2020–2021 BCSC Basic and Clinical Science Course™
7 Oculofacial Plastic and Orbital Surgery
Part II: Periocular Soft Tissues
Chapter 12: Periocular Malpositions and Involutional Changes
Upper Eyelid Paralysis
Upper eyelid loading remains the most commonly performed procedure for the treatment of paralytic lagophthalmos. The appropriate weight can be selected through a process of preoperatively taping eyelid weights of different sizes to the upper eyelid skin to determine which one best achieves adequate relaxed eyelid closure with minimal ptosis in primary gaze. After the weight is selected, it is inserted through an upper eyelid crease incision and is either sutured to the anterior surface of the tarsal plate (Fig 12-24) or placed behind the orbital septum; the latter may avoid thickening of the pretarsal area. If orbicularis function returns, the weight can be removed easily. Weights made of gold and platinum allow for magnetic resonance imaging (3 Tesla or less). Brow ptosis repair and blepharoplasty may be considered after improvement of corneal exposure.
Figure 12-24 Left upper eyelid loading with a platinum weight anterior to the tarsal plate.
(Courtesy of Bobby S. Korn, MD, PhD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.