Early management of the paralyzed upper eyelid using a gold implant

One main goal in the management of a peripheral facial paralysis is to provide the patient with adequate protection to the cornea in order to avoid keratitis. Medical treatment, (ophthalmic drops, ointments, taping, etc.), often fails and surgery has to be considered. The various methods hitherto described, e.g. tarsorraphy, plastic strips, magnetic implants and wire springs, are associated with drawbacks such as infection, poor cosmetic outcome or need for a revision procedure. Between 1990 and 1992, 12 patients, suffering from an upper eyelid paralysis, as a consequence of a peripheral impairment of the homolateral facial nerve function, were operated on in our Department with the implant of a gold weight within the upper eyelid itself. This procedure yielded, in all cases, an excellent lid closure, corneal protection as well as a good cosmesis. The surgical technique is simple, if performed under local anesthesia, and the patient leaves the hospital on the same day of surgery. Should the natural eye function return, the implant can be easily removed.