[Lidloading in facial palsy]

Various implants are used to treat paralytic lagophthalmos. Implantation of weights in the upper eyelid (lid loading) to close the lid by gravity is a very established procedure. If correctly performed, the advantages of the procedure include the complete closure of the eyelid without limiting the visual field, a technically simple operation, easy reversibility, and possible combination with other surgical lid corrections. Thus, this method is suitable for both irreversible and reversible facial nerve paralysis. Gold and platinum have, in the meantime, become the established implant material. Although both metals are suited for implantation in the upper eyelid, platinum tends to show better biocompatibility and has a higher density, in which a 10 % volume reduction can be achieved compared to common gold implants. Currently available are industrially manufactured rigid gold and platinum implants and a chain made of a platinum-iridium alloy. Based on ultrasound examinations of the upper eyelid tarsus, the flexible chain was designed to ensure an optimal pretarsal fit. First studies indicate that the serious postoperative complications with rigid implants can be considerably reduced with flexible chain implants, although there are no long-term results at present.