title: The staged management of ophthalmic complications of facial nerve palsy.
abstract: A six-stage approach to the management of the ophthalmic complications of facial palsy was developed to aid the physician in logically organizing therapy and to provide patients with reassuring goals. This stepwise approach was applied prospectively in 120 consecutive facial palsy patients from 1986 to 1990. The six stages included (a) supportive care (with and without tarsorrhaphy), (b) planning facial reanimation, (c) lower eyelid and lateral canthal resuspension, (d) passive upper eyelid reanimation, (e) dynamic eyelid animation (palpebral springs), and (f) soft tissue repositioning including eyebrow lift and blepharoplasty. Each stage was considered in order, although action in each stage was not appropriate for all patients. All 120 patients received supportive care, which was all that was necessary to accomplish the therapeutic goals for 63 (52.5%). Eight patients received temporary tarsorrhaphies (7%) and 14 (12%) permanent. One hundred ten were considered for stage 2. Thirty-five underwent stage 3 procedures, 30 received gold weights in stage 4, 5 had palpebral springs placed in stage 5, and 6 underwent stage 6 procedures. This staged approach was effective in achieving corneal compensation, maintaining vision, and improving the quality of life in all patients.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco 94143-0730.
authors.forename: S R
authors.initials: SR
authors.lastname: Seiff
authors.forename: J S
authors.initials: JS
authors.lastname: Chang
mesh_terms: D005141:Eyelid Diseases / Q000209:etiology / Q000601:surgery*; D005158:Facial Paralysis / Q000150:complications / Q000601:surgery*; D005260:Female; D006046:Gold; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019736:Prostheses and Implants; D011788:Quality of Life; D014785:Vision, Ocular / Q000502:physiology
chemical_list: D006046:Gold