Paralytic ectropion / facial nerve palsy
Introduction
Paralytic ectropion is caused by ipsilateral facial palsy and is related to retraction of the upper and lower lids and brow ptosis; the latter may mimic narrowing of the palpebral aperture.
Complications include exposure keratopathy thanks to lagophthalmos, and watering caused by malposition of the inferior lacrimal punctum, failure of the lacrimal pump mechanism and a rise in tear production resulting from corneal exposure.
Treatment
• Temporary
measures could also be instituted to guard the cornea in anticipation of spontaneous recovery of facial function.
○ Lubrication with higher viscosity tear substitutes during the day, with instillation of ointment and taping shut of the lids during sleep, are usually adequate in mild cases.
○ neurotoxin injection into the levator to induce temporary ptosis.
○ Temporary tarsorrhaphy could also be necessary, particularly in patients with a poor Bell phenomenon with the cornea remaining exposed when the patient attempts to blink; the lateral aspects of the upper and lower lids are sutured together.
• Permanenttreatment
should be considered when there's irreversible damage to the facial as may occur following removal of an acoustic neuroma, or when no further improvement has occurred for 6-12 months during a Bell palsy.
○ Medial canthoplasty could also be performed if the medial canthal tendon is unbroken . The eyelids are sutured together medial to the lacrimal puncta in order that the puncta become inverted and therefore the fissure between the inner canthus and puncta is shortened.
○ A lateral canthal sling or tarsal strip could also be wont to correct residual ectropion and lift the lateral canthus.
○ Upper eyelid lowering by levator disinsertion.
○ Gold weight implantation within the upper lid can assist closure.
○ little lateral tarsorrhaphy is typically cosmetically
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