Since the facial nerve a significant role in the production of tears, the manufacturing of tear fluid may be reduced, thus further increasing dryness of the eye. If the lower eyelid is very flaccid, there is "sagging" in the middle of the lower eyelid. This is referred to as lower eyelid ectropion. In extreme cases, the eyelid and eyeball lose contact. The continuous flow of tears, which, physiologically speaking, is regulated in the outer upper lid - where the tear gland is located- via the convex eyeball to the middle of the eye, is impaired. Tear fluid collects in the area of the lower eyelid forming a "lake of tears", which in turn impedes the free vision of the pupil, and thus sharp vision, in some patients. Frequently, the fluid runs over the edge of the lower eyelid onto the cheek and chronic watering (epiphora) develops. A reduced or even completely deactivated pumping function of the eye ring muscle in the area of the lacrimal canal system in the inner corner of the eye, which begins at the tear spots visible at the edge of the lower eyelid, also intensifies the condition. Ironically, the patient still has to struggle with a dry eye because the tear fluid is not evenly distributed. A slowed or absent blinking reflex also plays a role in facial paresis.