Early eyelid rehabilitation in facial nerve paralysis

Upper-lid gold-weight insertions and lower-lid-shortening procedures are standard surgical techniques used to restore eyelid function and protect the cornea in patients with facial nerve paralysis. Different opinions exist in the literature regarding the correct timing and the morbidity of these interventions. The retrospective analysis of 45 patients over a 5-year period revealed extrusion of the gold weight in one (2.2%) patient and delayed infections in three (6.6%). Sixty percent of all gold-weight insertions were performed within 4 weeks after the onset of facial nerve paralysis. We strongly favor gold-weight insertion, often combined with lower-lid-shortening procedures, as a simple, reliable, reversible, and successful technique for early rehabilitation of the paralyzed eyelid. Using these guidelines, we have markedly reduced the need for tarsorrhaphies.