Risks of upper lid gold implants in peripheral facial paresis

Peripheral facial paresis is often accompanied by incomplete closure of the eyelids and may lead to varying degrees of keratopathy. Conservative thera peutic measures are often not sufficient. To achieve better lid closure tar sorraphy has been the primary method of treatment but has certain functiona l and cosmetic drawbacks for the patient. Alternatively gold weight implant s have been used to close the upper lid by the farce of gravity and if need ed can be combined with further reconstructive facial surgery. From May 199 4 to January 1997 29 patients with peripheral facial paralysis were treated with gold weight upper lid implants. Postoperative closure of the lids was sufficient in all cases,and there was a statistically significant decrease in lagophthalmos and improvement in keratopathy. Complications observed in cluded ptosis (n=5), cosmetically unacceptable bulging of the gold implant (n=5), extrusion of the implant(n=1)and the development of a low-grade corn eal astigmatism (n=7). In all cases of astigmatism correction was achieved by the fitting of cylinder glasses. In all,functional results achieved show ed that the gold implant was superior to the cosmetically bothersome tarsor raphy.