A person with facial palsy may experience dry eye problems. The facial nerve is responsible for eye closure, if this nerve becomes damaged then the eye may no longer be able to blink or close properly on the affected side. Sometimes both eyes are affected.
What are the symptoms of dry eye?
Dry eye can be a very painful condition and is a common problem for people with facial palsy. Symptoms may include:
- Gritty, burning or scratchy feeling in the eye
- Redness of the eye
- Feeling of dryness in the eye
- Excessive watering of the eye
- Blurred vision
- Frequent eye infections
- Corneal damage
Where there has been severe damage to the trigeminal nerve (responsible for sensation in the face and some motor functions such as biting, chewing, and swallowing), some people may not be able to feel the pain of dry eye, but they may still suffer with other symptoms such as excessive redness and watering of the eye. This is more dangerous as damage can occur without the patient being alerted early.
Why does dry eye occur?
Above each eyeball are the lacrimal glands which continually secrete tears. Every time a person blinks, these tears are distributed across the surface of the eye. Tears lubricate the eye, reduce risk of eye infection and wash away any foreign bodies in the eye. When the eye does not blink properly, the tears do not cover the eye surface as they should.
What other factors can make dry eye problems worse?
- Age: dry eye can become more of a problem in the elderly.
- Medications: decongestants, antihistamines, antidepressants and blood pressure medicine can all reduce tear production.
- Gender: women can become more susceptible to dry eye problems due to hormone changes, for example during pregnancy, while taking the contraceptive pill and during menopause.
- Other medical conditions: various other medical conditions can be associated with dry eye problems such as rheumatoid arthritis, diabetes, Parkinson’s disease and thyroid conditions. Conditions such as blepharitis, seborrhoeic dermatitis and rosacea can affect the quality of tears and make dry eye problems worse. If you suspect you have any of these conditions then it is important to seek medical help.
- Dehydration: insufficient daily fluid intake can make dry eye problems worse.
- Meibomian gland dysfunction (MGD): Meibomian glands are found in the eyelids. When there is a blockage or they are not functioning properly, this means they don’t secrete enough oil into the tears. Because of this the tears evaporate too quickly. MGD is a leading cause of dry eye syndrome and is also associated with an eyelid problem called blepharitis. The risk of MGD is greater on the facial palsy side and will exacerbate dry eye issues.
How is dry eye diagnosed?
The diagnosis can often be made from the above symptoms. An optometrist can normally diagnose dry eye with a thorough eye examination. They will check the cornea and the eyelids using magnification and bright light. A Schirmer’s test can be used to check tear production. Fluorescein stain is used to check for any damage to the cornea / surface of the eye.
What steps can you take to help maintain healthy eyes?
- Regularly use eye ointments and/or drops as prescribed by your doctor or eye specialist. Lubrication can be used as frequently as required to treat or prevent the occurrence of symptoms, there are usually no side effects from the lubricants.
- Where Meibomian gland dysfunction (MGD) is a factor, carrying out daily hot compresses using a wheat bag can help. Please always follow the instructions carefully to avoid burning the delicate eye area.
- Ensure you drink at least 1.2 litres of fluid each day (approximately six to eight glasses) and increase this intake in warmer weather.
- If you work on computers, blink more often and take regular breaks in line with recommended health and safety guidelines.
- Wear sunglasses on sunny days; wraparound glasses can be good for sporting pursuits and going out outdoors. Moisture chamber glasses are also helpful for some people with facial palsy and dry eye.
- If you do not wear glasses normally, you could invest in plain lens glasses for windy days.
- Reduce use of air-conditioning and central heating in the home. Both have a drying effect on the eyes.
- Some people with facial palsy tape the affected eye closed at night time. See our taping guide below.
- A contoured sleep mask can help at night if you cannot tape your eye(s) closed.
- Speak to your optician about custom-made scleral contact lenses. Scleral lenses are larger than traditional contact lenses. Normal contact lenses sit on the cornea, whereas scleral lenses are dome-shaped and vault over the cornea, resting on the white of the eye (the sclera) instead. The area underneath the lens is bathed in saline solution and can bring relief to dry eye symptoms.
- A humidifier can be helpful in the bedroom, workplace or car for people with chronic dry eye problems. Humidifiers can be purchased from stores such as Argos. You can check humidity levels in your home using a hygrometer (humidity meter); hygrometers can be purchased relatively cheaply at Amazon. Recommended humidity levels are between 30 and 50% but people with dry eye problems will probably find they are more comfortable in the 40 to 50% range. An alternative when the heating is on is to place a saucer of water on top of a radiator.
- Punctal plugs can be inserted in certain cases to increase the wetting of the eye so that the eye becomes more comfortable and fewer lubricants are required.. They can however come out by themselves, and lead to increased mucus in the eye.
- Wearing eye makeup may irritate uncomfortable eyes further, try going without for some days of the week to see if this improves eye health.
- Temporary external eyelid weights may be available from ophthalmic specialists to help the eye blink.
- Be careful with eye patches, these can scratch the cornea if the eyelids are partially open underneath it. Always seek advice from your health care provider if you are unable to close or blink the eye fully.
- Some people get on well with Glad Press ‘n’ Seal which is an overseas product, a multi-purpose wrap. You can make a moisture chamber by covering the eye with a small square of film after putting drops in. This may not be suitable where the eye is completely open and you should always ask your eye specialist for advice before use. It doesn’t work for everyone but feedback suggests it works well for some people. It is much gentler than some of the tapes.
- If your lower eyelid is drooping try using a small, narrow piece of transpore tape to lift it.
Keep using your eye drops even if your eye is watering excessively, watering can be a sign the eye is too dry!
Which eye drops or ointments should you use?
There are many dozens of lubricants available, most of which can be bought over the counter without a doctor’s prescription. There is no one brand that is suitable for everyone, Its usually worth trying a few different ones to find out which suits you best. Your doctor or eye specialist can talk you through the different products that can be used to lubricate the eye. Ointments are often better for night time use because they can blur the vision; they also coat the eye for longer. Eye drops come in varying consistencies with thinner drops more suitable for daytime use and thicker more suitable for night time.
Please note that if you are regularly using eye drops throughout the day then you should request a preservative-free formulation from your healthcare provider. The main disadvantage of preservatives in eye drops is that they may cause preservative sensitivity, especially when using the drops more than 4 times a day over long periods.
Important note: The team at the Queen Victoria Hospital in East Grinstead who made this video are now recommending patients use Transpore tape for lower lid and cheek taping and Siltape for eyelid taping overnight as it’s more gentle to remove.
Which surgical procedures can help when a person experiences severe dry eye problems?
These can include:
- Upper eyelid weight implantation: a small weight is placed into the upper eyelid. When the person automatically blinks the paralysed eye, the weight should help it spontaneously close.
- Lateral canthoplasty: this procedure strengthens the muscle and tendon at the outer corner of the eyelid stopping the lower eyelid falling away from the eye.
Last reviewed: 29-05-2020 || Next review due: 10-05-2022