Abstract

FR.11.05

Facial nerve paresis – reconstruction of eyelid mechanics and protection of the cornea

Anja Eckstein

Abteilung für Erkrankungen des vorderen Augenabschnittes, Universitäts-Augenklinik Essen, Essen

Objective
To review possibilities of reconstruction of eyelid mechanics and protection of the cornea for patients with facial nerve paresis.
Methods
Own patient examples and relevant articles identified by searching MEDLINE are presented.
Results
Facial nerve palsies occurs most often idiopathically, with a stroke or in patients with tumors in the anatomical region of the facial nerve. Idiopathic palsies are associated with a very good prognosis (about 70% remission). However prognosis for tumor related palsies is poor. The loss of orbicularis innervation leads to malposition of the lids and incomplete lid closure. This results in corneal exposure. Patients with additional corneal hypoesthesia have a much higher incidence of corneal pathology than those with normal sensation.
Acute measures comprise regular topical ocular lubrication, moisture chamber and botulinum toxin A -induced ptosis (if corneal exposure developed despite conservative treatment). If regeneration is unlikely (in case of doubt – electrophysiology) - rehabilitative surgery can be initiated immediately.  Levator recession, temporal/nasal tarsorraphy, lateral canthal sling, medical canthoplasty and gold- or platinum weight insertion can be performed. All surgical procedures will reduce surface exposition and improve lid configuration. Additional brow elevation can also be performed.
Conclusions
Malposition of the lid and incomplete lid closure due to facial nerve paresis have to be treated immediately with lubrication and shields. If regeneration is unlikely surgical rehabilitation can be started straight away.

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