This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on ISI (1)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Neurology  • External Eye Disease  • Alert me on articles by topic

Adam S. Hassan, MD; Bartley R. Frueh, MD; Victor M. Elner, MD, PhD

Arch Ophthalmol. 2005;123:1221-1225.

Background  Facial nerve palsy often results in symptoms of ocular irritation due to inadequate eyelid closure. Weakened protractor function results in relative upper eyelid retraction and contributes to lagophthalmos.

Objective  To evaluate the role of müllerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy.

Methods  Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Müller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower eyelid retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, lagophthalmos, and keratopathy were compared.

Results  Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper eyelid position was lowered by an average of 1.35 mm (P<.001). Lagophthalmos (P = .002) and corneal exposure (P<.001) were significantly improved. Three patients required levator aponeurosis repair, 2 for preexisting dehiscence and 1 for inadvertent aponeurosis transection.

Conclusion  Müllerectomy is a rapid, safe, and reproducible surgical method for lowering the upper eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.

Author Affiliations: Departments of Ophthalmology (Drs Hassan, Frueh, and Elner) and Pathology (Dr Elner), University of Michigan, Ann Arbor.