Allergic contact dermatitis as a complication of lid loading with gold implants

Paralysis of the orbicularis oculi muscle in patients with a facial nerve injury causes functional and cosmetic disabilities including inability to close the eyelid. This complication is often treated by implanting a gold weight in the upper eyelid, which, however, is not without side effects. Four patients are described who, after lid loading with a gold implant, acquired an inflammatory reaction due to contact allergy to the metal inserted. The allergy was demonstrated by patch testing with gold sodium thiosulfate. The implant was removed and the dermatitis resolved. Contact allergy to gold occurs frequently and may explain many cases of complications to lid loading with the metal.