What it means for a patient
- When facial paralysis stops the eyelid from closing, a small gold weight placed in the upper lid can help it close and protect the eye.
- In this series, eye surface problems improved in every patient, and most no longer needed drops or ointment.
- A weight can be placed within a month of paralysis and removed later if nerve function returns.
- One patient's astigmatism worsened mildly and resolved with a lighter weight.
- Limits: one team's series of 37 patients with no comparison group.
Why this paper matters
It reported gold weight eyelid implants for facial paralysis, including early implantation within a month, with no infections or extrusions.
Overview
Facial paralysis can leave the eyelid unable to close, which exposes the cornea and reduces tear coverage, and this can lead to serious corneal damage (keratopathy). The authors placed gold weights in the upper eyelid to help it close. After good results in long-standing paralysis, they offered early implantation, within 1 month of paralysis, to selected patients.
Findings
- 37 patients, 38 gold weight upper eyelid implants; paralysis from various causes.
- When needed, implantation was combined with lower lid ectropion repair, medial canthoplasty or brow lift.
- Early implantation (within 1 month) was offered to patients with severe lagophthalmos when a severe nerve injury was documented during transtemporal surgery, or when a delayed, incomplete return of function was expected.
- Implantation achieved eyelid closure, eye protection and a cosmetic result the authors rate highly.
- No infections or extrusions.
- Lagophthalmos and exposure keratitis resolved or improved significantly in all patients.
- Most patients were able to stop using eye drops and ointments.
- Visual acuity improved in 95 percent of patients, often including patients without keratitis before surgery.
- 1 patient's existing astigmatism worsened mildly and resolved after the weight was replaced with a lighter one.
- The implant is easily removed in patients who regain adequate function after early implantation.
- The authors state gold weight loading became their procedure of choice for eyelid rehabilitation.
Terms
- Facial paralysis: loss of movement in the muscles of one side of the face.
- Lagophthalmos: inability to close the eyelids fully.
- Keratopathy: damage to the cornea, the clear front surface of the eye.
- Exposure keratitis: inflammation of the cornea from being left uncovered.
- Gold weight implant: a small gold plate placed in the upper eyelid to help it close.
- Ectropion: a lower eyelid that turns outward.
- Medial canthoplasty: surgery to tighten the inner corner of the eyelids.
- Transtemporal surgery: surgery through the temporal bone of the skull, near the ear.
- Extrusion: an implant working its way out through the skin.
- Astigmatism: blurred vision from an unevenly curved cornea.