title: A new lid sign in seventh nerve palsy.
abstract: This paper describes a new lid sign in two patients with facial nerve paralysis. The facial nerve palsy was secondary to a pontine abscess in the first case and a complication of acoustic neuroma resection in the second patient. Both patients were found to have absence of the normal nasal twist of the lower lid during eyelid closure. The nasal twist is felt to help pump tears into the lacrimal drainage system. This paper will describe the absence of an important eyelid function in a patient with facial nerve paralysis. By way of background, Doane's slow motion movies have shown that during a normal blink, the upper lid moves both down and nasally, while the lower lid moves from 2 to 5 mm nasally. As the upper lid descends, the lower lid normally moves 2 to 5 mm in a horizontal and nasal direction. This motion of the lower lid helps produce a partial vacuum in the lacrimal system and is responsible for moving the fluid and debris in the tear mentiscus across the eye and into the lacrimal drainage system. The two cases of facial nerve paralysis to be presented demonstrate absence of tear drainage on the side of the lesion and a build-up and overflow of the tears on that side.
mesh_terms: D000038:Abscess / Q000150:complications; D000368:Aged; D001927:Brain Diseases / Q000150:complications; D005143:Eyelids / Q000503:physiopathology*; D005158:Facial Paralysis / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery; D011149:Pons; D011183:Postoperative Complications