Challenges in the treatment of paralytic eyelid syndrome

Paralytic eyelid syndrome remains one of the most challenging aspects of treating patients with facial paralysis. Avoidance of corneal desiccation is the universal priority. Previously-published treatment algorithms do not include more-recently published surgical innovations (including the BOOM flap and modified Hughes flap for eyelid coupling). These additional techniques have certainly changed the treatment paradigm at institutions that have incorporated them. Given the protean clinical presentations and presence of comorbidities such as ipsilateral 5th nerve palsy and negative vector relationship, an individualized approach is necessary but the authors’ current algorithm (including detailed descriptions of the recent surgical innovations) is presented.