Therapeutic strategy for the surgical treatment of eyelid disorders following facial nerve palsy

With regard to eyelid complications in facial nerve palsy, the conflicting functional disorders of eyelid closing and opening pose a problem. The main cause of eyelid closure disorder is palsy of the orbicularis oculi muscle. Causes of eyelid open- ing disorders are blepharoptosis of the upper eye-lid due to palsy of the frontal muscle, aponeurotic blepharoptosis and/or originally present blepharochalasis, and contracture of the orbicularis oculi muscle and involuntary closing of the eyelids responsible for pathologic synkinesis. With regard to the therapeutic strategy for surgical treatment of the eyelids in facial nerve palsy, treatment of eyelid closure should take precedence over the treatment of eyelid opening. Further, the combination of disorders of eyelid closing and opening, which are caused by several factors, should be considered, and a suitable balance between the two conflicting functions needs to be achieved.