What are two recommended methods for keeping the eye from drying out in patients with Bells palsy who are unable to close their eyes completely?

Figure 1.

Simultaneously recorded OO-EMG activities, upper eyelid and eye movements during blinking in one subject. (A) Superposition of six successive traces of voluntary blinks and their OO-EMG activities. (B) Superposition of six successive traces of palsied corneal air puff-induced blinks and their OO-EMG activities. Lines 1 and 2: OO-EMG activities in the palsied and nonpalsied eyelid, respectively; lines 3 and 5: vertical displacement; lines 4 and 6: the horizontal eyelid displacement at palsied and nonpalsied sides; lines 7 and 9: represent the vertical eye displacement at palsied and nonpalsied sides; and lines 8 and 10:represent the horizontal eye displacement at palsied and nonpalsied sides. Note the abnormal vertical displacement (lines 7 and 9) and the large horizontal displacement (lines 8 and 10) of the eyes during voluntary blinking. The bar in front of lines 1 and 2 corresponds with a 200 μV OO-EMG signal. Vertical bar in front of lines 3 to 10corresponds with a 50° rotation; duration bar: 100 ms.

Figure 1.

Simultaneously recorded OO-EMG activities, upper eyelid and eye movements during blinking in one subject. (A) Superposition of six successive traces of voluntary blinks and their OO-EMG activities. (B) Superposition of six successive traces of palsied corneal air puff-induced blinks and their OO-EMG activities. Lines 1 and 2: OO-EMG activities in the palsied and nonpalsied eyelid, respectively; lines 3 and 5: vertical displacement; lines 4 and 6: the horizontal eyelid displacement at palsied and nonpalsied sides; lines 7 and 9: represent the vertical eye displacement at palsied and nonpalsied sides; and lines 8 and 10:represent the horizontal eye displacement at palsied and nonpalsied sides. Note the abnormal vertical displacement (lines 7 and 9) and the large horizontal displacement (lines 8 and 10) of the eyes during voluntary blinking. The bar in front of lines 1 and 2 corresponds with a 200 μV OO-EMG signal. Vertical bar in front of lines 3 to 10corresponds with a 50° rotation; duration bar: 100 ms.

Figure 2.

Profiles of six superimposed successive traces of simultaneous recorded eyelid and eye movement during voluntary and reflex blinking measured from the same patient as in Figure 1 . (A) Eyelid movement during voluntary blinking recorded at the onset of the affliction. (B, C) Eyelid and eye movement during voluntary blinking recorded at 30 and 72 weeks, respectively. (D) Eyelid movement after a corneal air puff on the palsied side recorded at the onset of the affliction. (E, F) Eyelid and eye movement after a corneal air puff on the palsied side recorded at 30 at 72 weeks, respectively. Eyelid movement motility remained impaired in both types of blinking throughout the study. Both eyes move in the same abnormal direction during voluntary blinking, whereas in reflex blinking the direction of eye movement is normal after 72 weeks; however, the amplitude on the palsied side remains smaller.

Figure 2.

Profiles of six superimposed successive traces of simultaneous recorded eyelid and eye movement during voluntary and reflex blinking measured from the same patient as in Figure 1 . (A) Eyelid movement during voluntary blinking recorded at the onset of the affliction. (B, C) Eyelid and eye movement during voluntary blinking recorded at 30 and 72 weeks, respectively. (D) Eyelid movement after a corneal air puff on the palsied side recorded at the onset of the affliction. (E, F) Eyelid and eye movement after a corneal air puff on the palsied side recorded at 30 at 72 weeks, respectively. Eyelid movement motility remained impaired in both types of blinking throughout the study. Both eyes move in the same abnormal direction during voluntary blinking, whereas in reflex blinking the direction of eye movement is normal after 72 weeks; however, the amplitude on the palsied side remains smaller.

Figure 3.

Schematic representations of OO-EMG and eyelid kinematics during recovery. Shown are eyelid movement start time (A), duration of the up phase (B), maximum amplitude (C), maximum velocity (D), and time maximum velocity (E), along with the amplitude (F), the summed amplitudes (G), and the start time (H) of the OO-EMG over the recovery time. Light blue: voluntary blinking, red: corneal air-puff–induced blinking on the nonpalsied side; green: corneal air-puff–induced blinking on the palsied side; purple: acoustic-click–induced blinking. Thick lines: values on the palsied side; thin lines: values on the nonpalsied side. In (A), (E), and (H), values from voluntary blinking (light blue) are absent, as an exact start time of a “trigger” cannot be determined for this type of blinking.

Figure 3.

Schematic representations of OO-EMG and eyelid kinematics during recovery. Shown are eyelid movement start time (A), duration of the up phase (B), maximum amplitude (C), maximum velocity (D), and time maximum velocity (E), along with the amplitude (F), the summed amplitudes (G), and the start time (H) of the OO-EMG over the recovery time. Light blue: voluntary blinking, red: corneal air-puff–induced blinking on the nonpalsied side; green: corneal air-puff–induced blinking on the palsied side; purple: acoustic-click–induced blinking. Thick lines: values on the palsied side; thin lines: values on the nonpalsied side. In (A), (E), and (H), values from voluntary blinking (light blue) are absent, as an exact start time of a “trigger” cannot be determined for this type of blinking.

Table 1.

OO-EMG and Eyelid Kinematics at Four Moments during Recovery of Voluntary and Reflex Blinking

Table 1.

OO-EMG and Eyelid Kinematics at Four Moments during Recovery of Voluntary and Reflex Blinking

Table 2.

Differences in OO-EMG and Eyelid Kinematics between Nonpalsied and Palsied Sides

Table 2.

Differences in OO-EMG and Eyelid Kinematics between Nonpalsied and Palsied Sides

Table 3.

Eye Movement Parameters after 30 and 72 Weeks of Recovery

Table 3.

Eye Movement Parameters after 30 and 72 Weeks of Recovery