid procedures that are described in a previous article by Bergeron and Moe in this issue of the journal.

Cranial Nerve Seven Palsy and Its Influence on Meibomian Gland Function

“…11 With CN VII palsy and eyelid paralysis, tear insufficiency is believed to result from increased tear evaporation, secondary to exposure, and/or decreased tear production. 4,7 Important consideration should be given to the role meibomian glands play in tear insufficiency and dry eyes.…”

“…The loss of the blink reflex in the affected eye also predisposes the eye to ocular sequelae such as lagophthalmos with corneal exposure, eyelid retraction, ectropion, brow ptosis, and decreased tear production. 4,6,7 The authors hypothesize that the inability to blink adequately after cranial nerve seven injury leads to stasis of the meibomian gland secretions, resulting in poor lubrication and subsequent corneal irritation. The purpose of this study was to investigate if a relationship between CN VII palsy and meibomian gland dysfunction exists.…”

The Effectiveness of Simultaneous Lateral Tarsal Strip With Endonasal Dacryocystorhinostomy for the Treatment of Nasolacrimal Duct Obstruction and Lower Lid Laxity

“…Secondary lid supports include the lower lid retractors, which help maintain the lid in anterior-posterior balance, the orbicularis oculi muscle, which forms a muscular sling around the eyelid and orbital contents and prevents the lid from tilting posteriorly. 17 Abnormal position, orientation, and tension of the lower eyelid can cause symptoms and signs including foreign body sensation, grittiness, burning, superficial punctuate keratopathy, and epiphora, as well as corneal scarring and visual loss. 18 Lower eyelid malposition and laxity can be caused by involutional attenuation or fatty infiltration of the supporting medial and lateral canthal tendons and by traumatic, neoplastic, neuropathic, and inflammatory damage to various components of the eyelid and the surrounding tissues.…”

Surgical management of facial nerve paralysis in the pediatric population

“…Ocular competence is one of the most important functional aspects that must be maintained in a pediatric patient so as to prevent ocular dryness, corneal abrasion, and potential irreversible blindness [50,95]. More complicated procedures including lateral tarsorrhaphy for the upper eyelid [96] and medial canthopexy for ptosis of the lower eyelid [97] are generally avoided in children, unless all other options have failed. In adult patients, other static reanimation techniques are frequently used including fascia lata or W. L. Gore & Associates, Inc (Newark, Delaware) facial suspension [98,99] and brow ptosis correction [100].…”