• Adam S Hassan, Bartley R Frueh, and Victor M Elner.
• Department of Ophthalmology, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, USA.
• Arch Ophthalmol Chic. 2005 Sep 1; 123 (9): 1221-5.

BackgroundFacial 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.ObjectiveTo evaluate the role of müllerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy.MethodsThirty-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.ResultsOf 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.ConclusionMüllerectomy 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.

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