A patient with an acute facial nerve palsy is drooling and cannot close or blink the eye on the affected side. All of the following are expected consequences EXCEPT one. Which is the EXCEPTION?

Correct answer: A. Glaucoma

• A. CORRECT — this is the EXCEPTION. GLAUCOMA is a rise in intraocular pressure from impaired aqueous humour drainage. It has nothing to do with orbicularis oculi function and is not caused by facial nerve palsy.
• B. This IS expected. Incomplete lid closure during sleep (lagophthalmos) causes overnight exposure and discomfort, which is why the eye is taped and lubricant ointment used at night.
• C. This IS expected. Without blinking, the cornea is neither lubricated nor protected, and exposure keratitis with abrasion and ulceration is the most serious ocular complication of facial palsy.
• D. This IS expected. Blinking distributes the tear film; without it the eye dries. Involvement of the greater petrosal nerve fibres can also reduce lacrimal secretion directly.

Note: Eye protection is the urgent priority in facial palsy: artificial tears through the day, lubricating ointment and taping or a moisture chamber at night, and ophthalmology referral if any corneal change appears. Sight can be lost from a nerve problem if the eye is neglected.