The enhanced palpebral spring

Abstract

The inability to close the eye and the loss of blinking are among the most devastating effects of facial paralysis, often leading to extreme discomfort and visual loss. I have modified the palpebral spring operation, originally described by Morel-Fatio and Lalardrie, and have found it to be the best procedure for managing the ocular sequelae of facial paralysis in patients in whom the paralysis is expected to last at least 6 months, and/or in whom medical management alone is not adequate. In recent years, I also tighten the levator palpebrae superioris when I implant a spring, an operation I call the “enhanced palpebral spring.” Tightening the levator reduces pseudoptosis and increases blink speed. Although technically demanding, the satisfaction achieved by both the patient and the surgeon makes the effort worthwhile.