Managing dry eye due to facial palsy
One of the lesser-known, yet significantly uncomfortable complications of facial palsy (like Bell’s palsy) is dry eye. This issue arises when damage to the facial nerve prevents your eye from blinking or closing properly. This leads to inadequate tear distribution, exposure of your eye, dryness, and irritation. Read on to learn more about the symptoms, causes, and most effective ways to manage and treat dry eye caused by facial palsy.
What are the symptoms of dry eye?
Dry eye can cause both discomfort and damage to the eye. Common symptoms include:
A gritty, burning, or scratchy feeling
Eye redness
A sensation of dryness
Excessive tearing (paradoxically due to dryness)
Blurred vision
Frequent eye infections
Potential corneal damage
In cases where the facial nerve (7th cranial nerve) and trigeminal nerve (5th cranial nerve, responsible for sensation in the face and eye) are both affected, the pain of dry eye may not be felt. The lack of pain sensation due to trigeminal nerve injury increases the risk of eye damage, since you are not aware and alerted early when the damage occurs.
Why does facial nerve palsy cause dry eye?
The surface of the eye is normally kept moist and protected by a film of tears produced by the lacrimal glands. Blinking spreads these tears evenly across the cornea. When blinking is impaired due to facial nerve damage, the tear film becomes uneven or absent. This exposes the eye to dryness and possible injury.
Other factors that can worsen dry eye due to facial palsy
Several additional risk factors can contribute to or exacerbate dry eye:
Age: Tear production naturally decreases with age.
Medications: Decongestants, antihistamines, antidepressants, and blood pressure medications can all reduce tear production.
Hormonal changes: Pregnancy, menopause, and use of contraceptives can make females more susceptible.
Medical conditions: Rheumatoid arthritis, diabetes, Parkinson’s disease, and thyroid issues are all linked with dry eye.
Dehydration: Not drinking enough fluids reduces tear production.
Meibomian Gland Dysfunction (MGD): These glands secrete oils that keep tears from evaporating. Dysfunction is common on the side affected by facial palsy.
How is dry eye diagnosed?
Diagnosis is usually clinical, based on symptoms and a thorough eye exam. Some specific tests include:
Schirmer’s test to assess tear production
Fluorescein staining to check for corneal surface damage
How to manage and treat dry eye due to facial palsy
Effective management of dry eye involves consistent care and several possible interventions.
Lubricating Eye Drops & Ointments
Daytime use: Preservative-free artificial tears applied frequently.
Nighttime use: Thicker ointments provide long-lasting relief.
Important: If the eye feels dry, then it is really too dry! If using drops more than four times daily, opt for preservative-free formulations to avoid irritation. Consult with your optometrist or ophthalmologist for specific recommendations.
Hot Compresses & Eyelid Hygiene
Use a warm compress daily to help with Meibomian gland function.
Follow with gentle eyelid massage and cleaning.
Protective Measures
Moisture chamber glasses or wraparound sunglasses to shield eyes from wind and evaporation. These can be helpful to protect your eye in the shower.
Taping your eye shut at night or using a contoured sleep mask to prevent corneal exposure.
Glad Press ‘n’ Seal as a makeshift moisture barrier.
Eyelid weights to help with eye closure. These can be external or may be surgically placed into the upper eye lid.
Environmental Adjustments
Use a humidifier in dry indoor environments.
Stay hydrated - aim for at least 1.2 litres (6 to 8 glasses) of water daily.
Reduce exposure to air conditioning and central heating.
Specialized Lenses
Scleral lenses: Dome-shaped lenses that bathe the eye in saline and protect the cornea. These are challenging to apply.
Therapeutic contact lenses: May be used to heal or protect the cornea but require close supervision.
Remember: even if your eye waters excessively, it might still be dry so don’t stop using your lubricants. If over-the-counter preservative free drops aren’t helping, consult your doctor for a personalized treatment plan.
Living with facial palsy brings many challenges and dry eye can be one of the most uncomfortable. With proper eye care, hydration, protective measures, and the guidance of your eye care provider, you can manage symptoms and protect your vision.
Looking for more support? Book an appointment with our experienced facial nerve palsy physiotherapists.