Facial Nerve or Bell's Palsy

Certain conditions such as a Bell’s palsy, stroke or trauma to the face can cause problems with closure of the eyelids (lagophthalmos). When this happens, the patient's vision is put at risk from exposure and drying out of the cornea. In severe cases, the eye can get infected and need to be removed. Surgery to help the eye close better can often improve these conditions and better protect the eye.

The exact surgery that needs to be performed will vary from patient to patient depending on the patient’s problem, severity, age and goals. Commonly, more than one procedure is done at a given surgery. Placement of a gold or platinum weight in the upper eyelid under the skin can help achieve a more complete blink and improve closure of the eye at night. It will NOT help the patient to blink faster. A tarsorrhaphy is a procedure whereby a portion of the eyelids are sewn together to keep some or all of the eye closed permanently or semi-permanently if the palsy is expected to recover. Sometimes lower eyelid surgery is performed at the same time for an eyelid that is turned outward (ectropion).

The results of this surgery depend upon each patient’s symptoms, unique anatomy, appearance goals, and ability to adapt to changes. Eyelid closure surgery is NOT cosmetic surgery. It is being done to save the eye and make the patient more comfortable. The eye may appear more droopy or look partially closed. The surgery can often be reversed if the palsy recovers.

Eyelid closure surgery is done as an outpatient procedure. Frequently this is done in the office with local anesthesia (injection of medicine to numb the area). For patients who desire or need sedation, a procedure may be scheduled in an outpatient surgery center where intravenous sedation (also known as conscious or twilight sedation) may be offered. The specifics of the procedure are tailored to each patient's needs.

You may be willing to live with the symptoms and appearance of poor eyelid closure and decide not to have surgery on your lids at this time. In some cases the symptoms of poor closure can be improved with aggressive lubrication and taping the eyelids shut. Some patients are able to keep the eyelids closed with a patch.

Sometimes when a patient's facial nerve function returns, an eyelid may be droopy or the affected side may twitch. This is called aberrant regeneration of the facial nerve and happens when the "wires cross" as the nerve wakes back up again. Common symptoms may include a drooping lid when a patient smiles or tearing mostly when eating or chewing. These symptoms may be controlled with Botox injections.