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Left side facial paralysis issues

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  • Left side facial paralysis issues

    I had very successful LASIK surgery in 2000 with 10 units of correction on the right side and 8 on the left with no need for enhancement. I had mild post-surgical dryness that resolved rapidly. I still consider LASIK to be one of the best medical expenditures I have made. I am also very glad that I had the surgery then, because I would no longer be a candidate.

    In 2008 I had microvascular decompression surgery for hemifacial spasm. (This involved a craniostomy and is similar to the retrosigmoid surgery for acoustic neuroma.) My left facial nerve was distressed during the surgery and I awoke with left side facial paralysis. (My full HFS story may be read at http://www.hfs-assn.org/diarylinks/shartman-mvd.htm)

    In the nearly five years since my surgery I have regained significant facial function - I would say 65-70% - but my left eye still has diminished tear capacity and an incomplete blink. I have a 1.8 gram platinum eyelid weight that gives me complete nighttime closure but not a complete blink. I currently use Refresh PM ointment 24/7 which has kept my cornea healthy. Of course it blurs my vision on that side, but my brain has learned to compensate.

    I first heard about scleral lenses about three years ago and asked my ophthalmic surgeon about them. He told me that they were designed primarily for Gulf War soldiers who had lost their eyelids and had zero protection for their eyes, that they were extremely expensive and really not necessary for a case like mine. A year or so ago I brought it up again and he gave me permission to pursue a specialist in dry eye care.

    Life happened and things came up but last month I finally found a optometrist in the next city over who fits scleral lenses. My first visit was a couple of weeks ago and he persuaded me to give Lotemax and Restasis a 3-month trial first. He said that my right eye was slightly dry and should also be treated. Taken by surprise, I agreed.

    Now I regret that decision. I use the Restatis twice daily and can barely stand the 15 minutes of stinging and burning before I can reapply Refresh PM. I searched for Restatis use among the members of a facial paralysis support forum and could not find a single instance where it helped. I believe this is due to two factors. First, my ophthalmic surgeon told me that how much tear production I would regain was dependent on where the nerve was injured. After five years, I have what I am ever going to get. Second, without a complete blink. even if the tears could be increased, they wouldn't be distributed properly over my eye.

    Another regret is that I purchased an expensive pair of glasses with progressive lenses. My right eye has regressed slightly, to a -1. The left lens is -0.25, I believe just to have something there. The glasses do help when I am driving or watching TV, but I don't find the progressive part at all helpful. I have to tilt my head back to see and I end up taking off the prescription glasses and put on a pair of readers. If I am going to swap out anyway, I wish I had just bought a pair of single vision glasses. Live and learn.

    I have just been in contact with the optometrist again and he agreed to allow me to move up the scleral fitting. I just made an appointment for next Thursday. I am hoping that we are able to fit a scleral lens on the left and a regular soft or gas permeable lens on the right.

  • #2
    I was looking back in my notes about past appointments. The first time I asked about a scleral lens was September 19, 2008, almost FIVE years ago. I had read an article about the Boston Foundation for Sight work with soldiers and printed it out to show my ophthalmic surgeon at the follow-up for my eyelid implant. I told him I thought it would make a great research project to look at the effectiveness of the lens for facial paralysis patients. He said had been at the hospital where they treat the soldiers to confer with the doctors there. At that time the lens was primarily used in burn wards where the patient has no eyelids. It shows promise in short-term use, but he thinks it is not suitable for mobile patients with other options.

    If this works out for me I am definitely making a follow-up appointment to show him otherwise.

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