Right Bell's palsy
This 72 year-old man was referred because of recurrent right ocular irritation and epiphora. He suffered from a right facial nerve palsy 5 years earlier but no cause was found despite extensive work up including MRI brain scan. Examination revealed a right medial ectropion and significant conjunctival exposure during lid closure. A combined medial canthoplasty and a lateral tarsal sling were carried out to reposition the punctum and reduce the conjunctival exposure. 

Right medial ectropion.

Right ocular expsoure during lid closure. The Bell's phenomenon is normal. 
The upper lid does not close completely due to paralysis of the orbicularis.

Post-operative appearance of right  medial canthoplasty and lateral sling.

The medial ectropion is corrected with reduced ocular expsorue.


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