Gold weight and wire spring implants as alternatives to tarsorrhaphy

Tarsorrhaphy has been the classic method of providing corneal protection in patients with eyelid paralysis. However, tarsorrhaphy is cosmetically unsatisfactory, limits vision, and provides poor corneal protection. The results of implanting 94 gold weights and 139 wire springs in 202 patients over a period of eight years have shown that these methods can provide good corneal protection in selected patients without the shortcomings of tarsorrhaphy. The gold weights worked best for patients with lid paresis, whereas the spring was most effective in patients with total eyelid paralysis. In selected patients these techniques reestablished a voluntary blink and provided corneal protection without the limitations of tarsorrhaphy. This report describes patient selection, surgical technique, and advantages as well as limitations of gold weight or spring implantation.