Hypothesis: In early management of facial paralysis the eye is best protected by conservative upper and lower eyelid support. Once the prognosis for recovery of paralysis is appreciated, a definitive plan for permanent support of eyelid function may be needed. Treatment of the lower eyelid is essential in complementing upper eyelid descent in achieving functional closure.

Methods: 20 patients with complete unilateral flaccid facial paralysis are selected for retrospective review. All patients had a gold weight loader inserted into the upper eyelid following the diagnosis. The type of operative support for the lower eyelid was directly correlated to the orbital anatomy and the relative position of the eye. An algorithm will permit the appropriate operative design to predict closure and eyelid apposition.

Conclusion: Permanent lower eyelid support is essential in achieving eyelid closure in complete facial paralysis. Individualized selection of the method of support will decrease morbidity and ocular complications. Achievement of closure can be objectively predicted by choosing the technique appropriate to the patient's orbital anatomy.