Linder T, Linstrom C, Robert Y
Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie, Universitätsspital Zürich.
Klin Monbl Augenheilkd. 1997 May;210(5):293-5. doi: 10.1055/s-2008-1035055.
Upper-lid gold weight insertions in patients with long-standing facial palsy allow closure of the eye through an increased gravitational pull on the relaxed eyelid and complete opening without restriction of the peripheral visual field.
Between 1990 and 1995, 45 patients underwent eyelid rehabilitation for facial nerve paralysis at the New York Eye & Ear Infirmary. Their charts and outcomes were reviewed retrospectively. Twelve patients were followed prospectively at the University Hospital Zurich since December 1995.
One gold weight extruded twice in one patient. Delayed infections 1-3 months after surgery occurred in 6.6% and could be treated without removal of the gold weight. Tarsorrhaphies were necessary in 11%. Overall one third of all patients had their gold weight removed during this 5-year observation period. They all had return of their facial movements and did not require further lid loading. All prospectively evaluated patients had a marked improvement of their dry eye symptoms and a better quality of life.
The analysis of 57 patients indicates, that gold weight insertions are a simple, reliable, reversible and successful technique for early rehabilitation of the paralyzed eyelid, often combined with lower lid shortening procedures. We favor early implantation in patients with severe facial nerve injury, concomitant Vth nerve palsy, inadequate patient compliance, in patients with one eye only or with disturbing dry eye symptoms.
