Ophthalmic surgical management of facial paralysis.

Combinations of these procedures have been performed on more than 50 patients to date, with the longest follow-up being greater than 8 years. All of these patients presented with complaints of ocular irritation, tearing, photophobia, and impaired vision. Several had severe epithelial keratopathy. Some patients have also been treated following neurosurgical procedures which caused paralysis of the fifth and seventh cranial nerves, resulting in both corneal anesthesia and facial paralysis. Patients have done very well after these procedures and have achieved ocular comfort, reduced tearing, and corneal protection without the need for disfiguring and visually occluding tarsorrhaphies or other procedures. In some instances, they may still require artificial tears during the day or a lubricating protective ointment for the eye at bedtime. There have been no significant complications in this series; no cases of gold weight extrusion, recurrent ectropion, or persistent corneal epithelial keratopathy. Some patients have complained of continued excessive tearing which is most likely due to paralysis of the lacrimal pump, resulting in ineffective tear drainage to the nasal lacrimal duct. However, these patients have still noted markedly reduced tearing compared to their preoperative condition. One patient underwent secondary release of her medial canthoplasty following return of facial nerve function.(ABSTRACT TRUNCATED AT 250 WORDS)