[The paralyzed eyelid: an alternative to gold weight, levator palpebrae lengthening]

Patients with complete facial nerve palsy are at risk of severe eye complications due to corneal exposure. The aim of this study was to highlight the effects of using a gold weight in paralyzed eyelid, and to prove the safety of the levator palpebrae lengthening.

This retrospective study compared the records of 24 patients who received a gold weight of the upper eyelid between 1976 and 2003 with those of 22 patients who benefit from levator palpebrae lengthening between 1997 and 2005. Two endpoints were seen in postoperative: the occurrence of complications related to lagophthalmia secondary to facial palsy, and the occurrence of complications related to surgical technique.

The occurrence of a complication related to the facial palsy is significantly associated with the surgical technique. Patients with gold weight had significantly more complications related to their pathology than others (67% versus 18%, respectively, p=0.001). The occurrence of a surgical complication was significantly associated with the surgical technique. Patients with gold weight have significantly more complications due to surgery than others (83% versus 5%, respectively, p<0.0001).

Our clinical study and statistical comparison of the two surgical techniques for paralysed eyelid clearly show that the oldest is unsatisfactory and that it should be abandoned. Levator palpebrae lengthening improves eye symptoms with a very low morbidity.