• Medical
  • Goal: Maintaining a normal corneal epithelium
    • Temporary: Lubrication, moisture chamber
    • Used at varying intervals
    • Ointments are more effective in corneal protection; however, they often substantially blur vision.
    • If this is not effective or if the paralysis is expected to persist, more permanent therapy would include procedures which narrow the palpebral fissure such as tarrsorhaphy (see below)

    • BlinkezeT External Lid Weights provide an immediate, voluntary blink mechanism for treating ocular exposure associated with temporary facial paralysis such as Bell's palsy.

      BENEFITS

      • Effective non-surgical eyelid closure treatment
      • Superior patient comfort and ease of use
      • Simplifies supportive eye care
      • Enhanced patient satisfaction

• Surgical (usually wait several months)
  • Goal: Closure of the eyelids  to narrow the palpebral fissure and decrease evaporation.
    • Horizontal Closure
      • Permanent: lateral tarsorraphy
        • Tarsorrhaphy has been the standard method of managing exposure keratitis and is often effective if large enough.
        • large tarsorrhaphies may be disfiguring and limit peripheral vision.
        • a lateral tarsorrhaphy of <5 mm is not noticeable and can be integrated with other procedures to obtain optimal results.
      • Medial tarsorrhaphies
        • more disfiguring
        • generally used as a last resort in managing surface exposure.
    • Vertical Closure
      • Lower-lid elevation with spacers
        • fascia lata or silicone sling to lower eyelid
        • Hard palate or Alloderm implant
        • Midface lift
      • Upper eyelid lowering
        • gold weight (e.g. Lid Load) insertion a light (1 mg weight ) manufactured by various companies in weights from 0.6 to 1.6 grams may be fixed to pretarsal space of the upper eyelid.
        • The weight allows the eyelid to close more easily.
        • The weights may be taped to the pretarsal portion of the upper lid to determine which size will be needed to reduce the Lagophthalmos .
        • Excess weight may cause Ptosis .
        • Implantation involves an incision at the upper lid crease which  exposes the anterior surface of the tarsal plate. The weight is then secured in position

Terms

Lagophthalmos : Patients with lagophthalmos have an inability to close eyelids. This may occur, for instance, in patients with Thyroid eye disease. Visit the lagophthalmos page for more details.

Ptosis : Ptosis is also known as Blepharoptosis. It refers to an eyelid which is droopy. This may cause a loss of vision, especially while reading, headaches, and eyebrow strain. Please click on the Ptosis page for more details.