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Introduction
Paralysis of the facial nerve causes lagophthalmos and leaves the eye exposed. Lack of blinking and incomplete eyelid closure prevent the tear film from spreading evenly over the surface of the cornea, which subsequently becomes dry. This causes irritation and congestion of the eye, which can lead to corneal keratitis, ulceration, perforation or, in severe cases, even blindness.
Eyedrops and eye ointments are simple measures but are inconsistent in providing long term relief. Taping the eyelid at bedtime is also a temporary measure which offers unreliable results and hampers vision if used during the day.
Tarsorrhaphy has been one of the standard surgical procedures for management of the exposed eye. However, tarsorrhaphy restricts the field of vision, offers incomplete corneal protection and is cosmetically disfiguring. In addition, it can cause trichiasis or permanent adhesions. Reversal of tarsorrhaphy can result in persistent lid deformity.
Tantalum gauze mesh was used by Sheehan1 as early as 1950. Wire spring implants2,3 were used to oppose the action of the levator muscle. However, comparison of the complications and failures of wire spring implants (including extrusions requiring removal) with the superior performance of gold eyelid implants suggest the latter as the preferred technique.4
Gold weight implantation in the upper eyelid was first described by Smellie,5 and it is the most widely accepted and useful procedure to reanimate the paralysed eyelid.6-9 The action of the orbicularis oculi on the affected side is substituted by a gold weight implanted in the affected eyelid; combined with the effect of gravity, this helps to shut the eye when the levator palpebrae relaxes. This procedure offers excellent protection to the eye and also very good cosmesis. It can be used as a temporary or permanent procedure.
From 1997 to 2005, we prospectively analysed 50 patients for whom a customised technique of gold eyelid implant preparation was employed.
Patients and methods
Following the granting of approval by the relevant institutional review board, a prospective study was conducted from January 1997 to December 2005. Fifty patients underwent upper lid gold weight implantation as treatment of lagophthalmos caused by facial palsy. Forty-eight of the patients were followed up for at least one year, and these patients form the main...