Here we have a younger patient with left-sided Bell’s palsy. Bell’s palsy is paralysis of the facial nerve from an unknown cause. As you can see, she has a few problems. The most pressing is that she can’t close her eye. She’s not winking; that’s what happens when you ask her to close her eyes. When you can’t blink or otherwise close your eye, the eye dries out and is prone to injury. It’s very uncomfortable! We performed a gold weight procedure to allow her to close her eye again.
Eyelid opening and closing comes from a balance between muscles that open the eye and muscles that close the eye. The muscles are controlled by different nerves. The closing muscles are controlled by your facial nerve. When you wish your eye to be open, the opening muscle fires, the closing muscle relaxes, and your eyelid opens. When you want your eyelid to close, the closing muscle fires and the opening muscle relaxes.
In this case, her closing muscle doesn’t work. When her brain tells her eye to close, the opening muscle relaxes normally, but her eye doesn’t close because the closing muscle doesn’t fire. We place a weight into the eyelid under local anesthesia in the office to make the eyelid heavier. When the opening muscle relaxes, gravity takes over and pulls the eyelid shut. The weight is light enough that the opening muscle can still pull the eyelid open when she desires. The scar is invisible when the eye is open. If the paralysis resolves we can remove the weight if the patient desires.