When your affected eye is wide open, doesn’t fully close or blink
In the early stages of facial paralysis, your eye may appear wide open and huge compared to your unaffected eye. You may have difficulty closing you affected eyelid no matter how hard you try. Your blinking is either not happening, or very slow and delayed compared to your unaffected eye. This is because the muscle that closes the eye – the orbicularis oculi is not working due to dysfunction of the facial nerve that normally innervates it.
In addition, your eye may feel dry, red, itchy or burning. The tears that normally lubricate the eye are no longer there or are reduced. The facial nerve also supplies the lacrimal gland which is responsible for tear production. Thus tear production can also affected when there is an insult to the facial nerve.
Consequently, eye care is of utmost importance in the early stages of onset of facial paralysis or weakness. Preventing eye dryness and it’s potential sequelae of infections or cornea damage is priority.
There are very simple strategies you can do to help prevent severe eye dryness and its sequelae.
Firstly, you should seek an evaluation from an opthamologist who can evaluate your eye thoroughly and guide you accordingly and recommend eye drops, gel or ointment as required.
Secondly, a Physical Therapist specifically trained to treat facial paralysis can guide you on some easy tips for eye care. Such tips can include eye taping options and variations, protective eyewear, eyelid stretches to maintain length of the upper eye lid, and eye closure retraining strategies. If you have had a eyelid weight inserted to assist your eye closure, you may still need some relearning strategies to learn to blink and close your eye simultaneously with your unaffected eye.
When you affected eye is smaller, feels tighter, and closes with other facial expressions
In some cases, as the facial nerve heals, there is often more innervation to the affected eye and it will feel tighter and smaller on the affected side. You may even notice that your affected eye closes with other facial expressions such as smiling, puckering, eating or talking.
Physical Therapy can teach you very gentle strategies to help to release this eye tension. Massage to the eye are is very difficult as the skin is very delicate, however there are gentle techniques that help to reduce eye tension. You can also learn movement retraining strategies to prevent the eye from closing when you use your facial muscles for another expression.