Free muscle grafting and other treatments for paralytic lagophthalmos

Abstract

The various static and dynamic corrective surgical procedures used in the treatment of paralytic lagophthalmos are reviewed. Dynamic corrections are mainly used for the upper eyelid, whereas the lower eyelid only warrants static correction.The paralytic upper eyelid can be reanimated with a variety of methods. Cross-face free muscle transplantation is the best way for obtaining unconscious eyelid closure with only autologous tissues. A simpler way is lid loading with a metal weight. Transposition of a flap of the temporal muscle may also achieve similar results.None of these methods will rival normal eyelid function. Yet, relatively simple procedures may bring about good protection of the cornea and alleviation of epiphora without diminution of the field of vision as after tarsorrhaphies.