Poor Eye Closure

ANATOMY & FUNCTION OF THE FACIAL NERVE

Facial nerves are responsible for triggering the muscles related to facial expression. More specifically, the frontalis muscle raises the eyebrows, the orbicularis oculi muscle closes the eyes, and the zygomaticus muscles raise the angle of the mouth. Incomplete eye closure, also known as lagophthalmos, occurs when the eyes fail to close completely. This can cause a person’s eyes to get dry and irritated, and can also damage the cornea.

Lagophthalmos can be caused by several problems. Damage to the facial nerve, specifically the 7th cranial nerve, can result in weakness/paralysis of the muscles controlling eyelid closure: this condition is called paralytic lagophthalmos. Structural issues can result from scarring, tumors, or bulging/recessed eyes and can also cause can poor eyelid closure: this condition is called mechanical lagophthalmos. Nocturnal lagophthalmos occurs when eyelids do not fully close even though they do when awake. Finally, trauma or surgery can also cause poor eye closure: injuries or surgical procedures can damage the tissues or muscles involved in eyelid closure.

ETIOLOGIES

A weakened orbicularis oculi muscle can be congenital or acquired, and can lead to a number of conditions. It can cause partial paralysis leading to diminished blinking, incomplete eyelid closure, and sometimes nasolacrimal impairment. The inability to blink and close the eyes leads to corneal exposure and excessive evaporation of the tear film. Symptoms may include tearing and atonic eyelids.

Some specific caused of poor eye closure are related to Moebius’s Syndrome, Bell’s Palsy, vascular lesions, and tumors. Moebius’ Syndrome is a congenitally rare condition and results from underdeveloped facial nerves that control eye movement and facial expressions. It can impact the nerves for speech, swallowing, and chewing. In addition, poor eye closure can be acquired from trauma resulting in Bell’s Palsy or vascular lesions. Tumor trauma can also result in poor eye closure; more specifically, such tumor trauma can include acoustic neuroma, the parotid gland, and temporal bone tumor.

At Idaho Eyelid and Facial Plastic Surgery, we provide solutions to poor eye closure resulting in discomfort and sometimes pain. The most common surgical treatment for lagophthalmos is the insertion of a gold weight implant in the upper eyelid. This enables eyelid closure and protects the cornea. Ectropion repair can also be a useful technique in addressing lagophthalmos, as the lower lid margin is raised to meet the upper lids. When the lid is stitched back together, the tendons and muscles will tighten causing the lid to rest properly on the eye. Contact us to learn more about the best solutions to your poor eyelid closure concerns.