Daf. Ellis et La. Kleiman, ASSESSMENT AND TREATMENT OF THE PARALYZED LOWER EYELID, Archives of otolaryngology, head & neck surgery, 119(12), 1993, pp. 1338-1344
Paralysis of the upper part of the face results in both loss of functi
on and cosmesis of the eyelids. While much has been discussed concerni
ng the upper lid, assessment of the lower lid has often been nonspecif
ic. The dysfunctional lower lid can be classified into medial and late
ral problems. Medial canthal laxity results in retraction of the infer
ior punctum away from the globe in a lateral, anterior, and inferior p
osition. The interruption of the passive lacrimal drainage system, in
combination with the ablation of the lacrimal pump provided by the orb
icular muscle of the ye, results in epiphora. Lateral canthal laxity p
roduces scleral show and when severe, ectropion. These features contri
bute to the failure of the lower lid to approximate the upper lid even
when the upper lid has been fully rehabilitated. A margin gap of the
lid aperture can ultimately lead to corneal keratitis and deterioratio
n of vision. Rehabilitation of the lower lids is dependent on accurate
assessment of the presenting anatomical deformities and their correct
ion. In a series of nine patients, these deformities have been address
ed. To correct medial canthal laxity and to reestablish contact of the
inferior punctum to the globe, support has been provided with static
slings. Polytef (Gore-Tex), which is nonelastic, has proved to be an e
xcellent static sling material. To correct lateral canthal laxity resu
lting in scleral show and ectropion, lateral lid shortening procedures
were performed. These procedures, in conjunction with upper lid rehab
ilitation, have been successful in providing better function and cosme
sis to the paralyzed eye.