What is Facial Palsy (Facial Weakness) ?
The facial nerve, also known as the seventh cranial nerve, innervates the muscles of facial expression. Bell’s palsy is the most common cause of facial weakness, accounting for up to 70% of all cases. Anyone can be affected but the peak age group is between 15-45 years.
What are the effects of facial weakness?
As the facial nerve supplies so many of the muscles in the face, there are many possible consequences of the nerve malfunctioning. Working from the upper face downwards these include:
- Droopy eyebrow (brow ptosis).
- Upper eyelid retraction (eye more open than the unaffected side).
- Slow, incomplete blinking.
- Inability to close eyes.
- Lower lid drop and/or ectropion.
- Sagging of the co
Treatment of facial weakness
The main priority initially is to protect the eye as reduced blinking and closure can rarely be sight-threatening. The surface of the eye can get extremely dry very quickly, making the eye prone to corneal ulcers.
Various simple measures can immediately help to improve the situation:
- Regular use throughout the day of a topical lubricating drop or gel.
- Ensuring the eye is protected at night either by using tape to close the eyelids or a thick ointment.
- Botulinum toxin can be injected into the upper eyelid in order to temporarily close the eye (ptosis) and protect the ocular surface.
Some patients, especially when it is known that the facial weakness is unlikely to recover, require surgery. There are various oculoplastic procedures which can be helpful in protecting the eye, improving function, reducing watering and re-establishing upper facial symmetry. Commonly, patients require a combination of surgical techniques from a list which includes:
- Eyebrow lift: This involves raising the dropped eyebrow, usually via a wound just above the brow hairs, and fixing the brow higher up to match the unaffected side.
- Upper lid lowering: Lowering the upper eyelid, often by inserting a gold weight into the lid, improves blinking and eyelid closure.
- Lower eyelid ectropion correction: The paralysed lower eyelid can be tightened and elevated back into contact with the eye surface.
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