HF 7613

Eye Care in Facial Paralysis

Facial paralysis occurs when some of the muscles of the face are either weak or paralyzed. There are many causes such as: 

  • Bell’s palsy 

  • Stroke 

  • Infection 

  • Trauma 

  • Some types of tumors 

Your doctor will help find the cause. They may start you on treatment. All types of facial nerve paralysis may affect your ability to close your eyelids all the way. 

Incomplete Eye Closure (Lagophthalmos)

Incomplete eyelid closure can result when the upper eyelid does not close, does not properly blink, or when the upper and lower eyelid does not make a tight seal. Certain types of facial paralysis may also decrease tears. These issues can cause severe drying of the eye. You must protect the eye when it cannot close or blink. It is important that the eyelids close completely when sleeping and blinking. This may lead to Exposure Keratopathy.

Signs of Eye Irritation (Exposure Keratopathy)

  • Burning or eye pain

  • Decreased or blurry vision

  • Sensitivity to light

  • Dry eye or a gritty sensation

  • Eye watering

  • Red eye 

Exposure Keratopathy can lead to decreased vision, infection, scarring, and loss of the eye in extreme cases. See a doctor right away if you have any signs of eye irritation. 

Treatment

You must take steps to protect the exposed surface of the eye if you have incomplete eyelid closure. This will help to avoid permanent damage.  

All patients with incomplete eye closure should lubricate the surface of the eye. You can do this with either an ointment or eye drops. Treatment options include:

  • Frequent use of lubricating drops called artificial tears.

  • Night time lubricating ointment with eye patching or taping.

  • Wrap-around sunglasses, goggles, and moisture chambers.

  • External, upper eyelid weights or surgery.

Eye drops do not work as well as ointments, especially at night. Ointments are great at adding moisture to the eye, but they can cause some blurry vision. 

Apply “artificial tears” at least 3-4 times a day. Sometimes you may need to use them every hour. Common brands include: 

  • Systane®

  • Refresh®

Gel tears can be used in place of regular “artificial tears” but can temporarily blur vision. Common brands are:
• Refresh Optive Gel Drops®
• Blink Gel Tears®
• Genteal Gel Drops®

Use the ointments before bed, or if drops do not provide enough lubrication. Common ointments include: 

  • Genteal®

  • Lacri-lube®

  • Refresh PM®

Other Treatments

Let your eye doctor know if you still have eye irritation, light sensitivity, or decreased vision after using drops or ointments. 

Your doctor may suggest a moisture chamber or eye patch. Taping the eyelids shut can also be done at night. Discuss how to do this with your doctor to avoid hurting the eye. Eyeseals® is a common moisture chamber. 

You can also use swim goggles. Wear large or wraparound sunglasses to protect the eye from wind or dust when outside. DryEyeZone.com has many moisture chambers.

Upper Eyelid Weights

For some patients, we can place a weight to help the upper eyelid close. These work with gravity to help the eye close when sitting upright or with the head slightly raised in bed. Options include:

  • Blinkeze® External Lid Weights For patients with short-term incomplete eye closure, a stick-on weight is useful to try. This is very useful during the day time when sitting upright.

  • Gold or Platinum Eyelid Weight Surgery 

A gold or platinum weight placed into the upper eyelid may help with eye closure. The weight can be taken out later if needed. 

Your eye doctor may give you other options. Your doctor may suggest a suture (stitch) to keep your eyelids together. This is called a temporary tarsorrhaphy. Punctal plugs or eyelid surgery might be other options to improve the position and support of the lower lid.

Who to Call

To schedule a visit with UW Health General Ophthalmology or Optometry call (608) 263-7171. 

If your facial paralysis lasts for more than three months, you may ask your doctor to refer you to the UW Facial Nerve Clinic. 

To schedule a visit with the UW Facial Nerve Clinic call (608) 263-6190. 

To find out more about facial paralysis visit our website at https://www.uwhealth.org/facialnerve