Paralysis of the eyes and eyelids can result in a number of problems. The most serious problem is the inability to close the eye, which can remain open while sleeping. Persistent problems with eye closure may lead to drying of the cornea. In turn, this may result in permanent scarring and eventual blindness. This is the most compelling reason to treat facial paralysis.
Other problems include the appearance of the droopy lower eyelid. Initially, the droop may be subtle, but with time, the lower eyelid will fall further. This causes a noticeable deformity and one of the stigmata of facial paralysis. The upper eyelid may also have trouble doing its part to close the eye and can worsen the problem of the “wide eyed” look. Lastly, the dynamic effect of blinking can be affected. This is typically one of the most difficult functions to restore.
Several solutions exist for the variety of problems that can affect the eye in facial paralysis. The decision to pursue surgery is made in conjunction with an ophthalmologist’s evaluation. If signs of corneal scarring (ie, keratopathy) are present despite aggressive lubrication regimens, then the decision to undergo surgery is made urgently. Alternatively, if eyelid drooping (ie, lagophthalmos) is causing a severe cosmetic deformity, then one can also proceed with surgical correction.
A number of surgical techniques are available to correct eyelid paralysis depending upon severity. These include placement of an upper eyelid weight, lower eyelid tendon sling, or tarsorrhaphy (suturing outer part of upper and lower eyelids together), among others.
Synkinesis is the involuntary movement of facial muscles that can occur after recovery of the facial nerve. This happens most often in the setting of Bell’s palsy and can be quite disconcerting for patients. It is the result of miswiring of the downstream branches of the facial nerve during the process of nerve regeneration. In the setting of facial paralysis, eyelid twitching may be triggered by voluntary activation of other facial muscles, such as smiling or moving the mouth. Treatment to correct this problem can include surgical denervation of the interconnections between the involved muscles or with use of Botox.
Whether mild or severe, correction of eyelid problems is an important part of any treatment plan for facial paralysis. Dr. Panossian’s years of experience and specialized training in the correction of facial paralysis have assisted hundreds of patients seeking relief from their symptoms.