DEC 21, 2011
By Shimon Rumelt, MD
Oculoplastics/Orbit
This is the first series on the use of gold weight implantation in patients with nonfacial palsy with lagophthalmos on blink (LOB) and minimal or absent lagophthalmos on gentle closure. This retrospective review included 12 patients, 11 of whom experienced an improvement in LOB and increased frequency of blinding (FOB), resulting in improvement of keratopathy and reduced ocular discomfort. The authors conclude that upper eyelid loading with gold weight implantation is a useful and predictive method for improving exposure-related keratopathy due to LOB in the absence of facial palsy.
All patients included in the study had features of dry eye keratopathy with widespread punctate epitheliopathy predominately of the inferior to two-thirds of the cornea. They all underwent gold weight implantation into the upper eyelid, with nine of them treated bilaterally. Mean follow-up was 20.38 ± 16.61 (range, 6 to 58) months.
The reduction in LOB and improvement in FOB seen among the patients seemed to reduce the eyelid wiper effect. Also there was a subjective improvement in the patients’ vision and ocular discomfort. Persistent epithelial defect healed in all three patients with the condition. However, one patient developed superior corneal thinning and descemetocele, requiring removal of the gold weight; one patient required ptosis surgery; and one patient developed a gold allergy and underwent platinum chain exchange.
This study highlights the importance of paying attention to poor blinking, partial eyelid closure (lagophthalmos) and poor eyelid apposition after facial nerve palsy in every patient who develops punctate keratopathy or persistent epithelial defects. However, the patients in this series had many other surface disorders that could have caused keratopathy, and the causes for their low blinking rates were not elucidated. Furthermore, a statistical analysis was not performed, so it is unclear whether the improvement in lagophthalmos was statistically significant.