Long-Term Results for the Use of Gold Eyelid Load Weights in the Management of Facial Paralysis

Background: The placement of gold eyelid load weights to improve passive upper eyelid animation is integral to the management of patients with facial palsy, particularly for patients with long-term paralysis. Methods: In a retrospective cohort review, outcomes after placement of 104 gold weights in 94 eyelids implanted by one surgeon from 1986 to 2000 were evaluated. The primary outcome measures were improvement in corneal exposure and visual acuity. Secondary outcome measures included time to removal and rates of adverse effects and complications. Results: Mean time of follow-up was 43.37 +/- 41.40 months (range, 1 to 53 months). Visual acuity and corneal compensation improved after weight placement (p = 0.0001), while the necessary daily ocular care decreased. Overall, 91 (97 percent) of the 94 first-time weights implanted were successful in providing improved protection for the patient's eye and decreasing the daily care needs. Eleven weights (10.6 percent) became exposed and were removed. Kaplan-Meier survival curve analysis predicted a 3 percent exposure rate at 12 months, 5 percent at 24 months, and 10 percent at 5 years, which increased to 35 percent at 153 months. When needed, replacement weights were equally effective in maintaining ocular health. Conclusions: This study demonstrates that gold eyelid load weights help preserve vision and improve corneal compensation, while minimizing ocular nursing care. The complications are few, but after approximately 5 years, the incidence of weight exposure increases to approximately 10 percent. The exposure rate continues to increase with longer follow-up intervals. Extruded weights can be replaced multiple times with the expectation that they will continue to provide a good result. (Plast. Reconstr. Surg. 125: 142, 2010.)