Authors of section


Damir Matic, John Yoo

General Editors

Daniel Buchbinder

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Irreversible paralysis - Eye complex

Eye complex

The eye complex is composed of:

  • Brow
  • Upper lid
  • Lower lid

The consequences of a paralyzed eye complex include:

  • Brow ptosis, causing asymmetry and reduction in visual field
  • Upper eyelid paralysis leading to corneal dryness and exposure, causing epiphora and pain. This may lead to corneal ulceration
  • Lower eyelid paralysis, resulting in poor tear drainage causing epiphora
  • Lower eyelid laxity, resulting in ectropion, leading to corneal exposure and pain

The immediate priority in managing a patient with facial paralysis is ensuring adequate cornea protection. This is important regardless of whether or not the paralysis is reversible.

Facial paralysis

Facial paralysis management needs to be considered based on location and degree of functional loss. Facial paralysis may involve the entire face, a portion, or any combination (e.g. brow, upper eyelid, lower eyelid, midface, lower lip). Paralysis can be either complete or partial loss of function and it can be reversible or irreversible based on the cause of nerve/muscle injury.

Definition of irreversible paralysis

Paralysis can be considered irreversible if:

  • Present for longer than 2 years
  • The distal nerve/motor unit is not present
  • Congenital facial paralysis (e.g. Moebius Syndrome)
  • No proximal or distal ending of facial nerve available


Imaging such as CT or MRI may be necessary in situations where the diagnosis or anatomy is uncertain. More details can be found in additional material, under the patient evaluation and management section.

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