Prospective evaluation of eyelid function with gold weight implant and lower eyelid shortening for facial paralysis

Objectives: To assess which signs and symptoms were relieved by gold weight implantation and which signs and symptoms persisted. Design: Prospective observational cohort. Setting: Tertiary care neurotology and oncology center. Patients: Sixteen (4 males and 12 females) consecutive patients whose avera ge age was 56 years (age range, 31-76 years). Inclusion criteria were gold weight implant, lagophthalmos of 2 mm or more, and a House-Brackmann score of 3 or less at the completion of followup. Mean follow-up was 13 months. Interventions: Each patient received a gold weight implant. Six of these pa tients underwent a lower eyelid procedure. Main Outcome Measures: Surgical complications, static and dynamic lagophtha lmos, static and dynamic corneal coverage, visual acuity, keratitis, topica l treatment, and patient satisfaction. Results: There were no extrusions. The preoperative mean lagophthalmos was 7.5 mm and the postoperative mean was 0.5 mm, (P<.001). Corneal coverage wi th eye closure before implantation was 73% and after implantation was 100%, (P<.001). Corneal coverage with normal (reflex) blink was less than 50% in 9 of 14 patients. When wearing correction, no patients had 20/20 visual ac uity. The mean patient satisfaction score before the procedure was 3.5 and after was 7.1, (P<.001). Patient satisfaction was most closely related to v isual acuity. The relationship was linear and statistically significant (P< .04). Conclusions: Cold weight implantation provides significant reduction in lag ophthalmos and significant improvement in corneal coverage. But owing to de layed closure time and disrupted tear film, irritation may persist. As a re sult, some patients require ongoing topical treatment of the eye, which can compromise visual acuity.