Restoration of lower eyelid support in facial paralysis

Lower eyelid dysfunction in the patient with facial paralysis is frequently the result of several deleterious factors, including the loss of orbicularis tone, involutional changes in the cathal ligaments, the effect of aging on the midfacial soft tissue structures, and malposition of the lower eyelid punctum. This dysfunction is manifested as lagophthalmos, ectropion, and epiphora. Fortunately, there are several surgical methods by which the various abnormalities can be corrected or compensated for. This article addresses the management of the lower eyelid and several of the current methods available to the surgeon for management of the lower eyelid in facial paralysis.