GOLD WEIGHT IMPLANTS FOR EARLY EYELID REH ABILITATION IN FACIAL-NERVEPALSY

Background Upper-lid gold weight insertions in patients with long-stan ding facial palsy allow closure of the eye through an increased gravit ational pull on the relaxed eyelid and complete opening without restri ction of the peripheral visual field. Material and methods Between 199 0 and 1995, 45 patients underwent eyelid rehabilitation for facial ner ve paralysis at the New York Eye & Ear Infirmary. Their charts and out comes were reviewed retrospectively. Twelve patients were followed pr ospectively at the University Hospital Zurich since December 1995. Res ults One gold weight extruded twice in one patient. Delayed infections 1-3 months after surgery occurred in 6.6% and could be treated withou t removal of the gold weight. Tar-sorrhaphies were necessary in 11%. O verall one third of all patients had their gold weight removed during this 5-year observation period. They all had return of their facial mo vements and did not require further lid loading. All prospectively eva luated patients had a marked improvement of their dry eye symptoms and a better quality of life. Conclusion The analysis of 57 patients indi cates, that gold weight insertions are a simple, reliable, reversible and successful technique for early rehabilitation of the paralyzed eye lid, often combined with lower lid shortening procedures. We favor ear ly implantation in patients with severe facial nerve injury, concomita nt Vth nerve palsy, inadequate patient compliance, in patients with on e eye only or with disturbing dry eye symptoms.