Treatments for Facial Palsy
Non-surgical Eye Treatments for Facial Palsy
- Lubricant Eye drops- ideally these should be preservative-free so they can be safely instilled as frequently as required e.g/ Hyabak (available online from Mr Ataullah’s clinic Face & Eye’s online shop at: www.faceandeyeshop.co.uk)
- Lubricant Ointment e.g. Lacri-Lube or VitA-POS – this is very useful as a long-acting lubricant at night when the partly open eyelids can result in marked drying of the eye
- Taping of the eyelids at bedtime is beneficial but the patient has to be careful to completely close the eyelids with the tape to prevent the eye rubbing on the tape
- External upper eyelid weights – these small skin-coloured weights stick onto the upper eyelid skin and help with blinking and eyelid closure
- Botulinum toxin injections (e.g. Botox, Dysport) Some patients need to have their upper eyelids lowered with Botox to paralyse the muscle which opens the eye — this allows the eyelid to drop over the surface of the eye and protect it. This usually lasts 3-4 months and may help to protect the surface of the eye whilst the facial nerve recovers some function
- Hyaluronic Acid (HA) filler injections (e.g.Restylane) into upper eyelid – HA filler can be placed through the inside of the upper eyelid to help lower a retracted upper eyelid. The filler may also act as a weight and improve eye closure and blinking
Surgical Procedures for The Eye in Facial Palsy
Surgery can improve a number of problems patients experience after a facial palsy:
Incomplete eyelid closure (lagophthalmos)
A lateral tarsal strip can improve the lax lower eyelid position and tension. Click here for more information on this procedure.
A medial canthoplasty can also be performed to improve closure of the inner corner of the eyelids by stitching the inner corner of the eyelids together.
A lateral tarsorrhaphy (the outer parts of the upper and lower eyelids are stitched together to help closure) can be performed on a temporary or permanent basis. A permanent tarsorrhaphy tends to reserved for cases where other measures have not helped. It results in shortening of the horizontal opening of the eye and so is less satisfactory from an aesthetic perspective and can compromise the patient’s visual field.
A gold or platinum weight can be implanted into the upper eyelid. This can aid upper eyelid closure significantly and can improve comfort and health of the surface of the eye. An incision through the upper eyelid skin crease and muscle is made. The weight is then stitched to the underlying tissues to secure it in position. These weights are very well tolerated and can be easily removed if facial function and eye closure were to improve at a later date.
Brow ptosis surgery
A brow droop associated with a facial palsy can be corrected surgically if there is no significant recovery of facial function.
Click here for more information on brow ptosis surgery
Watery eye surgery
Correction of a paralytic ectropion (lax out-turning lower eyelid) can often improve watering in facial palsy patients.
Click here for more information on ectropion surgery.
Occasionally the lacrimal pump function of the eyelid muscle cannot be improved (lacrimal pump failure) despite tightening the lower eyelid and the tears fail to enter the tear drainage system. In such cases a Lester Jones tube can be inserted to drain tears directly form the corner of the eye into the nose.
Click here for more information on Lester Jones tube surgery
This procedure can be used to support the sagging mid-face (a mid-face ptosis) and to reduce the constant downward dragging effect a mid-face ptosis exerts on the lower eyelid.
A mid-face lift can be performed by either lifting the SOOF (a layer of fat underneath the muscle) or by lifting other midface structures (including a sub-periosteal mid-face lift) with stitches to the bony rim or use of an Endotine mid-face device.
Click here for more information on mid-face lifts