Minimally invasive techniques can protect ocular surface in short-term after facial nerve palsy

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Minimally invasive, non-surgical measures can serve as a bridge to permeant surgery in patients with facial nerve palsy patients, protecting the ocular surface, according to a presentation at AAO 2020 Virtual by Cesar A. Briceno, MD.

“It is important to have at one’s disposal several techniques to deal with in the short-term exposure keratopathy in a way that can serve as a bridge to a more permanent solution such as surgery,” he said.

The 3 main minimally invasive techniques include stick-on weights, botulinum toxin, and injectable weighting with hyaluronic acid fillers.

Stick-on eyelid weight

Stick on weights are commercially available with a prescription and sold in multiple colors to improve appearance. The weights, which are usually made of tantalum, are similar to the weights ophthalmologists typically use when sizing implantable weights. They are attached to the upper eyelid using double-sided tape and typically only last for a few days.

Botulinum toxin

Botulinum toxin can be used to induce a chemical paralysis of the levator palpebrae superioris and Muller muscle. The degree of ptosis and duration may vary according to dose and injection technique, lasting anywhere from weeks to months. Dr Briceno emphasized that it is important to make sure it has worn off completely before undergoing permanent surgery or else the patient may experience under correction.

Injectable weighting with hyaluronic acid fillers

Fillers are well-established in changing eyelid position and contour by acting as a weight or tissue expander. Different fillers will result in varying duration times, with some lasting years. The main benefit these fillers have over botulinum toxin is that it can be dissolved with a hyaluronidase injection, so patients do not need to wait for it to wear off before having permanent surgery.


Briceno CA, et al. Management of Facial Nerve Palsy. Presented at: AAO 2020 Virtual.

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