Treatment of the Periocular Complex in Paralytic Lagophthalmos

Myriam Loyo, Danielle Jones, Linda N. Lee, Ryan M. Collar, Josher Molendijk, Kofi D. Boahene, Lisa E. Ishii, Patrick J. Byrne

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objectives: Paralytic lagophthalmos can lead to devastating exposure keratitis. The main surgical intervention consists of upper eyelid loading. However, adjunctive lower eyelid and brow procedures are also available as necessary. We sought to analyze the use of periocular procedures in paralytic lagophthalmos at Johns Hopkins. Methods: The method was a retrospective review of patients treated at a single tertiary care center from 2006 to 2012. Results: One hundred one patients met inclusion criteria, and 20 patients were excluded for not meeting the minimum follow-up. Upper eyelid loading was required on 95/101 patients (95%). Adjunctive procedures were necessary in 73% (73/101) of patients. Lower eyelid procedures were used in 47% (47/101) and brow lifts in 47% (47/101). Older patients (>50 years) were more likely to require lower eyelid procedures (P =.04) and more likely to require revision (P =.003). Medial canthopexy and direct brow lift were associated with the need for revision (P =.006, P =.03). Conclusion: Paralytic lagophthalmos management is not one-size-fits-all. Upper eyelid loading is the mainstay of treatment; however, adjunctive procedures to the lower eyelid and brow are indicated in the majority of patients. Our retrospective review has allowed us to continue to refine our strategy for managing these patients.

Original languageEnglish (US)
Pages (from-to)273-279
Number of pages7
JournalAnnals of Otology, Rhinology and Laryngology
Issue number4
StatePublished - Apr 1 2015
Externally publishedYes


  • brow lift
  • canthopexy
  • facial paralysis
  • paralytic lagophthalmos
  • upper eyelid loading

ASJC Scopus subject areas

  • Otorhinolaryngology


Dive into the research topics of 'Treatment of the Periocular Complex in Paralytic Lagophthalmos'. Together they form a unique fingerprint.

Cite this