Exploring Surgical Options for Eyelid Closure Issues After Facial Nerve Damage

Eyelid malposition or eyelid closure insufficiency?

Hello Doctor, my left facial nerve was affected after surgery for an acoustic neuroma, resulting in my left eyelid not being able to close properly, leading to dryness and irritation.
Acupuncture and massage have had limited effects, and I need to use artificial tears long-term.
I came across a procedure involving the implantation of a gold weight in the eyelid to facilitate closure, but it seems there are not many cases to reference.
Is this considered a non-mainstream surgery? Additionally, what other surgical options are available to enable proper eyelid closure without relying on eye drops? I kindly request your response, thank you.

Xiao Yu, 30~39 year old female. Ask Date: 2018/03/22

Dr. Zhou Hongzhang reply Plastic Surgery

1.
After surgery for vestibular schwannoma, if there is nerve damage, it is advisable to observe for a period of time (several months).
If the ability to close the eye does not return, then surgical intervention may be considered.

2.
There are several surgical options for treating eyelid closure insufficiency, one of which involves implanting a metal plate to weight the eyelid and improve symptoms.

3.
This issue is quite complex and requires a specialized physician to manage it.

4.
It is recommended to consult a specialized plastic surgeon at a medical center to address such cases.
Thank you.

Reply Date: 2018/03/22

More Info

After facial nerve damage, particularly following surgeries like acoustic neuroma removal, patients may experience significant complications, including eyelid closure issues. This condition, known as lagophthalmos, can lead to dry eyes, irritation, and discomfort, as the eyelid is unable to fully cover the eye during blinking or sleep. The management of this condition is crucial to prevent further complications such as corneal abrasions or infections.

Surgical options for eyelid closure problems can vary, and while some procedures may be considered less common or "non-mainstream," they can still be effective. One such procedure involves the implantation of gold weights into the upper eyelid. This technique is designed to help the eyelid close more effectively by using the weight of the implant to assist in closure, especially during blinking. While there may be limited case studies available, many ophthalmologists and oculoplastic surgeons have reported positive outcomes with this approach. It is essential to consult with a specialist who has experience in this area to discuss the potential benefits and risks.

In addition to gold weight implantation, there are other surgical interventions that can be considered:
1. Tarsorrhaphy: This procedure involves partially sewing the eyelids together to reduce exposure of the cornea. It can be temporary or permanent, depending on the severity of the condition and the patient's needs.

2. Eyelid Reconstructive Surgery: In some cases, reconstructive surgery may be performed to restore normal eyelid function. This can involve repositioning or tightening the eyelid muscles to improve closure.

3. Facial Nerve Repair: If the facial nerve damage is recent, surgical options to repair the nerve may be considered. This can potentially restore some degree of function to the eyelid.

4. Botulinum Toxin Injections: In specific cases, botulinum toxin can be injected into the eyelid muscles to help facilitate closure, although this is generally a temporary solution.

5. Electrical Stimulation Therapy: While not a surgical option, some patients benefit from electrical stimulation of the facial muscles to promote recovery and improve eyelid function.

It is important to note that while these surgical options can help improve eyelid closure, they may not eliminate the need for artificial tears entirely. Patients may still require lubrication, especially in the initial postoperative period or if they have underlying dry eye conditions.

The decision to pursue surgical intervention should be made in consultation with a qualified ophthalmologist or oculoplastic surgeon who can evaluate the specific circumstances of your case. They will consider factors such as the extent of nerve damage, overall eye health, and personal preferences when recommending a treatment plan.

In summary, while there are several surgical options available for addressing eyelid closure issues following facial nerve damage, it is crucial to have a thorough discussion with a specialist to determine the most appropriate approach for your individual situation. The goal is to restore eyelid function as much as possible while minimizing reliance on artificial tears and ensuring the health of the eye.

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