{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:09:32Z","timestamp":1791821372845,"version":"4.3.4"},"reference-count":115,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Eyelid retraction, cicatricial entropion, and deformities associated with facial nerve palsy are among the eyelid malpositions most detrimental to the ocular surface, as they cause exposure, tear film instability, inflammation, and potentially significant visual impairment. These conditions present major functional and esthetic challenges, underscoring the need for a clear understanding of their mechanisms and management. A narrative review was conducted using PubMed, MEDLINE, Embase, and Google Scholar to identify English and non-English studies (with English abstracts) addressing eyelid malpositions related to thyroid eye disease, cicatricial processes, and facial nerve palsy. Screening and cross-referencing yielded 115 relevant publications. Studies were excluded if they lacked clinical relevance, did not address the target disorders, involved animals, consisted of insufficient case reports, lacked an English abstract, or were non\u2013peer-reviewed or duplicated. Extracted information included patient demographics, clinical presentations, diagnostic methods, treatments, complications, and outcomes. In thyroid eye disease, eyelid retraction results from adrenergic overstimulation, increased M\u00fcller muscle tone, and fibrosis involving the levator\u2013superior rectus complex. Temporary improvement may be achieved with botulinum toxin, corticosteroids, or soft-tissue fillers, whereas sustained correction requires individualized surgical approaches. Cicatricial entropion arises from posterior lamellar contraction caused by inflammatory or iatrogenic injury and is best treated with lamellar repositioning or grafting procedures. In facial nerve palsy, incomplete blinking, punctal malposition, and lacrimal pump dysfunction contribute to tearing and ocular surface instability; management prioritizes corneal protection, eyelid rebalancing, and adjunctive measures such as botulinum toxin or physiotherapy. Across all conditions, tailored, multidisciplinary care is essential to maintain ocular surface integrity, restore eyelid function, and preserve quality of life.<\/jats:p>","DOI":"10.3390\/jcm14238523","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"8523","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Eyelid Malpositions and Ocular Surface Disease: Clinical Correlations and Management Strategies"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7072-9006","authenticated-orcid":false,"given":"Francesco M.","family":"Quaranta Leoni","sequence":"first","affiliation":[{"name":"Orbital and Adnexal Service, Tiberia Hospital\u2014GVM Care & Research, Via Emilio Praga 26, 00137 Rome, Italy"},{"name":"Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazareno","family":"Marabottini","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic Surgery, San Giovanni Addolorata Hospital, 00184 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Iuliano","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Ophthalmology, School of Medicine, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Strianese","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Ophthalmology, School of Medicine, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9993-5986","authenticated-orcid":false,"given":"Gustavo","family":"Savino","sequence":"additional","affiliation":[{"name":"Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Ophthalmology Department, Universit\u00e0 Cattolica del Sacro Cuore (UCSC), 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jtos.2022.02.001","article-title":"Ocular surface disease in thyroid eye disease: A narrative review","volume":"24","author":"Rana","year":"2022","journal-title":"Ocul. Surf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s00417-011-1863-x","article-title":"Inflammatory cytokine profiles in the tears of thyroid-associated ophthalmopathy","volume":"250","author":"Huang","year":"2012","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S92","DOI":"10.1097\/IOP.0000000000002543","article-title":"Eyelid Surgery in Thyroid Eye Disease","volume":"39","author":"Naik","year":"2023","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1136\/bjo.74.8.484","article-title":"Graves\u2019 ophthalmopathy: V. Aetiology of upper eyelid retraction","volume":"74","author":"Feldon","year":"1990","journal-title":"Br. J. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.survophthal.2012.02.007","article-title":"Graves upper eyelid retraction","volume":"58","author":"Cruz","year":"2013","journal-title":"Surv. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.2147\/OPTH.S456543","article-title":"Subcutaneous Injections of Triamcinolone Acetonide for Upper Eyelid Retraction and Swelling Associated with Thyroid Eye Disease: A Retrospective Case Series Study","volume":"18","author":"Kozaki","year":"2024","journal-title":"Clin. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chng, C.L., Zheng, K., Kwee, A.K., Ming-Han, H.L., Ting, D., Wong, C.P., Hu, G., Ooi, B.C., and Kheok, S.W. (2023). Application of artificial intelligence in the assessment of thyroid eye disease (TED): A scoping review. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1300196"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1111\/j.1755-3768.1992.tb08576.x","article-title":"Tear film profile in Graves\u2019 ophthalmopathy","volume":"70","author":"Khurana","year":"1992","journal-title":"Acta Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e608","DOI":"10.1111\/aos.14622","article-title":"Results of surgical correction of upper eyelid retraction in Graves\u2019 Orbitopathy","volume":"99","author":"Pinas","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/SAP.0b013e31818c4b22","article-title":"Lower eyelid anatomy: An update","volume":"63","author":"Kakizaki","year":"2009","journal-title":"Ann. Plast. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1089\/thy.2022.0251","article-title":"Management of Thyroid Eye Disease: Consensus Statement","volume":"32","author":"Burch","year":"2022","journal-title":"Thyroid"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1136\/bjophthalmol-2018-313578","article-title":"Course of upper eyelid retraction in thyroid eye disease","volume":"104","author":"Lee","year":"2020","journal-title":"Br. J. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1097\/IOP.0000000000001120","article-title":"Transconjunctival Triamcinolone Injection for Upper Lid Retraction in TED","volume":"34","author":"Young","year":"2018","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/00002341-200405000-00001","article-title":"Botulinum toxin type A for dysthyroid upper eyelid retraction","volume":"20","author":"Morgenstern","year":"2004","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1038\/eye.2008.165","article-title":"Comparative study of Botox injection for upper eyelid retraction","volume":"23","author":"Costa","year":"2009","journal-title":"Eye"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/IOP.0000000000000130","article-title":"Hyaluronic acid gel injection for upper eyelid retraction in thyroid eye disease","volume":"30","author":"Kohn","year":"2014","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/IOP.0b013e318137aa41","article-title":"Treatment of lower eyelid retraction by expansion with hyaluronic acid gel","volume":"23","author":"Goldberg","year":"2007","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/IOP.0b013e3181c2a16d","article-title":"Nonsurgical management of upper eyelid margin asymmetry using HA filler","volume":"27","author":"Mancini","year":"2011","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e3809","DOI":"10.1097\/GOX.0000000000003809","article-title":"Facial and Eyelid Changes in TED Are Reversed by Teprotumumab","volume":"9","author":"Ugradar","year":"2021","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1080\/01676830.2024.2323543","article-title":"Change in upper eyelid position after teprotumumab treatment for TED","volume":"43","author":"Rosenblatt","year":"2024","journal-title":"Orbit"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/IOP.0000000000002707","article-title":"Effects of Teprotumumab on Eyelid Retraction in TED","volume":"41","author":"Zhou","year":"2025","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Quaranta Leoni, F.M., Verity, D.H., and Paridaens, D. (2024). Management of Eyelid Retraction. Oculoplastic, Lacrimal and Orbital Surgery, Springer.","DOI":"10.1007\/978-3-031-39634-2"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3109\/01676839409031146","article-title":"Free Levator complex recession in Graves\u2019 Ophthalmopathy our experience","volume":"13","author":"Uccello","year":"1994","journal-title":"Orbit"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1007\/s00417-022-05853-w","article-title":"M\u00fcllerotomy with anterior graded levator disinsertion for upper eyelid retraction","volume":"261","author":"Huelin","year":"2023","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s00266-017-0978-9","article-title":"A Comparative Study of Full-Thickness Blepharotomy Versus Transconjunctival Eyelid Lengthening in the Correction of Upper Eyelid Retraction in Graves\u2019 Orbitopathy","volume":"42","author":"Nogueira","year":"2018","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1080\/01676830.2020.1860092","article-title":"Single-stage Orbital Decompression, Strabismus and Eyelid Surgery in Moderate to Severe Thyroid Associated Orbitopathy","volume":"41","author":"Leonardi","year":"2022","journal-title":"Orbit"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1093\/asj\/sjx003","article-title":"Comparison of efficacy and complications among various spacer grafts in the treatment o lower eyelid retraction: A systematic review","volume":"37","author":"Park","year":"2017","journal-title":"Aesthetic Surg. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.ophtha.2019.11.011","article-title":"Bioengineered Acellular Dermal Matrix Spacer Grafts for Lower Eyelid Retraction Repair","volume":"127","author":"Tao","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1136\/bjophthalmol-2011-300698","article-title":"Combined orbital decompression and lower eyelid recession for retraction in TED","volume":"95","author":"Norris","year":"2011","journal-title":"Br. J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/ICU.0b013e3283499433","article-title":"Surgical techniques to correct upper eyelid retraction in TED","volume":"22","author":"Kazim","year":"2011","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1080\/01676830.2016.1193546","article-title":"Success rate of TED upper eyelid retraction reoperations","volume":"35","author":"Golan","year":"2016","journal-title":"Orbit"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Narang, P., and D\u2019Souza, S. (2025). Chronic Ocular Sequelae of Stevens-Johnson Syndrome: Recent Advances in Understanding of Patho-Physiology and Management. Semin Ophthalmol., 1\u201311. Epub ahead of print.","DOI":"10.1080\/08820538.2025.2545264"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jtos.2022.02.004","article-title":"Drug-induced cicatrizing conjunctivitis: Case series and review","volume":"24","author":"Singh","year":"2022","journal-title":"Ocul. Surf."},{"key":"ref_34","first-page":"3379","article-title":"Ocular cicatricial pemphigoid","volume":"20","author":"Branisteanu","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4675","DOI":"10.1167\/iovs.13-11787","article-title":"Doxycycline prevents matrix remodeling and contraction by trichiasis-derived conjunctival fibroblasts","volume":"54","author":"Li","year":"2013","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_36","first-page":"1087","article-title":"Real-world experience of using ciclosporin-A 0.1% in the management of ocular surface inflammatory diseases","volume":"106","author":"Deshmukh","year":"2022","journal-title":"Br. J. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e20240279","DOI":"10.5935\/0004-2749.2024-0279","article-title":"Surgical treatment of eyelid sequelae due to trachoma","volume":"88","author":"Joseph","year":"2025","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/IOP.0b013e3182467c11","article-title":"Outcomes of lower eyelid cicatricial entropion repair","volume":"28","author":"Malhotra","year":"2012","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.jfo.2016.12.020","article-title":"Marginoplastie par recul de la lamelle ant\u00e9rieure dans le traitement de l\u2019entropion trichiasis trachomateux de la paupi\u00e8re sup\u00e9rieure [Anterior lamellar resection with lid margin split of the upper eyelid in the treatment of trachomatous entropion]","volume":"40","author":"Bouazza","year":"2017","journal-title":"J. Fr. Ophtalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1038\/eye.2016.77","article-title":"Modified tarsotomy for severe cicatricial entropion","volume":"30","author":"Chi","year":"2016","journal-title":"Eye"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2781","DOI":"10.1038\/s41433-020-01306-y","article-title":"Recurrent upper eyelid trachomatous entropion repair: Long-term efficacy","volume":"35","author":"Diab","year":"2021","journal-title":"Eye"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1097\/SCS.0000000000009170","article-title":"Combined surgical strategies for severe upper eyelid cicatricial entropion","volume":"34","author":"Zhang","year":"2023","journal-title":"J. Craniofac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1177\/11206721241285066","article-title":"Long-term outcomes of eyelash-sparing technique for severe cicatricial entropion","volume":"35","author":"Anklesaria","year":"2025","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3341\/kjo.2018.0010","article-title":"Ophthalmologic clinical features of facial nerve palsy patients","volume":"33","author":"Lee","year":"2019","journal-title":"Korean J. Ophthalmol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1038\/sj.eye.6701383","article-title":"Ophthalmic management of facial nerve palsy","volume":"18","author":"Lee","year":"2004","journal-title":"Eye"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"E283","DOI":"10.1002\/lary.24542","article-title":"Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center","volume":"124","author":"Hohman","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"117","DOI":"10.4103\/sjopt.sjopt_3_25","article-title":"Ophthalmic and periocular management of facial nerve palsy","volume":"39","author":"Yao","year":"2025","journal-title":"Saudi. J. Ophthalmol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3109\/08820538.2010.488578","article-title":"Lagophthalmos","volume":"25","author":"Pereira","year":"2010","journal-title":"Semin. Ophthalmol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2147\/OPTH.S481124","article-title":"Epidemiology, Tear Film, and Meibomian Gland Dysfunction in Facial Palsy: A Comparative Analysis","volume":"19","year":"2025","journal-title":"Clin. Ophthalmol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"929e","DOI":"10.1097\/PRS.0000000000001186","article-title":"Facial nerve grading scales: Systematic review and suggestion for uniformity","volume":"135","author":"Pavesi","year":"2015","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"14","DOI":"10.5152\/iao.2024.231162","article-title":"Comparison of the Reliability of the House- Brackmann, Facial Nerve Grading System 2.0, and Sunnybrook Facial Grading System for the Evaluation of Patients with Peripheral Facial Paralysis","volume":"20","author":"Mengi","year":"2024","journal-title":"J. Int. Adv. Otol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/IOP.0000000000002748","article-title":"CADS as a decision-making tool","volume":"41","author":"Yao","year":"2025","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1097\/IOP.0000000000002700","article-title":"The Effectiveness of Facial Exercise Therapy in Ophthalmic Complications of Facial Nerve Palsy and the CADS Grading Scale as an Ophthalmic-Specific Grading System","volume":"40","author":"Lim","year":"2024","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/IIO.0000000000000185","article-title":"Innovations in treatment of lagophthalmos and exposure keratopathy","volume":"57","author":"Wolkow","year":"2017","journal-title":"Int. Ophthalmol. Clin."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.12998\/wjcc.v9.i5.1127","article-title":"Management of corneal ulceration with a moisture chamber due to temporary lagophthalmos in a brain injury patient: A case report","volume":"9","author":"Yu","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_56","first-page":"36","article-title":"Taping an eyelid closed","volume":"25","author":"Stevens","year":"2012","journal-title":"Community Eye Health"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"101185","DOI":"10.1016\/j.ajoc.2021.101185","article-title":"Synthetic rubber sheet to manage exposure keratopathy","volume":"23","author":"Yoshimura","year":"2021","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1746-160X-4-12","article-title":"Temporary ectropion therapy by adhesive taping","volume":"4","author":"Schrom","year":"2008","journal-title":"Head Face Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e001933","DOI":"10.1136\/bmjophth-2024-001933","article-title":"Patients\u2019 perspectives of ophthalmic management of facial nerve paralysis","volume":"10","author":"Coulson","year":"2025","journal-title":"BMJ Open Ophthalmol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.ajo.2025.06.038","article-title":"Periocular Management of Pediatric Facial Nerve Palsy","volume":"278","author":"Lim","year":"2025","journal-title":"Am. J. Ophthalmol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2147\/OPTO.S144357","article-title":"Therapeutic uses of scleral lenses","volume":"10","author":"Harthan","year":"2018","journal-title":"Clin. Optom."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"103","DOI":"10.4274\/tjo.galenos.2024.68253","article-title":"Scleral lens in chronic lagophthalmos to preserve a corneal graft","volume":"54","author":"Kefeli","year":"2024","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/ICO.0b013e31825fed01","article-title":"Scleral lenses vs tarsorrhaphy in exposure\/neurotrophic keratopathy","volume":"32","author":"Weyns","year":"2013","journal-title":"Cornea"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/S1542-0124(12)70263-X","article-title":"Nocturnal lagophthalmos: Overview and classification","volume":"4","author":"Latkany","year":"2006","journal-title":"Ocul. Surf."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"omx087","DOI":"10.1093\/omcr\/omx087","article-title":"External eyelid weights in acute facial palsy","volume":"2018","author":"Shanmuganathan","year":"2018","journal-title":"Oxf. Med. Case. Rep."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/S0002-9394(14)72212-3","article-title":"External eyelid weights for facial palsies","volume":"120","author":"Seiff","year":"1995","journal-title":"Am. J. Ophthalmol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/IOP.0b013e31824ee702","article-title":"Protective ptosis with botulinum toxin-A in FNP","volume":"28","year":"2012","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1001\/archopht.124.4.546","article-title":"Temporary eyelid closure appliqu\u00e9","volume":"124","author":"Robinson","year":"2006","journal-title":"Arch. Ophthalmol."},{"key":"ref_69","first-page":"45","article-title":"A Novel Long-term Therapy of Facial Synkinesis with Botulinum Neurotoxins Type A and Fillers","volume":"4","author":"Wiener","year":"2011","journal-title":"J. Clin. Aesthet. Dermatol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.3109\/09638280903514697","article-title":"Botulinum toxin for synkinesis after FNP","volume":"32","author":"Toffola","year":"2010","journal-title":"Disabil. Rehabil."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1080\/01676830.2024.2444497","article-title":"Positional lagophthalmos variability in facial nerve palsy with and without upper eyelid loading","volume":"44","author":"Lu","year":"2025","journal-title":"Orbit"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/IOP.0b013e3182467bf7","article-title":"Cosmetic comparison: Gold vs platinum loading","volume":"28","author":"Bladen","year":"2012","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1136\/bjophthalmol-2016-310089","article-title":"Late outcomes of gold weights and platinum chains","volume":"102","author":"Siah","year":"2018","journal-title":"Br. J. Ophthalmol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.ajo.2019.11.025","article-title":"Platinum segment chains: Long-term outcomes","volume":"214","author":"Ullrich","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Nowak-Gospodarowicz, I., Koktysz, R., and R\u0119kas, M. (2022). Impact of implantation site in gold weight loading. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-16169-4"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/IOP.0000000000002069","article-title":"Sutureless transconjunctival eyelid weight insertion","volume":"38","author":"Elahi","year":"2022","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1136\/bjophthalmol-2011-300732","article-title":"Indications and outcomes for revision of gold implants","volume":"96","author":"Bladen","year":"2012","journal-title":"Br. J. Ophthalmol."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Shapira, Y., Ullrich, K., Masqood, S., Okafor, L., and Malhoyta, R. (2024). Eyelid skin grafting in young FNP. J. Clin. Med., 13.","DOI":"10.3390\/jcm13072142"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1097\/IOP.0000000000000387","article-title":"Bupivacaine injection for long-standing idiopathic FNP lagophthalmos","volume":"31","author":"Rajabi","year":"2015","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.1097\/GOX.0000000000000084","article-title":"Lateral periosteal flap canthoplasty for paralytic ectropion; ectropion severity score","volume":"2","author":"Korteweg","year":"2014","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1177\/11206721211051931","article-title":"Spacer grafts for lower-lid retraction in FNP","volume":"32","author":"Kim","year":"2022","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_82","first-page":"1","article-title":"Dermis spacer graft + canthopexy + subperiosteal midface lift","volume":"21","author":"Keilani","year":"2022","journal-title":"J. Maxillofac. Oral. Surg."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Tao, B.K., Dhivagaran, T., Butt, F.R., Balas, M., Hussain, A., Nijhawan, N., Nassralla, G., and Ing, E. (2025). Ectropion repair techniques; role of superotemporal skin transposition. J. Clin. Med., 14.","DOI":"10.3390\/jcm14030827"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/01.sap.0000260815.89818.31","article-title":"Midface lifting as adjunct in ectropion repair","volume":"59","author":"Chung","year":"2007","journal-title":"Ann. Plast. Surg."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/01.PRS.0000169685.54862.18","article-title":"Autogenous fascia lata in facial reanimation","volume":"116","author":"Rose","year":"2005","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1089\/fpsam.2022.0096","article-title":"Lower eyelid sling for paralytic lagophthalmos","volume":"25","author":"Bartholomew","year":"2023","journal-title":"Facial Plast. Surg. Aesthet. Med."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"273","DOI":"10.4103\/ijo.IJO_774_17","article-title":"Upper eyelid levator-recession and anterior lamella repositioning through the grey-line: Avoiding a skin-crease incision","volume":"66","author":"Pandey","year":"2018","journal-title":"Indian J. Ophthalmol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e1116","DOI":"10.1111\/aos.14155","article-title":"Meibomian gland inversion: Under-recognized entity","volume":"97","author":"Siah","year":"2019","journal-title":"Acta Ophthalmol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/IOP.0000000000001794","article-title":"Direct brow lift in facial palsy: Four key modifications","volume":"37","author":"Butler","year":"2021","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1001\/archfaci.7.1.51","article-title":"Endoscopic forehead lift in persistent facial paralysis","volume":"7","author":"Ducic","year":"2005","journal-title":"Arch. Facial Plast. Surg."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.1016\/j.otot.2021.04.004","article-title":"Modified mini direct bone-anchored browlift","volume":"34","author":"Pool","year":"2023","journal-title":"Oper. Tech. Otolaryngol. Head Neck Surg."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1097\/IOP.0000000000000710","article-title":"Periorbital autologous fat grafting in FNP","volume":"33","author":"Siah","year":"2017","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.ajo.2003.08.002","article-title":"Jones-tube lacrimal canalicular bypass","volume":"137","author":"Lim","year":"2004","journal-title":"Am. J. Ophthalmol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1055\/s-0035-1549046","article-title":"Cross-facial nerve grafting for reanimation","volume":"31","author":"Peng","year":"2015","journal-title":"Facial Plast. Surg."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.otot.2022.02.004","article-title":"Modern cross-facial nerve grafting","volume":"33","author":"Kim","year":"2022","journal-title":"Oper. Tech. Otolaryngol. Head Neck Surg."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"62","DOI":"10.2340\/jphs.v58.6527","article-title":"Triple nerve transfers for early unilateral facial palsy","volume":"58","year":"2023","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/ICO.0000000000003126","article-title":"Sural-nerve vertical cross-face graft for lacrimal neurotization","volume":"42","author":"Giannaccare","year":"2022","journal-title":"Cornea"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Quaranta Leoni, F.M., Verity, D.H., and Paridaens, D. (2024). Facial Palsy. Oculoplastic, Lacrimal and Orbital Surgery, Springer.","DOI":"10.1007\/978-3-031-39634-2"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"104511","DOI":"10.1016\/j.amjoto.2024.104511","article-title":"Physical therapy for idiopathic facial paralysis: Systematic review","volume":"46","author":"Varelas","year":"2025","journal-title":"Am. J. Otolaryngol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1177\/02692155221110727","article-title":"Facial exercise therapy in Bell\u2019s palsy: Updated systematic review","volume":"36","author":"Khan","year":"2022","journal-title":"Clin. Rehabil."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1177\/1545968313481280","article-title":"Early physical therapy in severe Bell\u2019s palsy: RCT","volume":"27","author":"Nicastri","year":"2013","journal-title":"Neurorehabilit. Neural Repair."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"937","DOI":"10.18240\/ijo.2025.05.21","article-title":"Interventions in functional epiphora-a systematic review","volume":"18","author":"Tai","year":"2025","journal-title":"Int J Ophthalmol."},{"key":"ref_103","first-page":"441","article-title":"Lacrimal bypass tube for pump failure due to facial palsy","volume":"31","author":"Madge","year":"2010","journal-title":"Am. J. Otolaryngol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1038\/eye.2015.18","article-title":"Botulinum toxin for epiphora from lacrimal outflow obstruction","volume":"29","author":"Ziahosseini","year":"2015","journal-title":"Eye"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1001\/jamaophthalmol.2014.1093","article-title":"Management of functional epiphora in patients with an anatomically patent dacryocystorhinostomy","volume":"132","author":"Shams","year":"2014","journal-title":"JAMA Ophthalmol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1111\/aos.14762","article-title":"Proximal lacrimal obstructions: A review","volume":"99","author":"Fiorino","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"e569","DOI":"10.1111\/aos.14762","article-title":"Management of proximal lacrimal obstructions: A rationale","volume":"99","author":"Fiorino","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.ajo.2009.08.012","article-title":"Lacrimal bypass tube for pump failure due to facial palsy","volume":"149","author":"Madge","year":"2010","journal-title":"Am. J. Ophthalmol."},{"key":"ref_109","unstructured":"StatPearls (2025). Crocodile Tears Syndrome, StatPearls Publishing."},{"key":"ref_110","first-page":"382","article-title":"Lacrimal gland botulinum toxin for functional vs non-functional epiphora","volume":"35","author":"Singh","year":"2019","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_111","first-page":"1921","article-title":"Lacrimal gland botulinum toxin injection for epiphora","volume":"118","author":"Wojno","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"97","DOI":"10.5693\/djo.02.2023.09.001","article-title":"Crocodile tear syndrome treated with lacrimal gland incobotulinum toxin A injection: A report of two cases","volume":"29","author":"Krivda","year":"2023","journal-title":"Digit J Ophthalmol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"2322","DOI":"10.1016\/S0161-6420(99)90534-1","article-title":"Successful treatment of crocodile tears by injection of botulinum toxin into the lacrimal gland: A case report","volume":"106","author":"Riemann","year":"1999","journal-title":"Ophthalmology"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1080\/01676830.2023.2204493","article-title":"Lacrimal gland targeted therapies for refractory epiphora: Quantitative changes in the gland activity","volume":"43","author":"Singh","year":"2024","journal-title":"Orbit"},{"key":"ref_115","unstructured":"Quaranta Leoni, F., Panariello, S., and Quaranta Leoni, F.M. Is Lacrimal Gland Excision a Viable Alternative for the Treatment of Epiphora in Canalicular Obstruction? In Proceedings of the 43\u00b0 ESOPRS Meeting, Prague, Czech Republic, 11\u201313 September 2025."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8523\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:31:40Z","timestamp":1765211500000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":115,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238523"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238523","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}