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Facial Spasm/Paralysis

Facial Spasm or Weakness

A variety of neurologic conditions can affect facial animation. Benign essential blepharospasm is one such disorder causing uncontrolled spasms around the eyes and face. Hemi-facial spasm affects one side of the face and can be treated with neuromodulator injections around the eyes every 3-6 months typically. Sequela of Bell’s palsy causing initial facial weakness can result in long-term spasms. Hemifacial spasm is also a condition whereby spasms are on one side of the face. Sometimes tumors can cause this disorder and evaluation is necessary before initiating Botox treatment.

What is the treatment for benign essential blepharospasm (BEB)?

It is essential to reduce the triggers for eyelid blepharospasm if possible, including stress, lack of sleep, fatigue, dry eyes, and ocular surface irritation. Lubricant or allergy eye drops may be prescribed. Neuromodulator such as Botox injections every 3-6 months is the standard of treatment for BEB. If Botox or other neuromodulators are not sufficient, Dr. Amato performs a procedure called a partial Myomectomy that partially removes the eyelid muscles contributing to the spasms. This is an outpatient procedure performed under light sedation and local anesthesia. Myomectomy does not replace the need for neuromodulators after surgery but often is used in conjunction with them to complement the treatment for this chronic disease.

For more information, contact www.blepharospasm.org.

What is the treatment for hemifacial spasm?

MRI is usually indicated to determine if there is compression or a mass on the facial nerve. Neuromodulators such as Botox can improve the facial spasms with injections every 3-6 months. You may be a candidate for a nerve decompression surgery if the facial nerve appears compressed or irritated. Consultation with a neurosurgeon will determine if you are a candidate.

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What is Bell's Palsy?

Bell’s palsy is a hemifacial weakness causing facial droop. It can mimic symptoms of a stroke so prompt evaluation is necessary. Oculoplastic surgeons are highly qualified to treat effects of facial spasm or paralysis from Bell’s palsy, stroke or after surgery or trauma. If the condition does not improve on its own, more permanent treatments include Botox®, gold weight to close the eyelid, eyelid tightening/ectropion repair or midface lift/sling are various treatments. Botox® treatments usually last 3-6 months and require repeat surgery.

What causes facial palsy?

Facial paralysis is a weakness of the 7th cranial nerve that controls facial movement. It can result after an injury, stroke, tumor resection or Bell’s palsy. Loss of function of the facial muscles can result in drooping of the side of the face causing difficulty closing the eye (lagophthalmos), paralytic ectropion, blurred vision, trouble eating and drinking from drooping on the corner of the mouth, and facial droop. It is imperative to protect the eye surface by ocular lubrication and to tape the eyelid at night during this time. Some patients undergo electrical stimulation of the muscle and exercises.

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What is the treatment for facial palsy?

If the condition does not improve on its own after several months, there are several outpatient surgical procedures available to help close the eye, improve eyelid position and facial droop.

These outpatient procedures may include Gold weight placement in the upper eyelid, paralytic ectropion repair, midface, and lower facelift and brow lifting.