The evaluation and treatment of lower eyelid paralysis

The lower eyelid conforms precisely across its length to the complex topography of the cornea, conjunctiva, and globe. Along with the upper eyelid, it protects the eye from foreign bodies, prevents desiccation, and helps circulate the tear film from its origin in the lacrimal gland to its drainage at the lacrimal puncta. Paralysis of the lower eyelid may result in ectropion, lid laxity, epiphora, and lagophthalmos. This article presents a structural approach to the evaluation and treatment of lower eyelid paralysis and describes the surgical procedures designed to correct the three-dimensional anatomic abnormalities underlying this disorder. These procedures are frequently performed in conjunction with upper lid procedures that are described in a previous article by Bergeron and Moe in this issue of the journal.