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 average 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 follow-up. Mean follow-up was 13 months. INTERVENTIONS Each patient received a gold weight implant. Six of these patients underwent a lower eyelid procedure. MAIN OUTCOME MEASURES Surgical complications, static and dynamic lagophthalmos, static and dynamic corneal coverage, visual acuity, keratitis, topical 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 with 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 acuity. 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 visual acuity. The relationship was linear and statistically significant (P<.04). CONCLUSIONS Gold weight implantation provides significant reduction in lagophthalmos and significant improvement in corneal coverage. But owing to delayed closure time and disrupted tear film, irritation may persist. As a result, some patients require ongoing topical treatment of the eye, which can compromise visual acuity.

[1]  S. Seiff,et al.  Pretarsal Fixation of Gold Weights in Facial Nerve Palsy , 1989, Ophthalmic plastic and reconstructive surgery.

[2]  M. Pickford,et al.  Morbidity after gold weight insertion into the upper eyelid in facial palsy. , 1992, British journal of plastic surgery.

[3]  R. Jobe.  A TECHNIQUE FOR LID LOADING IN THE MANAGEMENT OF THE LAGOPHTHALMOS OF FACIAL PALSY , 1974, Plastic and reconstructive surgery.

[4]  S. Seiff,et al.  The Staged Management of Ophthalmic Complications of Facial Nerve Palsy , 1993, Ophthalmic plastic and reconstructive surgery.

[5]  M. Wexler,et al.  The Correction of Seventh Nerve Palsy Lagophthalmos with Gold Lid Load (16 Years Experience) , 1989, Annals of plastic surgery.

[6]  G. Smellie.  Restoration of the blinking reflex in facial palsy by a simple lid-load operation. , 1966, British journal of plastic surgery.

[7]  J. Kartush,et al.  Early Gold Weight Eyelid Implantation for Facial Paralysis , 1990, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[8]  C P Daspit,et al.  Reanimation of the Paretic Eyelid Using Gold Weight Implantation: A New Approach and Prospective Evaluation , 1991, Ophthalmic plastic and reconstructive surgery.

[9]  H. Biller,et al.  Comprehensive management of the eye in facial paralysis. , 1995, Archives of otolaryngology--head & neck surgery.

[10]  W. Larrabee,et al.  Surgical therapy of the eyelids in patients with facial paralysis , 1990, The Laryngoscope.

[11]  D. Soll.  New Surgical Approaches to the Management of Ocular Exposure Secondary to Facial Paralysis , 1988, Ophthalmic plastic and reconstructive surgery.

[12]  M. May,et al.  Gold weight and wire spring implants as alternatives to tarsorrhaphy. , 1987, Archives of otolaryngology--head & neck surgery.

[13]  C. Maas,et al.  Primary Surgical Management for Rehabilitation of the Paralyzed Eye , 1994, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.