What is your preferred surgical intervention for lagophthalmos secondary to a facial paralysis and signs of exposure keratopathy?

If temporary or early in the recovery, consider stick-on external eyelid weights.

If it has been several months without any improvement, I like to do gold or platinum permanent weights sutured to the tarsus, in addition to a lower lid tightening as Dr. @Dr. First Last mentioned.

Facial paralysis creates a flaccid ectropion unlike any other ectropion, senile or cicatricial. This is because the absence of orbicularis muscle tone also causes a flaccid punctal ectropion, which must be addressed as well. So, a combination of a medial tarsal suspension and a lateral tarsal strip ...

If temporary, then a temporary tarsorrhaphy can be very helpful. If permanent, then we can consider either ectropion repair with lateral tarsal strip if the primary issue is lower lid laxity and exposure from that. Can also consider 1/3 to 1/2 or more permanent lateral tarsorrhaphy, depending on how...

I almost always address lower lid laxity first if present. Upper lid weights are great, whether permanent or temporary. However, I do think attention should be paid to corneal sensation at the presentation, as patients with significant anesthesia or hypoesthesia have a markedly elevated risk for com...