Long-term outcome of gold eyelid weights in patients with facial nerve palsy

Objective: To assess the safety and efficacy of upper eyelid gold weight im plants in managing paralytic lagophthalmos and to compare two surgical tech niques for their insertion. Study Design: Retrospective case series. Setting: Tertiary referral center. Patients: One hundred four patients had a gold weight implanted for paralyt ic lagophthalmos between 1982 and 1996 at the Royal Prince Alfred Hospital in Sydney. Each patient had more than 2 years of follow-up of lid load func tion. Main Outcome Measures: The effectiveness of gold weights in reanimating eye lid closure, mean duration of gold weight retention, reasons for removal. a nd complications resulting from a gold weight; these outcomes were also com pared using two surgical techniques for gold weight insertion. Results: One hundred three patients maintained corneal integrity. At the ti me of assessment. 46 patients had had their lid loads removed from their ey elids, and 58 lid loads remained in situ. Of the lid loads that were remove d, 78% were because the facial nerve had recovered. The remaining 22% were removed because of cosmetic dissatisfaction (7 patients), the lid load beco ming too superficial (6 patients:), migration (3 patients), partial extrusi on (1 patient), and ptosis resulting from too heavy a weight (1 patient). Conclusion: Cold weights are well tolerated and effective in managing paral ytic lagophthalmos. An open surgical technique with direct suture fixation of the gold weight to the tarsal plate produced fewer complications than in serting the lid load into a prefashioned tissue pocket in the preseptal spa ce through a small lateral skin incision.