Medical Park Berlin Humboldtmühle, Neurologische Rehabilitation, Charité-Universitätsmedizin Berlin, An der Mühle 2-7, Berlin, Germany.
Arch Phys Med Rehabil. 2011 Aug;92(8):1333-5. doi: 10.1016/j.apmr.2011.03.007. Epub 2011 Jun 25.
This clinical note re-introduces external lid loading with the help of a lead weight for the temporary treatment of lagophthalmos. Although simple and effective, the technique is rarely used. Instead of wearing a monoculus, the patient uses an individually tailored lead weight (0.8-mm thickness, 1.0-2.0g) stuck on the lid to enable its closure. Spontaneous ptosis indicates a too-heavy weight. With the musculus (M.) levator palpebrae intact, lid lifting is possible. The effect is gravity dependent; therefore, the patient has to wear the monoculus at night. To minimize the risk for lead intoxication, the surface of the weight is varnished. In the case of persistent M. orbicularis oculi paresis, internal lid loading can follow. Since 1997, a total of 152 lagophthalmos cases have been treated. All patients could close the lid immediately. Almost half the patients had to readjust the weight several times per day because of hooded eyelids. Compliance was high, and partial or complete restoration of M. orbicularis oculi function occurred in 60% of cases. In some subjects, restoration of the M. orbicularis oculi was faster than for the M. orbicularis orbis. External lid loading for the temporary treatment of lagophthalmos is simple and effective. Compared with a monoculus, vision is unimpaired and the aesthetic is more appropriate for most patients. Faster restoration of the M. orbicularis oculi hints at a potentially facilitatory effect of the weight.
这篇临床笔记介绍了一种使用铅块对外眼睑进行加载以临时治疗睑裂闭合不全的方法。虽然这种方法简单有效，但很少使用。患者使用的是一个根据个人情况定制的铅块（0.8 毫米厚，1.0-2.0 克），贴在眼睑上使其闭合，而不是戴单眼罩。如果出现自发性上睑下垂，则说明重量过重。如果提上睑肌（M. levator palpebrae）完好无损，则可以抬起眼睑。这种效果依赖于重力，因此患者需要在夜间佩戴单眼罩。为了将铅中毒的风险降到最低，铅块的表面涂有清漆。如果眼轮匝肌（M. orbicularis oculi）持续瘫痪，可以进行内部眼睑加载。自 1997 年以来，共有 152 例睑裂闭合不全患者接受了治疗。所有患者都能立即闭眼。由于眼睑下垂，近一半的患者需要每天多次调整重量。患者的依从性很高，60%的患者眼轮匝肌功能部分或完全恢复。在一些患者中，眼轮匝肌的恢复速度比眼轮匝肌更快。使用外部眼睑加载来临时治疗睑裂闭合不全的方法简单有效。与单眼罩相比，这种方法不会影响视力，并且在美学上更适合大多数患者。眼轮匝肌更快地恢复提示铅块可能具有促进作用。
