Weakness of the facial nerve (cranial nerve 7) is common. It can be caused by Bell’s palsy, which can be associated with a viral infection as well as with genetic predisposition, as well as with traumatic injuries to the facial nerve, e.g. excision of acoustic neuroma tumor.
Facial nerve palsy can cause severe, vision- and eye-threatening, complications secondary to corneal exposure. When the eyelids cannot protect the cornea, the cornea dries out and can become infected and perforate.
The primary treatment for corneal exposure is lubrication with gels and ointments. Punctal plugs can help, as well as moisture chambers and eyelid taping.
Sometimes the palsy is temporary, and full function recovers in approximately 6 months. In such cases, lubrication and potentially a temporary partial closure of the outer corner of the eyelids can help.
When the palsy is permanent, there are a variety of techniques that can help restore eyelid function and normal appearance. For the upper eyelids, a platinum weight can be implanted to improve eyelid blink and closure. For the lower eyelids, elevation of the cheek and tightening of the eyelid ligaments can restore lower eyelid position. A lateral tarsorrhaphy (closure of the outer corner of the eyelids) can be a helpful adjunct in some situations.
Facial nerve palsy is often associated with dyskinesia – the mis-innervation of facial muscles causing “ticks” and “spasms.” Injections with botulinum toxin to cause targeted, partial chemodenervation can help control these spastic activities, improving comfort and appearance.
Dr. Kahana has extensive expertise in the treatment of the effects of facial palsy on the eyelids and eyes. During a consultation, a customized approach will be developed to address the functional and aesthetic needs of each patient.