Management of ophthalmic complications of facial nerve palsy.

Six stages--supportive care (with or without tarsorrhaphy), planning for facial reanimation, lower eyelid and lateral canthal resuspension, passive upper eyelid reanimation, dynamic eyelid reanimation, and soft tissue repositioning--should be considered in the management of the ophthalmic complications of facial nerve palsies. Each stage should be considered in order, although action in each stage may not be appropriate for all patients. In addition, after appropriate consideration, two or more staged procedures may be performed at the same time. Treatment may be held at any stage in which the cornea is compensated and the patient is comfortable and happy. By employing this staged approach, the surgeon has a method of organizing therapy in a logical fashion, and the patient is offered a set of reassuring goals, which combine to make the treatment plan more effective.