Tarsal Gold Weight Implant as a Surgical Treatment for Eyelid Akinesia Related to Facial Paralysis

To describe the use and outcome of a tarsal gold weight implant as a surgical treatment for facial paralysis in two patients.

Case 1: a four-year-old female neutered French Bulldog was referred for a perforated corneal ulcer of the right eye and a history of ipsilateral recurrent otitis. Case 2: a seven-year-old male neutered domestic short hair was referred for a deep corneal ulcer of the left eye and a four-year history of facial paralysis.

Complete ophthalmic examination revealed facial paralysis in both patients; associated with a perforated corneal ulcer in case 1 and with a descemetocele in case 2. Surgical treatment was required in both patients for corneal repair. Tarsal gold weight implantation was performed in both patients. An eyelid gold weight was implanted and anchored to the tarsal plate with 5-0 Nylon suture; the subcutaneous and skin layers were sutured with 5-0 Polyglactin910 in a simple interrupted pattern. Eyelid motion was achieved after surgery. Post-operative re-examination at 3 years for case 1 and 18 months for case 2 revealed persistence of facial nerve paralysis in both patients. Passive closure and active opening of the affected eyelid were noted in both patients. No signs of active exposure keratitis were noted.

These two cases represent a novel surgical treatment to support passive blink for facial paralysis in a dog and cat using a human tarsal gold eyelid weight.