Noninfectious inflammatory response to gold weight eyelid implants

We describe three patients with noninfectious inflammatory reactions to gold weight eyelid implants, a complication not previously reported. Eyelid edema and erythema developed gradually in each patient, and maximal inflammation that prompted treatment was present at 12, 3, and 5 weeks, respectively, after surgery in the three patients. Management involved removal of the implant in the first patient, oral corticosteroids followed by replacement of the implant by a platinum weight in the second patient, and a local corticosteroid injection with retention of the implant in the third. Histopathological features included a thick eosinophilic coagulum at the tissue-gold interface and an intense, predominantly lymphocytic infiltrate in the collagenous capsule that surrounded the implants. Gold weight eyelid implants can elicit a gradually progressive inflammatory response. In at least some cases, local corticosteroid injection may suppress the inflammation and permit retention of the implant.