The placement of a gold or platinum weight implant is currently the best option to correct paralytic lagophthalmos, the most dangerous ocular sequelae of facial palsy. Patients with lagophthalmos are unable to close the eye completely on the side of the palsy, thus exposing the cornea’s surface, causing significant dry eye symptoms, and putting the eye at risk. A gold implant of a predetermined weight will allow the person to close the eye without affecting eyelid opening.
A couple of factors should be addressed when contemplating a gold-weight implant in order to prevent complications and guarantee the best possible long-term outcome. First, determining the right weight for each patient is crucial. An ideal implant weight would allow adequate eyelid closure without affecting the patient’s ability to open their eye. Measuring different weights with trial implants in the surgeon’s office can effectively determine this ideal weight.
Secondly, one must ensure the implant’s long-term stability in the eyelid. It begins by selecting a good-quality implant from a recognized manufacturer. Rough edges in the implant or poor material increase the chance of postoperative infection and a higher risk of implant extrusion. This last point is vital, as extrusion, i.e., when the implant is pushed out through the skin, is the most common cause of reintervention to remove the implant. To lower the risk of this complication, many eyelid surgeons cover the implant with a thin sheet of a biological material that creates a barrier between the implant and the thin eyelid skin.
Most importantly, it is essential to choose an oculoplastic surgeon with experience in the surgical management of facial palsy and its ocular sequelae.
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