Comprehensive management of the eye in facial paralysis

To determine guidelines for the management of paralyzed eyelids following facial palsy, including surgical indications, timing, and type of procedure(s).

Prospective analysis of 60 patients diagnosed as having complete facial palsy. Follow-up ranged from 18 to 36 months.

All subjects had a complete unilateral facial palsy of various origins. Ages ranged from 6 to 81 years.

Forty patients underwent evoked electromyography and blink reflex testing of the facial nerve. Twenty additional patients had a known fifth-degree nerve injury that did not require testing.

Lack of interval improvement in clinical results of examination and/or evoked electromyography, coupled with length of time from injury, were used to determine surgical candidacy. All patients with fifth-degree nerve injury were considered surgical candidates, with clinical examination results of eyelid function used to determine which procedure(s) to be performed.

Of the 60 patients evaluated with facial palsy, 43 patients required surgical restoration of eyelid function. Forty-one patients required gold weight implants; 18 of these also required shortening of the lower eyelid. Two additional patients underwent eyelid shortening without gold weight implantation. Seventeen patients were treated only with corneal lubricants and moisturizers. No gold weights extruded; there were no infections. Two patients required revision of their lower eyelid surgery owing to progressive laxity. Four patients have had their gold weights removed an average of 9.5 months following insertion.

The degree of neural injury and its associated regeneration time, determined clinically and by evoked electromyography, are useful factors to assist in patient selection, surgical timing, and type of procedure(s) necessary to fully rehabilitate the upper and lower eyelids following facial paralysis.