Eyecare in Facial Palsy

In the very early stages after developing Facial Palsy, looking after your eye health is probably the most important thing you need to focus on.

When the facial nerve is injured in this acute phase, it does not transmit messages from the brain to the eye muscles that help with opening and closing the eye. This reduces the ability of the eye to blink as well as close for sleeping etc. Another job the facial nerve should do is power the tear ducts to create tears and provide feeling to the surface of the eye. Depending on the amount or location of injury to the facial nerve, both functions can also be affected.

As a result of lack of closure, lack of tears and lack of sensation, the eye can become very dry and irritated very quickly. Just to note…. A runny or tearing eye is the sign of a very dry eye!!

In addition to the eye feeling very sore and gritty there is also the risk of developing an ulcer on the eye if it becomes too inflamed. The presence of an ulcer can cause scarring and lead to permanent damage to your vision. This is a very serious condition and is best avoided, if at all possible, through robust management at this early stage.

The tear duct produces a tear, then the eyelids close fully (usually in a blink), and spread the tear over the surface of the eye to lubricate the full eye. If not looking at a screen, this usually occurs up to 15 times per minute.

The blink is also important to prevent grit/sunlight etc going into the eye.
In normal circumstances an outer lipid or oily layer of fluid helps keep the tear on the surface of the eyeball. This oil comes from your meibomian glands which are located at the  insertion of your eyelashes. An effective blink is required to keep squeezing the oil from these glands. If the blink is not effective, these glands can get clogged up and no longer pump out the oil.

When dryness occurs, it can be due to a lack of tear production or the lack of blink spreading the tear around the full surface of the eye or also due to evaporation of the tear if the eye does not fully close when sleeping for example.

A vicious circle occurs, as the drier and more inflamed the eye becomes, the lesser the ability of the tear to stick to it, resulting in excess tearing and further drying of the eye.

Eyedrops: Use of preservative free eye drops is recommended if you are using them more than 4 times daily and for longer than 3-4 days. Brands such as hyloforte are a good option. Ideally use the eye drops quite regularly throughout the day. Do not wait for the eye to feel dry before using them. You will probably have been prescribed a thicker ointment to use at night also.

Manual blink: After inserting the drop, you should manually close down your eyelid (to mimick a blink) to allow the drop to spread over the surface of the eye. Looking down will help the eyelid close slightly and then you should gently use your finger to bring your top eyelid down to close fully. See the below video. You should perform your manual blink throughout the day (not just post drops), ideally at a minimum of once per 15 minutes. This will help to reduce the dryness in your eye and also keep the flexibility in your upper eyelid.

Avoid extended screen time: When looking at a screen our normal blink is reduced significantly. Therefore, in facial palsy where the blink is already significantly impaired, screentime should be limited as much as possible or if necessary, or if not possible due to work etc, ensure you are using drops more frequently and performing manual blinks more regularly.

Protect your eyes with wraparound sunglasses if out in the wind and avoid sitting in air conditioning/near air fans/heaters or open windows in the car.
Avoid dusty environments and if you are sensitive to light, wear glasses. Use swimming goggles when using shampoo in your hair.
Tape your eye closed at night using tape such as transpore or siltape (you can order both of these through your chemist). Follow the instructions in the video  below. If it is not possible to use tape, ie the skin is too fragile or it is too difficult to get the tape to stick, then nighttime goggles such as these are recommended and are available at the following link.

Moist heat can help keep the meibomian glands softened to allow the oil to squeeze out when doing manual blinks. Simply place a warm face cloth or compress over your eyes in the evening for 5-10mins before applying your ointment and taping your eye closed. Ensure the temperature is ok and does not burn you.

If at any point your eye is becoming red and irritated you must seek medical attention immediately, ideally with your GP, optician or opthamologist.

If you do not regain full closure within 6 weeks of onset of Facial Palsy ask your GP to refer you to an Opthamologist for further guidance on options to help with eyecare and closure.