Paralytic eyelid syndrome results from the global loss of neuronal input to periocular and facial musculature. Loss of innervation to the orbicularis oculi muscle, the primary eyelid protractor, allows for unopposed eyelid retractor action. Gravitational inferior displacement of atonic midfacial muscles further stretches the retaining ligaments of the lower face. Over time, this syndrome can create an anterior lamellar deficiency, lacrimal pump failure, and exposure keratopathy.1-3 Surgical correction has traditionally been accomplished with eyelid shortening and repositioning, but recurrence of ectropion in paralytic eyelid syndrome remains high.4
Fleischman GM, Thorp BD, Shockley WW, Clark JM. The Bipedicled Orbicularis Oculi Myocutaneous Flap for the Repair of Paralytic Ectropion. JAMA Facial Plast Surg. Published online December 20, 2018. doi:10.1001/jamafacial.2018.1704
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