Facial Nerve Palsy

Facial palsy is caused by a problem with the nerve that supplies the muscles of the face. It usually occurs on one side but can rarely cause problems on both sides of the face. There are many different causes of a facial palsy and these will be discussed with you in clinic.

Facial palsy can affect the muscles that normally close the eye. This in turn can cause problems to the eye itself. Tears are normally wiped across the eye when you blink. In facial palsy the ability to close your eye or blink is reduced. This can result in the eye becoming very dry and exposed. When the muscle around the eye is weak, the lower eyelid will often become loose which further affects the protective tear film of the eye.

In cases of long term facial palsy the human body will sometimes try and regenerate the nerve. Sometimes when this occurs there can be some “mis-wiring” which we call “aberrant nerve regeneration”. For example the nerve that normally stimulates the muscles in the cheek may unfortunately also cause the eye to simultaneously close or to water. This can be quite problematic for patients and sometimes we treat this with Botulinum toxin commonly known as “Botox®”.

There are various different teams involved in patients with facial palsy which often include the Ear, Nose and Throat team, the Plastic surgery team and the Eye team. In some cases the palsy will improve with very little treatment required. However in some cases we need to offer treatment. Below are listed some of the treatments for your eyes and eyelids.

Medical treatments

There are a variety of treatments that can be used to protect your eye.

Firstly you should put in lubricants in the eye to protect the surface, this is particularly important at night before you sleep as the eye will often remain open during the night.

Surgical treatments

Often we can put a small weight in the eyelid to help you close your eye. This is made of either gold or platinum and is hidden underneath the skin and muscle in the eyelid.

In some urgent situations if the eye is severely affected we may actually surgically close the eyelids over the eye for protection.

If the lower eyelid is very loose then we can perform an ectropion correction.

Botulinum Toxin (Botox®/Dysport®) treatments

As mentioned occasionally the facial nerve in patients with facial plasy can regenerate and give rise to “aberrant nerve regeneration”. The treatment for this are injections of Botulinum toxin which is sometimes known as Botox®. This helps stop the wrong muscle being triggered and can help stop the eye watering when you eat.