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. (see information sheet on ectropion)
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®”.
At Oxford University Hospitals NHS Trust (John Radcliffe Hospital) Mr Norris sees patients with facial nerve palsy as part of a dedicated ‘Facial Palsy’ team consisting of a plastic surgeon, psychologist, speech and language therapist and a facial physiotherapist. The aim of the service is to aid in the rehabilitation of patients using a variety of surgical and non-surgical techniques. The team are happy to review any patient (irrespective of how long the palsy has been present) who would like to review the available treatments (please see the contact page for NHS referrals). Mr Norris also takes private referrals for patients with facial palsy and associated eye problems such as poor eyelid closure, grittiness, redness and change in vision.
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.
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.
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 (see separate sheet).
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.
Eyelid surgery performed for patients with facial palsy usually performed as a day case operation and we normally allow you to go home about 30 minutes after the surgery is finished. We perform Botox injections in the clinic and you may go home after these have been completed.
The risks of surgery include postoperative bleeding, scarring to the eyelids and infection. We advise that you use an antiobiotic ointment after the surgery (see below) to help reduce the risk of infection.
If we put a gold or platinum weight in the eyelid some patients can have an allergic reaction to the weight. The weight can also occasionally become exposed and further surgery may be required.
Occasionally we may under or over correct the position of the eyelid. This may result in a flattened or peaked contour of the eyelid. Most of these complications can be corrected if needs be with a second operation.
Some patients find that they have a dry eye for some time after surgery and we can prescribe lubricants if this is the case.
The most serious risk of any eyelid surgery performed is damage to your eyesight. Fortunately this risk is extremely rare.
The eyelids will be bruised after surgery and you may have some bloodstained tears which is quite normal initially.
You should avoid any strenuous activity including lifting heavy objects for at least two weeks and avoid swimming for three weeks after surgery.
We will give you some antibiotic ointment (usually Chloramphenicol) to apply to the wounds and to the eyes after the surgery to help protect against infection and to help lubricate the eyes for two weeks.
We advise that you apply ice compresses to the eyelids after surgery for three times a day for 5 minutes each time. This is to help reduce the bruising.
We normally see you after surgery to check the position of the eyelid and remove any sutures if necessary
Usually patients are quite anxious after having surgery near their eyes and most problems do settle with time. Problems that require immediate attention are the onset of new double vision, loss of vision and pain that cannot be controlled with regular painkillers. If you have had an upper eyelid weight then you should contact us of the eyelid becomes increasingly red and swollen.
Author: Mr Jonathan Norris FRCOphth