Paralysis of the orbicularis oculi muscle is by far the most serious consequences of loss of function of the facial nerve. The severity of the resultant ocular problems is related to the degree and duration of this paralysis. The primary goal of the ophthalmologist in managing the patient with orbicularis oculi paralysis is to protect the cornea. The alleviation of epiphora, correction of paralytic ectropion, and amelioration of the resultant cosmetic deformities are secondary goals. The major factor in determining the most appropriate therapeutic approach in the management of the patient with a facial paralysis is whether the paralysis is temporary or permanent. In temporary paralysis, conservative methods of treatment are usually adequate and are well documented. In permanent orbicularis paralysis, the development of lid abnormalities is inevitable, and corrective lid procedures are required. The procedures required depend on the resultant dysfunction and degree of deformity. This study reviews 65 patients who underwent surgical treatment for the ophthalmic consequences of established and permanent facial palsy in order to evaluate the efficacy of their treatment.