From the Guidelines
Treatment for eyelid palsy from stroke should prioritize surgical options, such as gold weight implantation or tarsorrhaphy, to permanently improve lid closure and mitigate the risk of ocular complications, as supported by the clinical practice guideline on Bell's palsy 1. When considering treatment options, it's essential to weigh the benefits of temporary measures, such as botulinum injections, against the permanent solutions offered by surgery.
- Key considerations in the management of eyelid palsy from stroke include:
- Preventing corneal damage through the use of artificial tears and lubricating ointments
- Protecting the eye with moisture chamber glasses or eye patches during the day
- Using medical-grade tape or ptosis crutches for temporary support
- Considering botulinum toxin injections for asymmetry
- Evaluating the need for surgical intervention, such as gold weight implantation or tarsorrhaphy, after 6-12 months The guideline on Bell's palsy 1 emphasizes the importance of prophylactic eye care to prevent complications like exposure keratitis and corneal ulcerations, which can arise from incomplete eyelid closure.
- Regular follow-up with neurologists and ophthalmologists is crucial to monitor the patient's condition and adjust treatment accordingly, taking into account the potential for spontaneous improvement in eyelid function during stroke recovery. As the clinical practice guideline on Bell's palsy 1 suggests, surgical options can provide a permanent solution to improve lid closure, thereby reducing the risk of ocular complications and improving the patient's quality of life.
From the Research
Treatment Options for Eyelid Palsy from Stroke
- The management of eyelid palsy from stroke involves protecting the ocular surface through optimization of eyelid position 2.
- Initial management consists of artificial tear drops and ointment for corneal lubrication and strategies to address lagophthalmos 2.
- Surgical treatment options are available, including temporary or permanent tarsorrhaphy for lagophthalmos, upper eyelid weight placement for retraction, and lateral canthoplasty with or without a middle lamellar spacer for lower eyelid retraction 2.
- External eyelid loading is a good option in patients who are poor surgical candidates or who have a known temporary palsy of short duration 2.
- Botulinum toxin injections can be used to treat various eyelid conditions, including crocodile tears, spastic entropion, and dysthyroid upper eyelid retraction 3.
- Apraclonidine eyedrops can be used to treat ptosis resulting from administration of botulinum toxins A and B 4.
- Botulinum toxin injections into the medial lower eyelid can improve lubrication of the ocular surface and reduce discomfort in patients with dry eye 5.
Complications and Associations
- Apraxia of eyelid opening (AEO) is associated with high mortality and right hemispheric infarction after stroke 6.
- AEO is observed in 6% of patients who undergo endovascular thrombectomy (EVT) and is associated with poor survival and outcome 6.
- AEO occurs exclusively in right hemispheric infarctions, suggesting that supranuclear eyelid control is under the influence of the right cerebral hemisphere 6.