Paralysis of the Upper Eyelid Required Surgical Correction
 

Occasionally the ocularist is confronted with a patient that had severe trauma to the globe, eyelids and all extraocular and intraocular muscles resulting in its enucleation.  When this happens, any and all forms, shapes, sizes and curvatures for a prosthetic model will not completely elevate a totally paralyzed upper eyelid.  The only option is to prepare an impression moulded plastic ocular prosthesis with a normal curvature and anterior projection to that of the fellow eye.  Once this is accomplished he/she is referred back to the oculoplastic surgeon for a frontalis sling or other ptosis correcting procedure to elevate the upper eyelid.

This case presents such a condition (total paralysis of the upper eyelid and remaining orbital muscles).  A motility implant may be embedded (for orbital volume loss) within the orbital tissues and attached to the recti muscles, but there will be no coordinated movement with the sighted eye excursions.  This is another case where cosmetic optics with tinted lenses would distract others from noticing the obvious lack of motility.

Figure 20A An ocular prosthesis has been fitted with a normal curvature and anterior projection. When instructed to look upward it is evident there is no muscular response from the extraocular muscles.  Fingers are place on the eyebrow to show the full extent of the paralysis.

Figure 20B After the frontalis sling procedure the prosthetic eye appears to have a near normal aperture.  There is unfortunately, the inability to close the eyelid completely (in some cases) and when looking downward the upper lid will lag (lagophthalmos).

Figure 20C This 'worm's eye view' shows balanced projection of the prosthesis to the sighted eye.  In upward gaze, the eyelid will be elevated by the eyebrow.