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 Gold Prosthesis lid loading procedure for re-animation of Paralyzed eye.

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Facial nerve paralysis often can have devastating consequences for vision. It is typically ocu­lar complaints related to facial paralysis that are the patient's primary concern after facial paralysis. Exposure keratitis and lagophthalmos are the most common ocular sequelae of facial nerve paralysis. Ultimately, if not managed appropriately, inadequate ocular surface protection can lead to corneal ulceration and ocular perforation. Although medical lubrication, patching, and taping do seem to be quite effective in the short term, conditions of prolonged facial paralysis often require surgical intervention.

Gravity assisted closure of the eyelid by loading it with prosthetic devices - 1950. Gold prosthesis - First described in 1950 by Illig in Germany.

Basis: Based on the fact that the uppder lid provides significantly more of the actual closure coverage of the cornea than the lower lid, which is only approximately 1 mm of extrusion on a normal blink reflex.

Other metals not acceptable because of their high density, availability and malleability.

The procedure is easy to perform, associated with minimum complications and results are excellent. . A number of studies in the past 9 years have re­ported a consistent 90% or better success rate using gold weight implants. We have performed this procedure in 36 patients in the last 9 years and all patients are doing very well.

Advantages of Gold:

1. Gold's colour allows it to be the most cosmetically accepted for the thin eyelid tissues.
2. One can pre-operatively measure and assess the result before the operation is done merely by attaching the gold weights to the skin of the upper eyelid to determine the proper sized implant to use.
3. Can be easily contoured to better fit the curvature of the cornea and the tarsal plate tissue.
4. Holes can be made for tarsal plate fixation and fibrous ingrowth.
5. Surgically simple.
6. Readjustments of the prosthesis usually are not necessary once the weight is in place.
7. The gold weight implant provides good cosmesis and is a good color match for eyelid skin.
8. The implant is essentially maintenance free, and removal is simple if orbicularis function should return.

Potential disadvantages:

1. Include extrusion and infection.
2. Cosmetic appearance of gold weight may be unacceptable.
3. May appear as a chalazion like subcutaneous irregularity in the eyelid.
4. Post-opertive ptosis may occur in the attempt to place a weight that is heavy enough eliminate lagophthalmos completely.
5. Lower lid problems are not assessed by this technique.

References:

1. Smellie GD. Restoration of the blinking reflex in facial palsy by a simple lid load operation. Br J Plast Surg 1966;19:279-284.

2. Jobe RP. A technique for lid loading in the management of lagophthalmos of facial palsy. Plast Re­constr Surg 1974;53:29-331.

3. Gilbard SM, Daspit CP. Reanimation of the paretic eyelid using gold weight implantation. Oph­thalmic Plast Reconstr Surg 1991;7(2):93-103.

4. Townsend DJ. Eyelid reanimation for the treatment of paralytic lagophthalmos: historical perspec­tives and current applications of the gold weight implant. Ophthal Plast Reconstr Surg 1992; 8(3):196-201.

5. Seiff SR, Chang J. Management of ophthalmic complications of facial nerve palsy. Otolaryngol Clin North Am 1992;25(3):669-690.

6. Seiff SR, Boerner M, Carter SR. Treatment of facial palsies with external eyelid weights. Am J Oph­thalmol 1995;120:652-657.

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