Skip to main content

Advertisement

SpringerLink
Log in

Lid Loading for Treatment of Paralytic Lagophthalmos

  • Review
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Lagophthalmos secondary to facial palsy is a most clinically important condition that requires effective and early treatment because prolonged corneal exposure may cause corneal lesions, ranging from corneal spots to corneal ulceration and finally blindness. Lid loading is the therapy used most commonly to treat the condition. This method was first described in 1950, modified in 1966, and popularized in 1974. Since its inception, only several reviews have referred to the technology, but they talked about only parts of this technology and did not provide information on the technology overall. This review discusses lid loading in detail. This method now often uses gold and platinum as the material for the implant and should be done as early as possible in those patients whose paralytic lagophthalmos has little chance of being reversed. This method has shown good clinical results and given patients a better perspective. Of course, this method has its intrinsic complications such as allergic reactions, extrusion, and migration. However, with modification of the implant and the surgical procedure, the complication rate has decreased. In conclusion, although lid loading cannot solve all the problems associated with the paralyzed eyelid, it is a simple, reversible, and effective way to treat paralytic lagophthalmos.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mavrikakis I, Beckingsale P, Lee E, Riaz Y, Brittain P (2006) Changes in corneal topography with upper eyelid gold weight implants. Ophthal Plast Reconstr Surg 22:331–334

    Article  PubMed  Google Scholar 

  2. Kim DW, Ali MJ (2007) Modified retrograde approach to upper eyelid static loading. Laryngoscope 117:2110–2114

    Article  PubMed  Google Scholar 

  3. Tucker SM, Santos PM (1999) Survey: management of paralytic lagophthalmos and paralytic ectropion. Otolaryngol Head Neck Surg 120:944–945

    Article  PubMed  CAS  Google Scholar 

  4. Mavrikakis I, Malhotra R (2006) Techniques for upper eyelid loading. Ophthal Plast Reconstr Surg 22:325–330

    Article  PubMed  Google Scholar 

  5. Mancini R, Taban M, Lowinger A, Nakra T, Tsirbas A, Douglas RS, Shorr N, Goldberg RA (2009) Use of hyaluronic acid gel in the management of paralytic lagophthalmos: the hyaluronic acid gel “gold weight”. Ophthal Plast Reconstr Surg 25:23–26

    Article  PubMed  Google Scholar 

  6. Abenavoli FM, De Gregorio A, Corelli R (2006) Upper eyelid loading with autologous cartilage in paralytic lagophthalmos. Plast Reconstr Surg 117:2511–2512

    Article  PubMed  CAS  Google Scholar 

  7. Jobe RP (1974) A technique for lid loading in the management of the lagophthalmos of facial palsy. Plast Reconstr Surg 53:29–32

    Article  PubMed  CAS  Google Scholar 

  8. Townsend DJ (1992) Eyelid reanimation for the treatment of paralytic lagophthalmos: historical perspectives and current applications of the gold weight implant. Ophthal Plast Reconstr Surg 8:196–201

    Article  PubMed  CAS  Google Scholar 

  9. Bair RL, Harris GJ, Lyon DB, Komorowski RA (1995) Noninfectious inflammatory response to gold weight eyelid implants. Ophthal Plast Reconstr Surg 11:209–214

    Article  PubMed  CAS  Google Scholar 

  10. Schrom T, Goldhahn A, Stange T (2000) The platinum chain as a new implant for lid loading. Eur Arch Otorhinolaryngol 257:104–105

    Google Scholar 

  11. Schrom T, Goldhahn A, Berghaus A (2000) The use of gold weight in facial palsy lagophthalmos. Eur J Plast Surg 23:72–77

    Article  Google Scholar 

  12. Schrom T, Bloching M, Wernecke K, Scherer H (2005) Measurement of upper eyelid implants curvature by ultrasound. Laryngoscope 115:884–888

    Article  PubMed  Google Scholar 

  13. Schrom T, Loch A, Holzl M, Scherer H (2006) Evaluation of a new lid implant for rehabilitation of the paralyzed eye: results of a questionnaire. Laryngorhinootologie 85:38–42

    Article  PubMed  CAS  Google Scholar 

  14. Baheerathan N, Ethunandan M, Ilankovan V (2009) Gold weight implants in the management of paralytic lagophthalmos. Int J Oral Maxillofac Surg 38:632–636

    Article  PubMed  CAS  Google Scholar 

  15. Lavy JA, East CA, Bamber A, Andrews PJ (2004) Gold weight implants in the management of lagophthalmos in facial palsy. Clin Otolaryngol 29:279–283

    Article  PubMed  CAS  Google Scholar 

  16. Lessa S, Nanci M, Sebastia R, Flores E (2009) Treatment of paralytic lagophthalmos with gold weight implants covered by levator aponeurosis. Ophthal Plast Reconstr Surg 25:189–193

    Article  PubMed  Google Scholar 

  17. Aggarwal E, Naik MN, Honavar SG (2007) Effectiveness of the gold weight trial procedure in predicting the ideal weight for lid loading in facial palsy: a prospective study. Am J Ophthalmol 143:1009–1012

    Article  PubMed  Google Scholar 

  18. Choi HY, Hong SE, Lew JM (1999) Long-term comparison of a newly designed gold implant with the conventional implant in facial nerve paralysis. Plast Reconstr Surg 104:1624–1634

    Article  PubMed  CAS  Google Scholar 

  19. Gilbard SM, Daspit CP (1991) Reanimation of the paretic eyelid using gold weight implantation. A new approach and prospective evaluation. Ophthal Plast Reconstr Surg 7:93–103

    Article  PubMed  CAS  Google Scholar 

  20. Caesar RH, Friebel J, McNab AA (2004) Upper lid loading with gold weights in paralytic lagophthalmos: a modified technique to maximize the long-term functional and cosmetic success. Orbit 23:27–32

    Article  PubMed  CAS  Google Scholar 

  21. Tower RN, Dailey RA (2004) Gold weight implantation: a better way? Ophthal Plast Reconstr Surg 20:202–206

    Article  PubMed  Google Scholar 

  22. Hontanilla B (2001) Weight measurement of upper eyelid gold implants for lagophthalmos in facial paralysis. Plast Reconstr Surg 108:1539–1543

    Article  PubMed  CAS  Google Scholar 

  23. Tremolada C, Raffaini M, D’Orto O, Gianni AB, Biglioli F, Carota F (2001) Temporal galeal fascia cover of custom-made gold lid weights for correction of paralytic lagophthalmos: long-term evaluation of an improved technique. J Craniomaxillofac Surg 29:355–359

    Article  PubMed  CAS  Google Scholar 

  24. Jayashankar N, Morwani KP, Shaan MJ, Bhatia SR, Patil KT (2008) Customised gold weight eyelid implantation in paralytic lagophthalmos. J Laryngol Otol 122:1088–1091

    Article  PubMed  CAS  Google Scholar 

  25. Choi M, Driscoll CF (2004) Fabrication of a custom eyelid implant prosthesis: a clinical report. J Prosthodont 13:101–103

    Article  PubMed  Google Scholar 

  26. Harrisberg BP, Singh RP, Croxson GR, Taylor RF, McCluskey PJ (2001) Long-term outcome of gold eyelid weights in patients with facial nerve palsy. Otol Neurotol 22:397–400

    Article  PubMed  CAS  Google Scholar 

  27. Sheehan JE (1950) Progress in correction of facial palsy with tantalum wire and mesh. Surgery 27:122–125

    PubMed  CAS  Google Scholar 

  28. Dalkiz M, Gokce HS, Aydin A, Beydemir B (2007) Gold weight implantation for rehabilitation of the paralysed eyelid. Int J Oral Maxillofac Surg 36:522–526

    Article  PubMed  CAS  Google Scholar 

  29. Kao CH, Moe KS (2004) Retrograde weight implantation for correction of lagophthalmos. Laryngoscope 114:1570–1575

    Article  PubMed  Google Scholar 

  30. Saleh GM, Mavrikakis I, de Sousa JL, Xing W, Malhotra R (2007) Corneal astigmatism with upper eyelid gold weight implantation using the combined high pretarsal and levator fixation technique. Ophthal Plast Reconstr Surg 23:381–383

    Article  PubMed  Google Scholar 

  31. Foda HM (1999) Surgical management of lagophthalmos in patients with facial palsy. Am J Otolaryngol 20:391–395

    Article  PubMed  CAS  Google Scholar 

  32. Choo PH, Carter SR, Seiff SR (2000) Upper eyelid gold weight implantation in the Asian patient with facial paralysis. Plast Reconstr Surg 105:855–859

    Article  PubMed  CAS  Google Scholar 

  33. Jacob JT, Pendleton K, Broussard E, Crisp A, DiLoreto DA (1999) Porous alloplastic material encasement of gold weights for the treatment of paralytic lagophthalmos. Ophthal Plast Reconstr Surg 15:401–406

    Article  PubMed  CAS  Google Scholar 

  34. Thomas DA, Khalifa YM (2005) Temporalis fascia in the management of gold eyelid weight extrusion. Ophthal Plast Reconstr Surg 21:153–155

    Article  PubMed  Google Scholar 

  35. Foster JA, Perry JD, Cahill KV, Holck DE, Kugler L (2004) Processed human pericardium barrier for gold weight implantation. Ophthal Plast Reconstr Surg 20:107–109

    Article  PubMed  Google Scholar 

  36. Bjorkner B, Bruze M, Moller H, Salemark L (2008) Allergic contact dermatitis as a complication of lid loading with gold implants. Dermatitis 19:148–153

    PubMed  Google Scholar 

  37. Manktelow RT (1999) Use of the gold weight for lagophthalmos. Oper Tech Plast Reconstr Surg 6:157–158

    Article  Google Scholar 

  38. Schrom T, Wernecke K, Thelen A, Knipping S (2007) Results after lidloading with rigid gold weights: a meta-analysis. Laryngorhinootologie 86:117–123

    Article  PubMed  CAS  Google Scholar 

  39. Misra A, Grover R, Withey S, Gorbbelaar AO, Harrison DH (2000) Reducing postoperative morbidity after the insertion of gold weights to treat lagophthalmos. Ann Plast Surg 45:623–628

    Article  PubMed  CAS  Google Scholar 

  40. Chepeha DB, Yoo J, Birt C, Gilbert RW, Chen J (2001) Prospective evaluation of eyelid function with gold weight implant and lower eyelid shortening for facial paralysis. Arch Otolaryngol Head Neck Surg 127:299–303

    PubMed  CAS  Google Scholar 

  41. Abell KM, Baker RS, Cowen DE, Porter JD (1998) Efficacy of gold weight implants in facial nerve palsy: quantitative alterations in blinking. Vision Res 38:3019–3023

    Article  PubMed  CAS  Google Scholar 

  42. Sonmez A, Ozturk N, Durmus N, Bayramicli M, Numanoglu A (2008) Patients’ perspectives on the ocular symptoms of facial paralysis after gold weight implantation. J Plast Reconstr Surg 61:1065–1068

    Article  Google Scholar 

Download references

Acknowledgment

This study was supported by Program for New Century Excellent Talents in University (NCET-07-0578) and the Fund for Outstanding Young Academic Leader of Sichuan Province (06ZQ026-008).

Disclosure

The authors declare that they have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China

    Yongchun Yu, Lin Chen & Lei Liu

  2. Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China

    Jie Sun

Authors
  1. Yongchun Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jie Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lei Liu.

Additional information

Y. Yu and J. Sun contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yu, Y., Sun, J., Chen, L. et al. Lid Loading for Treatment of Paralytic Lagophthalmos. Aesth Plast Surg 35, 1165–1171 (2011). https://doi.org/10.1007/s00266-011-9740-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-011-9740-x

Keywords

Search

Navigation