Eye Effects of Facial Paralysis

The facial nerve controls many muscles in the face, including those that help you smile, frown, close your eyes, and raise your eyebrows. If this nerve is damaged — due to trauma, surgery, stroke, Bell’s palsy, or infection — one side of the face may become weak or paralyzed.

When this happens, the eye on the affected side may:

• Water or tear constantly

• Feel dry, scratchy, or irritated

• Have a droopy upper or lower eyelid

• Have trouble blinking or closing fully

Some people may also have facial drooping, speech changes, or difficulty eating.

Sometimes facial nerve function improves over a few months. In other cases, recovery is only partial or incomplete. As the nerve heals, some muscles may move in unusual or uncoordinated ways — this is called synkinesis.

Common symptoms of synkinesis:

• Eyelid spasms or twitching

• Squinting when chewing

• Drooping of the upper eyelid

These changes are often permanent, but treatments are available to help manage symptoms.

For Eye Protection

If the eye does not close well, it may dry out, especially at night. Treatment may include:

• Artificial tears and ointment

• Moisture goggles or eye taping at bedtime

• Surgery to improve eyelid closure, such as:

   • Tightening a loose lower eyelid

   • Partially sewing the eyelids together at the outer corner (tarsorrhaphy)

   • Placing a gold or platinum weight in the upper eyelid to help it close

These procedures are often reversible if nerve function improves.

For Facial Symmetry

When paralysis is long-lasting, surgery may be considered to:

• Lift the brow or corner of the mouth

• Improve balance between both sides of the face

• Restore muscle movement (facial reanimation surgery)

For Synkinesis

Treatment for uncoordinated facial movement may include:

• Physical therapy to retrain muscles

• Botulinum toxin injections to reduce spasms

• Medication or, in some cases, surgery

Your oculofacial plastic surgeon will help you decide what options are best based on your symptoms and goals.

• Repeat procedures may be needed, especially if nerve function changes over time.

• As with any surgery, bleeding and infection are possible but uncommon.

• Let your doctor know if you take blood thinners, as they can increase the risk of bleeding.

No surgeon can guarantee a perfect result, but the goal is always to improve eye comfort, protect vision, and restore balance to the face. Every case is different, so it’s important to discuss your concerns openly with your doctor.