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Facial Palsy is the loss of function of the facial nerve and presents as loss of facial movement.
Bells Palsy is a type of facial palsy in which the nerve is affected after it emerges from the brain. The exact cause is not known and it affects one half of the face.
What is lagophthalmos?
Lagophthalmos is the incomplete closure of the eye.
Facial palsy is the most common cause. Other causes include
– Proptosis- due to any cause which produces bulging of the eye to a degree sufficient to prevent the complete closure of the eye
– exophthalmos due to Thyroid eye disease
What are the effects of facial palsy on the eye?
As the facial nerve supplies most of the muscles of facial expression, in facial palsy, the affected side of the face does not move well leading to an asymmetrical appearence. This loss of tone leads to
– Brow Ptosis- drooping of the brow
– Inablitlity to close the eye (lagophthalmos) and incomplete blink
– Ectropion of the lower lid
– Dry eye and Exposure keratitis due to incomplete eye closure
– Watering of the eye
How is facial palsy treated
The treatment is directed towards 2 goals
- Temporary measures to prevent complications and alleviate symptoms
- Treat the underlying cause
Temporary measures include
- Regular use of topical lubricants to keep the eye moist and comfortable
- Taping the eye closed
- Botulinum toxin injection to induce Ptosis/ drooping of the upper eyelid
- Punctual plugs
- Temporary tarsorrhaphy (stitching the eyelids together
If the defects are permanent, surgery may be required to protect the eye by correcting lagophthalmos, reduce watering, and improve the symmetry of the eyelids and face. Dr Sneha will choose one or a combinations of procedure best suited to you.
- Permanenet tarsorrhaphy– simple procedure to partially close the eye allowing the eye to see while improving eye closure
- Ectropion correction– to reposition the outturned lower eyelid, hence reduce discomfort and watering and improve eye closure
- Gold weight implant – to the upper lid weighs the lid down assisting in lid closure
- Browpexy– to support and lift the eyebrow, to improve facial symmetry
Crocodile tears – is an unusual complication of facial palsy wherein the eyes begin to water whenever the patient chews or even thinks of food. This may be treated by Botox injections to the tear gland.
Unusual eye and lid movements may also ensue due to aberrant regeneration of the nerve , which are dealt with as per the presentation of the patient.