Paralysis of the upper part of the face results in both loss of function and cosmesis of the eyelids. While much has been discussed concerning the upper lid, assessment of the lower lid has often been nonspecific. The dysfunctional lower lid can be classified into medial and lateral problems. Medial canthal laxity results in retraction of the inferior punctum away from the globe in a lateral, anterior, and inferior position. The interruption of the passive lacrimal drainage system, in combination with the ablation of the lacrimal pump provided by the orbicular muscle of the eye, results in epiphora. Lateral canthal laxity produces scleral show and, when severe, ectropion. These features contribute 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 deterioration of vision. Rehabilitation of the lower lid is dependent on accurate assessment of the presenting anatomical deformities and their correction. In a series of nine patients, these deformities have been addressed. 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 excellent static sling material. To correct lateral canthal laxity resulting in scleral show and ectropion, lateral lid shortening procedures were performed. These procedures, in conjunction with upper lid rehabilitation, have been successful in providing better function and cosmesis to the paralyzed eye.
(Arch Otolaryngol Head Neck Surg. 1993;119:1338-1344)
Ellis DAF, Kleiman LA. Assessment and Treatment of the Paralyzed Lower Eyelid. Arch Otolaryngol Head Neck Surg. 1993;119(12):1338-1344. doi:10.1001/archotol.1993.01880240074009