Upper-eyelid weight implants for patients with lagophthalmos-comparison of rigid and flexible implants

For treatment of lagophthalmos, metallic weight implants can be inserted in the upper eyelid to aid eyelid closure. Rigid and flexible implants are available. The objective of this study was to investigate the effect of implant type and patient variables on the survival of lid load implants.

Forty-four patients with lagophthalmos were recruited to undergo upper-eyelid weight implantation. The predictor variable was type of implant inserted (rigid or flexible). The outcome variable was survival of the inserted implant (survival or extrusion). Other study variables were demographic data (age, gender), implant features (material, weight), and other conditions, such as history of radiation. An NMLE test was used to compare implant survival, depending on implant type (flexible versus rigid). Other variables were analysed by use of a χ² test.

Forty-four participants were recruited, 29 female (65.9%) and 15 male (34.1%). Forty-six implants (23 rigid implants, 50.0%; 23 flexible implants, 50.0%) were inserted (bilateral implantation in two patients). The average weight of implants used was 1.76 g (range 1.4-2.2 g). One to two years after surgery, average vertical aperture (eyelid gap) for the closed eye was 0.65 mm (range 0-4 mm). Incidence of extrusion was 15.2% (one in the rigid implant group, 2.2%; six in the flexible implant group, 13.0%). Incidence of extrusion was significantly higher for flexible implants than for rigid implants (p = 0.0273).

The study results suggest that flexible implants are more likely to perforate the skin. The assumed advantages of the expensive chain lid weight must, therefore, be re-evaluated.