As an eyelid specialist in Denver, I take care of patients with droopy eyelids constantly. I also take care of patients who have Bell's palsy. Some patients have both. In those patients it is critical as an eyelid specialist to know what you are doing and treat both problems
When a patient has Bell’s palsy, they can have trouble closing the eyelid. This is called lagophthalmos. Along with that, sometimes Bell’s palsy patients can have a drooping eyelid. What are the considerations when determining how to lift the eyelid in a patient who has Bell’s palsy? These three things are critical for the health of the eye especially if the surgery is being done on the affected side as the Bell’s palsy.
Make sure that eye can close completely before you lift it
In patients with a residual facial nerve palsy such as Bell’s palsy, it is important to assess the ability to close the eye. Along with that one must look at their cornea on a slit lamp microscope. This is only available in an oculoplastic surgeon’s office. When we lift the eyelid the eyelid closure problems can be worse. If the cornea or front of the eye is threatened, this can be made worse from surgery. It is important to assess this.
Correct the drooping conservatively
It is key in Bell’s palsy ptosis repair patients to be conservative in how high you lift the eyelid. If you lift an eyelid too much, eyelid closure will be much worse and the cornea can be damaged or destroyed. It goes without saying that you need to make sure that if a gold weight is placed on that eyelid that is drooping, you address the weight and positioning of the gold weight, not performing a ptosis repair.
Be aware of synkinesis
Eyelid Synkinesis is when the nerve that controls eyelid closure or opening goes off when the patient smiles or whistles or many other facial expressions. Synkinesis can cause the eyelid to appear closed or more narrow and botox is the treatment, not surgery
These are three things for my patients in denver with drooping eyelids and bell's palsy seeking treatment need to know about. It is key to find a doctor who looks at these issues and knows how to prevent a complication in the eye or cornea by not missing them.
In the patient above I lifted the left eyelid conservatively so she could still close the eye, see better. I did not remove skin above the eyelid so the eye closure was kept intact. To remove that skin would be aggressive and potentially cause lagophthalmos or eyelid closure problems after surgery