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A woman in her 60s had made an incomplete recovery from an episode of right peripheral facial palsy 1 year earlier (figure 1), despite receiving prednisolone, valacyclovir and physiotherapy at symptom onset. In addition to the distress caused by motor symptoms, she reported right eye tearing while eating (figure 2). Neurological examination showed several distinct motor long-term complications of peripheral facial palsy, specifically, right hemifacial spastic contracture and ipsilateral motor synkinesis, characterised by right ocular-oral synkinesis with platysma involvement and by an inverse Marcus Gunn phenomenon. Mastication and salivation triggered right eye tearing when she was asked to eat, a phenomenon consistent with crocodile tear syndrome (online supplemental video 1). An MR scan of the brain showed no structural lesions, supporting the previous diagnosis of idiopathic facial nerve palsy complicated with motor and autonomic synkinesis. Periodic botulinum toxin injections into the right orbicularis oculi muscle improved both the motor and the autonomic symptoms.SP110.1136/pn-2025-005038.supp1Supplementary video