Condition: Facial palsy2019-07-29T17:03:43+00:00

Facial palsy Overview

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The best way to figure out whether your specific condition can be treated or not is to give us a call. We can answer any questions you have and help you clarify which treatment options might be suitable for you.

There are different treatment options available for this condition and the most common ones are listed below:

  • Medical Treatment

  • Surgery
Learn more about treatment options

Facial palsy

What is a facial palsy?

Facial palsy is a neurological disease that affects the nerve in the face (Cranial Nerve VII). When the nerves recruited in facial muscle movement are affected, those muscles (usually on one side of the face, very rarely on both sides) cannot properly function. The most common etiology is Bell’s Palsy or idiopathic facial palsy which usually recovers spontaneously. The Ramsay-Hunt syndrome is due to a viral infection of the nerves supplying the ear, a branch of the facial nerve.

Patients with facial palsy cannot close the eye properly. This is due to a retraction of the upper lid (it is always “up”), and a drooping lower lid. The eyelids can remain open at night and as a result, the eye becomes dry and painful, and the patient may have corneal damage.

This can be very serious in some cases, particularly if there is associated loss with the nerve relating to sensation of the eye, the trigeminal nerve (Cranial Nerve Va). A neuropathic cornea cannot feel if there is a minor injury and will form an ulcer called a neurotrophic ulcer. This risks corneal scarring, perforation and loss of vision.

Causes of facial palsy

Tumours such as acoustic neuromas or surgery to remove these tumours can cause facial palsy.

Facial palsy can cause the eyebrow to droop, called a brow ptosis. The upper eyelid on the affected side has retraction and the eyelid fails to close fully. The lower lid not only sags, but can form an ectropion (eyelid turning outwards) with a cheek ptosis below and a loss of volume within the cheek. The cheek descent and atrophy accentuates the facial asymmetry. All these aspects are treated surgically by the oculoplastic surgeon, and the cheek descent and loss volume can be treated by fillers such as Restylane.
Jane Olver does not do brow lifting or cheek lifts. She does use botulinum toxin A to address asymetrical eye brow height. Patients who have long standing facial nerve palsy can develop aberrant regeneration of the facial nerve with a blepharospasm or hemifacial spasm whereby the eye starts to close up and develops an eyelid ptosis. Aberrant regeneration is treated with Botulinum Toxin A injections to the relevant muscles by the oculoplastic surgeon.

Video: What is ptosis and how can you treat it?

Examination for facial palsy

Before considering treatment, a full history and ophthalmic examination must be performed by the oculoplastic surgeon. The visual acuity is first measured and the cornea examined for dryness, exposure and ulcers. To make sure that there are no serious underlying causes of the condition, you may need a full neurological assessment by a neurologist including neuroimaging techniques such as a CT scan or MRI.

The oculoplastic surgeon will then conduct a thorough examination of the patient’s entire face, including the forehead, eyebrow, eyelid closure, orbicularis muscle strength, Bell’s phenomena, lid laxity, cheek and mouth. The eyelid examination is the most important part for planning the treatment. As assesment of eyelid laxity, palpebral aperture, corneal sensation and, possiblty, tearduct tests may also be performed.

The surgeon may take photographs / videos to document the face and eyelids movements.

Symptoms of facial palsy

A patient with facial palsy gets dry eye from lack of blinking, tear evaporation and inability to close the eye fully. The natural response is to produce excess tears which cannot drain due to the eyelid muscle (orbicularis oculi) weakness and pump failure. The patient experiences a paradoxically watering eye, when it is also dry and exposed. Facial palsy patients with eye involvement have a potentially site threatening condition that must be assessed and treated by an oculoplastic surgeon from the beginning. The surgeon will monitor the vision and decide what treatment is required.


Preserving patient’s vision and ocular comfort in facial palsy

The treatment of facial palsy is first directed at preserving the patient’s vision, secondly their ocular comfort, and thirdly correcting facial asymmetry and improving function. Good vision requires a normal tear film with normal position and function of the eyelids. The following medical and surgical treatments are used in the rehabillitation in patients with facial nerve palsy. Many of these surgeries also address the correction of the asymmetry, e.g. brow lifting, upper lid lowering and lower eyelid tightening and elevating as well as mid-face lift.

1. Medical Treatment

  • Dry eyes are treated medically using a plethera of lubricating eye drops and gels.
  • Lagophthalmos can be treated with simple measures such as padding or taping the eyes shut at night can help prevent corneal damage.

2. Surgery

  • Severe dry eyes are treated surgically using punctal plugs (temporary) or punctal cauterisation (permanent).
  • Brow ptosis is treated by raising the brow
  • Upper eyelid closure is assisted dynamically by surgical insertion of a lid load which is often a thin, gold plate weighing 1.2 or 1.4 grams, which is sutured inside the eyelid usually under local anaesthetic. For patients with gold allergies, a platinum chain weight can be used instead.
  • The lower eyelid sag and ectropion is corrected by a canthopexy/canthoplasty, such as a lateral tarsal strip or augmented strip. This tightens and elevates the lower lid at the lateral canthus.
  • The medial corner of the eyelid can be closed with a medial canthoplasty.
  • In patients with severe keratitis and risk of severe loss of vision, the upper eyelid can be lowered by a levator recession in order to protect the cornea.
  • Protective ptosis can be induced with an injection of Botulinum Toxin A (e.g. Boto ®, Dysport ®) into the inner surface of the eyelid.
  • Rarely, the eyelids are closed using a tarsorraphy with stitches between the upper and lower lids. This is typically a temporary surgery when there is a severe keratitis.
  • Watering eyes in facial palsy can be due to drying, eyelid malpoisiton or poor eyelid pump. Poor tear drainage caused by malfunctioning orbicularis muscle may require a dacryocystorhinostomy (DCR) and Jones’ Tube.
  • Some patients with chronic watering eye during eating (crocodile tears) can be treated using an injection of Botulinum Toxin A into the lacrimal gland to prevent watering for an extended period of time.

Correction of Facial Asymmetry in Facial Palsy

Treatment of the appearance of the patient’s face is very important if the facial palsy does not improve spontaneously. Medical and surgical options to regain facial symmetry include:

  • The eyebrows can be equalised by injecting the non-affecting forehead with Botulinum Toxin A to abolish the horizontal frown lines.
  • The affected eyebrow ptosis can be elevated with a direct, pretrichial or endoscopic brow lift.
  • A lateral tarsal strip (see also above) can be performed, or spacers insterted to raise the lower lids. Common spacers consist of the patient’s own ear cartilage or hard palate. At Clinica London, we also use Surederm® which is donor human collagen.
  • A mid-face lift can be performed in more severe cases of facial palsy. This is usually done under general anaesthetic. Incisions are made in specific areas that allow for minimal scarring, ideally hidden with hair or natural wrinkles. Specific devices to pull the tissues upwards (threads, Endotine®, etc.) can be used, placed beneath the muscles of the face and may be reabsorbable or remain permanently.
  • Filler injections with a hyaluronic acid gel (e.g. Restylane®, Perlane®) can also be used in facial palsy rehabilitation. More longer acting fillers include Sculptra® or autologous fat transfer. The filler is injected into the cheek on the affected side and the nasal labial fold on the unaffected side.

What our patients say

“Dr Jane Olver was fantastic! She was so caring and sweet and it was clear that she knew what she was doing – very professional! I am absolutely over the moon with my results now!”
“If you have a similar problem, Jane Olver is your woman – I wish I had found her at the start. I will be forever grateful for her care and expertise.”
Nancy W.
“Just wanted to thank you for your exceptional assistance with my eye condition. I was so worried but you really helped me feel at ease.”
David T.
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Julia S.
“Just a quick note for saying thanks for looking after my Mum so wonderfully as she was very worried about the appointment and you really made such a big difference to the experience.”
Sven K.
“Thank you very much for seeing me yesterday, you were marvellous and a pride to the NHS”
Mariah P.
“From the moment I met her to the moment I left, I was treated with great courtesy and kindness, and everything was explained to me in layman’s terms so I could fully understand my condition. I was immensely impressed.”
“Many thanks to Mr Khan. His prompt diagnosis and explanation was very reassuring indeed.”
Heather M.
“Just keep up the good work Dr Khan. My wife, who accompanied me, and I were both very impressed by the care and consideration shown by the whole team when I had surgery. I just hope they haven’t lost the knack by the time I get my other eye fixed. joking apart the care of this team has made it a wonderful experience for me.”
David S.
“Dearest Brian, Merry Christmas and a Happy New Year! Competent, sensitive doctors like you are the prize of the medical profession! I am so grateful that my experience was so positive. Love you Olga from Estonia”
“Dear Mr. Leatherbarrow and the Staff at Clinica London, Just a little not to say thank you very much for the great work you did to my eyes and the treatment I received. I am delighted with the results. Kind regards, Alexia M.”
Alexia M.
“Dear Professor Michel Michaelides , Thank you very much for your letter of the 4th September 2012. Ths means so very much to myself and Victor, during this terrible stressful time. Ever sind my first consultation with you, the caring dedication and understanding I have received from you has been priceless. Thank you with all my heart. Wishing you a healthy and happy future. Yours sincerely Doreen S.”
Doreen S.
“Dear Dr. Michaelides, I just wanted to express mine and my parents gratitude for arranging to see us all today and taking the time to answer all our questions. We left with a much greater understanding of the issues involved with genetic testing, the potential pattern of inheritance I have, and a renewed optimism over advances that could be happening in the field. It was also very helpful and reassuring to see Dr Amar again and be introduced to Jonathan the genetic counsellor – please do pass on our thanks to them as well. Yours sincerely Rachael S.”
Rachael S.
“Dear Professor Michaelides ,
Well done and thank you! You saw me last November for my annual RP assessment. You recommended to see the Glaucoma unit which I duly attended last week. (There was a delay because I had a cataract op in February)I do indeed have glaucoma as well as RP. Thankfully glaucoma is likely to be treatable with drops, so now at last the deterioration in my sight may be least partially arrested. I hope you will recommend to the retinal team that all RP suffers are tested for Glaucoma at fitting intervals. Yours sincerely, Edmund S.”
Edmund S.
“Dear Professor Michaelides ,
On behalf of my mother as well as myself, I would like to thank you for the consultation we had with you last Friday regarding my Usher Type 2/ RP condition. The knowledge and advice you shared with us was much appreciated. Today I received copy of the letter which you sent to my GP as record of the consultation. You might recall I mentioned that I have and indoor cycling frame which is great for an ex-road cyclist. If you should have any other patients who have to give up cycling on the road, I can recommend the “e-motion rollers” which is an American product and allows cyclists to ride their actual bike without modifications – suitable only for road bikes with high tyre pressure. Kind regards, Chris B.”
Chris B.
“Thank you for this, it’s nice to know you got the information you needed and were treated with respect. The team at Clinica London are good and the key thing, as you say, is seeing someone with the speciality in retinal degeneration. David “
“Dear Michel, My wife and I wish to thank you for your kindness and attention with regard to my poor eyesight. Your caring attitude and honest approach to help relieve my problem and find the best solution is overwhelming. And it is with this in mind we would like to express our sincere thanks for everything you have done for me. Kind regards, Maurice K”
Maurice K.
“Mr. Reddy was extremely kind and his special ‘duck’ noises certainly helped catch Talia’s attention and helped his examination run smoothly. Mr. Reddy informed us that Talia’s squint was severe and that glasses would not help her. He explained that she would need surgery. We have recently seen Mr. Reddy and the Orthoptist for a follow up and everyone involved is really pleased with the results of the surgery, most of all it seems is Talia.”
Rebecca and Daniel Corney
“What I loved most was her willingness to take my knowledge of my disease and experience into consideration. I am very impressed and feel lucky to be in her care.”
Fiona M.
“Dr Crawley is always in such a good mood and always does her utmost to help. Best doctor I have ever seen!”
Matthew K.
“Dr Crawley has a wonderful manner, is clearly knowledgeable and is an asset to the hospital.”
Lisa A.
“Thank you for forwarding the medical report. Please convey my thanks to Jane, I was deeply impressed by the politeness and empathy shown to me. I found the surgery very peaceful and beautifully decorated and I hope to see Jane again soon.”
Jeffrey W.
“Dear Jane,
I just wanted to say thank you for seeing me at such short notice. I felt much better after speaking to you and being reassured. I am much calmer and actually got some sleep last night.
I would also like to thank Ingrid, who was so lovely and very professional.
Best wishes, Catherine M.”
Catherine M.
“Thank you for forwarding the medical report. Please convey my thanks to Jane, I was deeply impressed by the politeness and empathy shown to me. I found the surgery very peaceful and beautifully decorated and I hope to see Jane again soon. Jeffrey W.”
Jeffrey W.
“I highly recommend Jane Olver. The whole experience was calm,and highly professional..”
Lorraine M.

“Dear Both,

Many thanks for taking care of my ptosis surgery today.
I am now back home and resting but wanted to send a quick note to thank you for taking such good care of me.

Many thanks, Charmaine”



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