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Eyelid in facial paralysis

Causes and symptoms

The seventh cranial nerve (facial nerve) supplies the circular muscle around the eye and other important facial muscles. There are a number of different causes Paralysis can have a variety of causes, including diabetes, multiple sclerosis, tick bite disease (Lyme disease), accident, tumor or infection. Paralysis may also persist since birth or may be temporary following vaccination. However, in more than 50% of cases, no cause can be found. Medicine then speaks of “idiopathic facial paralysis”.

The typical symptom of the eye is the incomplete eyelid closure (lagophthalmos): the lower eyelid is deeper than normal and the circular muscle does not receive enough orders from the nerves to completely close the eye.

If a facial paralysis has occurred only recently, then only the dry eye should be treated and it should be awaited whether the paralysis returns by itself. However, if the paralysis has been around for some time, the prospects for spontaneous recovery are small. Then the eyelid closure function should be improved for medical reasons, as there is a permanent eye irritation, which in extreme cases can lead to a corneal ulcer and complete vision loss.

The operation

Depending on the extent of facial nerve paralysis, one or two operations are needed:

  • Lateral block: to tighten the lower eyelid. The operation is identical to the operation of ectropium.
  • Gold weight in the upper eyelid: If there is a pronounced weakness of the eyelid, a small gold plate can be sewn into the upper eyelid. This comes under the skin to lie and is barely recognizable. The idea of ​​this plate is to help the upper lid by an additional weight (about 1 gram) to close correctly. How high the weight of the plate must be, we can determine before the operation.

Risks and complications

Although infections of the wound area may occur, they are extremely rare after this type of eyelid surgery and are treated with antibiotics.

A complete cosmetic normalization of the lid position can not be achieved because the facial nerve is still paralyzed. The aim is to ensure eyelid closure in order to prevent serious diseases of the cornea.

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