[Risks of upper eyelid gold implantation in peripheral facial paralysis]

Peripheral facial paresis is often accompanied by incomplete closure of the eyelids and may lead to varying degrees of keratopathy. Conservative therapeutic measures are often not sufficient. To achieve better lid closure tarsorraphy has been the primary method of treatment but has certain functional and cosmetic drawbacks for the patient. Alternatively gold weight implants have been used to close the upper lid by the force of gravity and if needed can be combined with further reconstructive facial surgery. From May 1994 to January 1997 29 patients with peripheral facial paralysis were treated with gold weight upper lid implants. Postoperative closure of the lids was sufficient in all cases, and there was a statistically significant decrease in lagophthalmos and improvement in keratopathy. Complications observed included ptosis (n = 5), cosmetically unacceptable bulging of the gold implant (n = 5), extrusion of the implant (n = 1) and the development of a low-grade corneal astigmatism (n = 7). In all cases of astigmatism correction was achieved by the fitting of cylinder glasses. In all, functional results achieved showed that the gold implant was superior to the cosmetically bothersome tarsorraphy.