Considerations on the Operation of Gold Lid Load for Seventh Nerve Palsy Lagophthalmos

Kim, Do Wan; Minn, Kyung Won

Abstract

The correction of seventh nerve palsy lagophthalmos with gold weight implant is popular since it is simple, biocompatible and reversible. But this method may result in various complications, because we insert a foreign body with high density into the upper eyelid whose skin is the thinnest in the body and have to consider the dynamic function of blinking. The operator should pay attention to the preoperative patient evaluation, the design of the gold weight implant to prevent complications. We have improved the patient's evaluation technique, design of the implant and operation procedure considering some critical points. During the preoperative evaluation, the operator must consider the coexistence of trigeminal nerve palsy, upper blepharochalasis, lower eyelid ectropion, and eyebrow ptosis and also note the most severe point of lagophthalmos in the upper lid. Estimating suitable weight, the operator must consider not to interfere the movement of eyelid using the adhesive spray on the back of gold load and also check the eyelid closure in supine position with a pillow. Designing the implant, the operator should consider the shape of tarsal plate of each patient to make fusiform in shape with blunt edge. During the operation, the operator should insert the implant into pretarsal layer to make the implant cross the equator of eyeglobe in supine position, and fix the implant at 5 points to adjust the widest point at the widest gap.