Facial paralysis is quite common in our population. It happens when damage to the facial nerve causes weakness of facial muscles, thus interfering with blinking, smiling, and chewing on the affected side of the face. Facial muscle weakness will also affect the patient’s quality of life by producing an undesired impact on routine activities such as driving, reading and working on the computer.
Facial paralysis is more than just a nuisance; it may become a handicap that interferes with daily life and work. The most irritating and significant problem arises from a weakened blinking mechanism. This interferes with the lubrication of the cornea, causing severe dry eye symptoms. It also puts the eye at risk of ulceration and bacterial infections.
The most common visual symptoms of facial paralysis include hypersensitivity to light, a constant foreign body sensation, chronically irritated eyes, tearing and poor vision. A patient’s inability to close the affected eye completely will cause these and other symptoms which usually worsen at night because the cornea is exposed to air for a prolonged time.
The visual symptoms of facial paralysis can be treated with non-surgical options or in some cases, may require surgery.
Non-surgical treatment of facial paralysis in ophthalmology
If the paralysis is presumably caused by a viral infection (Bell’s palsy), the best approach is to wait six months and complete physical therapy as this may be enough to experience a full recovery and avoid surgical intervention. During this time, the patient must lubricate the eye with preservative-free artificial tears and ophthalmic ointments. They should also patch the affected eye at night. The majority of patients will experience improvement without the need for surgery.
Surgical treatment of the visual symptoms of facial paralysis
When the paralysis is secondary to irreversible trauma to the facial nerve, previous surgery or a Bell’s palsy that does not improve with conservative treatments, the problem should be addressed surgically to prevent visual complications and irreversible corneal damage. The upper and lower eyelids will require surgical intervention to restore their proper blinking function.
In the upper eyelid, the best treatment is the implantation of a gold or titanium weight to allow the lid to close with each blink. The implants come in different weights, from 0.8 grams to 2.2 grams, and the weight that best accomplishes this task is calculated in the examination room. Once the correct weight is identified, the oculoplastic surgeon will place the implant under the skin and muscle of the eyelid. This procedure is performed in an operating room under local anesthesia and mild sedation. The operation is painless, and the downtime needed is about one week. The implant will allow the patient to open and close the eye normally, significantly decreasing dry eye symptoms and irritation of the ocular surface.
The lower eyelid should also be operated to restore its natural tone. This entails surgery to correct ectropion of the lower eyelid (the eyelid turning away from the eye). This surgery is usually performed at the same time that the gold weight implant is placed on the upper eyelid.
Facial paralysis does not have to affect your vision!
You do not have to live with the uncomfortable symptoms of facial paralysis anymore. Our experienced oculoplastic surgeon can help you treat the unwanted symptoms of facial paralysis that are affecting your quality of life.
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