ASSESSMENT AND TREATMENT OF THE PARALYZED LOWER EYELID

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.