title: Management of the eye in facial paralysis.
abstract: Facial nerve palsy, whether the cause is idiopathic, or following such insults as surgery, trauma, or malignancy, places the health of the ocular surface at risk. Reduced or absent orbicularis oculi function results in lagophthalmos and exposure of the cornea, which is exacerbated by eyelid malposition. Management of the exposure keratopathy is paramount to prevent corneal breakdown, scarring, and permanent vision loss. Significant exposure keratopathy can be complicated by loss of corneal sensation, leading to a neurotrophic corneal ulcer. Initial management consists of artificial tear drops and ointment for corneal lubrication and strategies to address the lagophthalmos. Once the condition of the ocular surface has been stabilized, a variety of surgical treatment options are available depending on the severity and persistence of eyelid and ocular findings. The most common surgical options include temporary or permanent tarsorrhaphy for lagophthalmos, upper eyelid weight placement for retraction, and lateral canthoplasty with or without a middle lamellar spacer for lower eyelid retraction. External eyelid loading is a good option in patients who are poor surgical candidates or who have a known temporary palsy of short duration. The goal of all such procedures must be protection of the ocular surface through optimization of eyelid position.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Sohrab
authors.affiliation: Department of Ophthalmology, Howard University Hospital, Washington, District of Columbia.
authors.forename: Usiwoma
authors.initials: U
authors.lastname: Abugo
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Grant
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Shannath
authors.initials: S
authors.lastname: Merbs
mesh_terms: D003316:Corneal Diseases / Q000209:etiology / Q000517:prevention & control*; D005141:Eyelid Diseases / Q000209:etiology / Q000628:therapy*; D005143:Eyelids / Q000601:surgery*; D005154:Facial Nerve / Q000503:physiopathology; D005158:Facial Paralysis / Q000150:complications*; D005782:Gels; D006801:Humans; D065346:Lubricant Eye Drops / Q000627:therapeutic use; D009824:Ointments / Q000627:therapeutic use; D019651:Plastic Surgery Procedures
chemical_list: D005782:Gels; D065346:Lubricant Eye Drops; D009824:Ointments