Pretarsal fixation of gold weights in facial nerve palsy

Implantation of a gold weight in the pretarsal space was performed on 17 patients with poor eyelid closure secondary to facial nerve weakness. Successful results were obtained in 14 (82%) of 17 patients. Postmortem histopathology of such a case demonstrated firm fibrous encapsulation of the weight. Although some authors advocate fixation of lid weights to the orbital septum, fixation in the pretarsal space is preferred for the following reasons: (a) "cheesewiring" is less likely to occur, (b) a limited levator recession may be more easily performed, (c) greater mechanical benefits are obtained, and (d) the potential for inferior migration is less.