Facial nerve paresis is often associated with eyelid malposition that causes ocular surface exposure. Symptomatic dry eye or vision loss may ensue if the eyelids are not treated effectively. The paretic eyelidParetic eyelid may demonstrate loss of upper and lower eyelid tone, ectropion, upper and lower eyelid retraction, lagophthalmos, and an inadequate blink. Inadequate blinking can disrupt the tear pump mechanism and exacerbate epiphora. Concomitant vectors may add to the management. These include a prominent globe, midfacial descent, volume loss, laxity, or cicatricial vectors. Addressing eyelid malposition appropriately demands thorough attention to each vector. Interventions include acute and long-term measures to protect the ocular surface. In this chapter, the authors detail some of the preferred and expedient surgical interventions for paralyzed eyelids.