COMPLICATIONS OF GOLD WEIGHT EYELID IMPLANTS FOR TREATMENT OF 5TH-NERVE AND 7TH-NERVE PARALYSIS

Complications occurred in six patients after gold weights were implant ed into the upper eyelid tissues for fifth and seventh nerve palsies. These complications included implant infection without extrusion (in o ne patient); entropion with trichiasis and presumed inflammatory react ion to the gold weight material (in one patient); upper eyelid distort ion and poor eyelid contour with corneal ulceration and scarring (in o ne patient); significant residual lagophthalmos with exposure keratiti s (in one patient); and blepharoptosis obscuring the pupillary access (in two patients). Resolution of the complications required 1. implant removal in four of six patients without reinsertion of a second weigh t, 2. recession of the retractors of the upper eyelids with medial and lateral canthoplasty (in four patients), and 3. permanent tarsorrhaph y (in one patient). The authors conclude that complications may be min imized by careful preoperative determination of the optimum implant si ze, weight, and placement within the eyelid as well as meticulous atte ntion to the surgical technique of implantation, The use of other eyel id protective procedures is often necessary to augment corneal protect ion especially in patients with combined fifth and seventh cranial ner ve palsies. Endogenous implant infection without extrusion of the gold weight may be distinguished from presumed inflammation due to gold al lergy by clinical response to antibiotics in the former and requiremen ts of steroids or removal of the implant in the latter.