A COMPARISON OF TEMPORAL MUSCLE TRANSFER AND LID LOADING IN THE TREATMENT OF PARALYTIC LAGOPHTHALMOS

Temporal muscle transfer (n = 78) and lid loading with a gold plate (n = 52) were compared in the treatment of paralytic lagophthalmos. Thre e sizes of gold plate (1.0, 1.2 and 1.4 g) were used. Lid loading was inferior to temporal muscle transfer in improving functional ability t o close the eye, but it did protect the cornea from irritation. There were no significant differences among the sizes of plate, but there wa s most relief from corneal irritation when the 1.4 g gold plate was us ed. The plate had to be removed in 25% of the patients, but this did n ot make the condition worse than before lid loading. Lid loading has t he advantage that patients can close their eyes without conscious effo rt. We therefore recommend lid loading as the first choice for correct ion of paralytic lagophthalmos, and that temporal muscle transfer shou ld be undertaken after plate removal in only those patients for whom l id loading has not given a satifactory result.