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Facial Paralysis and Bell’s Palsy

What is Lagophthalmos?

Lagophthalmos is the inability to close the eye completely.  It is most commonly caused by paralysis of the facial nerve.  This can be from a trauma, a surgery, infection, inflammation, or a tumor.  When there is no known cause it is called Bell’s palsy.  Lagophthalmos can be very damaging to the cornea, the front part of the eye.  Ulcers can develop which can cause severe pain, scarring, and vision loss. Lagophthalmos must be treated with frequent lubrication and taping of the eye at night. 

Paralytic Ectropion
Paralytic Ectropion and Lagophthalomos of Right Eye
(​Top image shows paralytic ectropion and bottom image shows lagophthalmos)

What is the Treatment for Facial Paralysis and Bell’s Palsy?

If the facial palsy is permanent, the lagophthalmos will often need to be corrected with the surgical placement of a gold weight implant.  The weight helps the patient to close his or her eye while being light enough to allow adequate opening of the eye.  Dr. Hellman may test several weights in clinic before the surgery to determine the ideal weight.  In some cases a weight is not enough and part of the upper lid and lower lid must be sewn together with a procedure called a tarsorrhaphy.

Facial palsy also causes weakness of the orbicularis muscle in the lower eyelid.  This can cause problems with tearing and an outward turn of the lower eyelid called ectropion.  Surgical repair of a loose lower lid can also help with lagophthalmos.

The facial nerve controls the frontalis muscle, which elevates the eyebrow.  A drooping brow can be treated surgically with an endoscopic brow lift.

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