Corneal astigmatism as a special complication after lid-loading in patients with lagophthalmos

Lid-loading with precious metals, described by Illig in 1958, has become in creasingly important. Because of its good functional and cosmetic results t his method is superior to tarsorrhaphy. Furthermore, lid-loading can be com bined with additional surgical techniques to achieve more dynamic lid-closu re. In a prospective study we examined the results after lid-loading and di scuss postoperative changes of the cornea. Patients and methods: Between May 1994 and June 1998, 36 patients with peri pheral facial paresis and lagophthalmos were treated with a pretarsally fix ed upper-lid implant. We used 99.99 % gold for the implants with a weight o f 1.5 g on average. Results: In all cases we obtained sufficient postoperative lid closure whic h resulted in a statistically significant reduction in lagophthalmos and im proved keratopathy. Postoperative complications were: pseudoptosis, remaini ng lagophthalmos, bulge, extrusion, migration and corneal astigmatism. Depe nding on the implant pressure, an astigmatism of 1-2 D developed in the ver tical meridian. In all cases the initial visual acuity was reached by an or dination of cylindrical glasses. Conclusions: So far, corneal astigmatism as a complication after lid-loadin g has not received much attention in the literature. In our opinion, the de velopment of astigmatism is caused by implants that are too heavy, an incor rect implant radius and individual cofactors (consistency of lid and cornea ). There has been no need for an explantation in any case.