Upper Eyelid Postseptal Weight Placement for Treatment of Paralytic Lagophthalmos: Long-Term Outcomes

Paralytic lagophthalmos, a common consequence of facial nerve palsy, leads to corneal exposure and ophthalmic complications. The postseptal upper eyelid weight technique was first described in 2013 to address complications associated with the traditional pretarsal approach including weight visibility, extrusion, migration, eyelid ptosis, entropion, and astigmatism. This follow-up study assesses the long-term efficacy of the postseptal technique.Patients treated with postseptal upper eyelid weight implantation from 2008 to 2023 were included. Outcome measures included the presence of complications and degree of eye closure, assessed through videographic and photographic review.One hundred twenty-three patients were included. The mean follow-up time was 46 months, ranging from 12 to 143 months. The overall complication rate was 16%, with 9% experiencing extrusion. The adjusted extrusion rate in the present study was 2.3 extrusions per 100 person-years while the mean adjusted extrusion rate was 2.9 extrusions per 100 person-years for the evaluated studies in the literature (p = 0.005). No entropion or astigmatism was observed. Complete or near-complete eye closure was achieved by 98% of patients. A history of previous upper eyelid blepharoplasty was associated with more complications (p = 0.024).The postseptal technique is safe, reproducible, and effective for primary and secondary lid weight implantation, even in high-risk cases. Complication rates for the postseptal approach are similar to or lower than those reported in the literature for the pretarsal approach, with similar functional outcomes, and improved aesthetics. Upper eyelid skin resection prior to lid weight insertion was associated with increased complications.