Correction of paralytic lagophthalmos

Bell's palsy causes lagophthalmos of the involved eyelids. Secondary to the atonicity of the eyelids, xerophthalmia, conjunctivitis and epiphora develops. There are dynamic (muscle transfers) and static (gold weights, tarsorrhaphy) approaches to alleviate these problems. The GOALS of this study are to present a technical note for a surgical method for lengthening the retracted upper eyelid with autogenous temporalis fascia and elevation of the lower eyelid with transplantation of autogenous morselized conchal cartilage graft via standard blepharoplasty incisions.

The proposed technique is illustrated in details with an example of a patient with paralytic lagophtalmos. The 4 years follow up of the case operated by this technique shows a stable occlusion of the eyelids with a lowering of the upper eyelid and elevation of the lower eyelid margin.

If the paralysis is complete this technique will not accomplish adequate relieve of symptoms. In this cases re-animation of the eyelids with either temporalis muscle transfers or free micro neurovascular muscle transfers are indicated.