Orbicularis Oculi Strength Test

The Orbicularis Oculi Strength Test is a clinical manual muscle test to assess the function of the orbicularis oculi muscle, which is responsible for closing the eyelid. This muscle is innervated by the facial nerve (cranial nerve VII). The test is an important component for screening facial nerve integrity and detecting facial palsy, such as Bell’s palsy.

How the Test is Performed

  • Client position: Seated or lying comfortably.

  • The client is asked to close both eyes tightly.

  • The therapist gently but firmly tries to open the eyelids by separating the upper and lower lids on one side at a time using their clean fingers.

  • Normal (negative test): The client can keep the eyes closed against the therapist’s resistance.

  • Positive test: The client is unable to keep one (or both) eye(s) closed against gentle resistance—the eyelids are easily opened.

    • This suggests weakness or palsy of the orbicularis oculi and possibly facial nerve dysfunction.

Clinical Significance

  • A positive Orbicularis Oculi Strength Test is commonly seen in facial nerve palsy (Bell’s palsy), other cranial nerve VII lesions, or severe facial muscle weakness.

  • The test helps differentiate neurogenic weakness (from facial nerve issues) versus local (muscle) pathology.

  • Integrity of the orbicularis oculi is a key indicator of facial nerve health and symmetry.

  • In a neurological exam context, this test is often accompanied by other facial muscle strength checks and functional tasks (e.g., puffing cheeks, smiling, frowning).

Assessment

  • Use this test in clients reporting:

    • Unilateral facial weakness, drooping, difficulty closing an eye, facial asymmetry, or altered facial sensation.

    • In the context of headaches, TMJ dysfunction, or after trauma/surgery involving the face or parotid region.

  • Document which side is affected, the degree of weakness, and any associated symptoms (tearing, drooling, inability to blink).

Treatment

  • If positive:

    • Avoid strong manual therapy or deep work around the affected periorbital area—use only gentle touch when working near the eyes.

    • Referral is warranted for any acute or unexplained facial palsy—especially if accompanied by sudden onset, pain, hearing changes, or other neurological deficits, as urgent medical investigation may be needed.

    • After diagnosis and stabilization, collaborate with healthcare providers for rehabilitation and facial retraining as appropriate.

  • Use gentle lymphatic, relaxation, or myofascial techniques for periorbital tension, but never apply force over weakened or non-contractile orbicularis oculi.

Safety and Referral

  • Refer clients with new, unexplained, or rapidly progressing facial weakness to a physician or neurologist immediately.

  • Monitor and document changes over time—recovery may be slow and progress may guide manual therapy interventions or indicate further medical assessment needs.