Upper eyelid gold weight implantation in the Asian patient with facial paralysis

Patients with facial paralysis may develop ophthalmic complications. Poor e yelid closure and lagophthalmos place the patient at increased risk for the development of corneal problems such as epithelial defects, stromal thinni ng, bacterial infection, and even perforation. Initial treatment should be conservative and include the use of ocular lubricants, moisture chambers, a nd taping of the lower eyelid into proper position. Surgical intervention m ay be required in patients who have failed medical therapy or in whom the f acial paralysis is not expected to improve. Gold weight implantation in the upper eyelid has become a popular procedure to correct upper eyelid retrac tion and to improve corneal coverage. Previous descriptions of gold weight placement in the upper eyelid have focused on Caucasian eyelid anatomy. How ever, there are distinct anatomic differences between the Caucasian and Asi an eyelids, which dictate the overlying aesthetic differences. We describe our technique for placement of a gold weight in the Asian upper lid, with a ttention to the maintenance of symmetric eyelid creases. We reviewed the ch arts of six Asian patients with facial paralysis who underwent gold weight placement in the upper eyelid for the correction of lid retraction. All pat ients did well functionally and aesthetically, and none developed an extrus ion of the implant with this approach.