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Type IV hypersensitivity reactions to upper lid gold weight implants-is patch testing necessary?
E Doyle1, I Mavrikakis, E J Lee
1Sussex Eye Hospital, Brighton and Sussex University Hospitals, Brighton, East Sussex, U.K. EdRachie@btinternet.com
Orbit (Amsterdam, Netherlands)
|September 20, 2005
Summary
Allergic reactions to upper eyelid gold implants can occur. Pre-implantation patch testing can help predict gold hypersensitivity in patients with a history of gold allergy or dental work.
Area of Science:
- Ophthalmology
- Allergology
- Materials Science
Background:
- Upper eyelid gold weight implants are used to treat facial nerve palsy-induced lagophthalmos.
- Allergic reactions to gold implants, though rare, can necessitate removal and alternative treatments.
Observation:
- Two cases of allergic reactions to upper eyelid gold weight implants are reported.
- One patient with a history of gold allergy and dental work showed a positive patch test to gold sodium thiosulphate.
- Histological examination of tissue from the second patient indicated type IV hypersensitivity.
Findings:
- Patch testing can identify patients hypersensitive to gold before implantation.
- The purity of the gold implant (99.99%) suggests direct gold sensitivity, not impurities, caused the reaction.
- Histopathology confirmed hypersensitivity as the cause of the inflammatory reaction.
Implications:
- Pre-implantation screening for gold allergy is crucial, especially with personal or family history.
- Patch testing is recommended for patients with prior gold exposure or uncertain allergy history.
- Identifying gold hypersensitivity allows for alternative treatment strategies to prevent implant-related complications.