Purpose

To present and evaluate upper eyelid weight implantation as a surgical method for managing lagophthalmos, with the aim of protecting corneal integrity and preserving visual function.

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Methods

Lagophthalmos is initially managed conservatively using lubrication, moisture chambers, therapeutic contact lenses, and punctal occlusion. In chronic or severe cases where these measures are insufficient, surgical intervention is indicated. We describe a technique involving fixation of a metallic weight (gold or platinum) to the upper eyelid tarsal plate, enabling passive eyelid closure via gravity. A series of clinical cases was analyzed, including patients with lagophthalmos following tumor excision and long-standing facial nerve palsy. Proper implant weight selection and the use of adjunctive procedures were considered when necessary.

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Results

In all presented cases, upper eyelid weight implantation resulted in significant improvement in eyelid closure. Patients demonstrated reduced corneal exposure and reported high levels of satisfaction with both functional and cosmetic outcomes. The procedure proved effective across different etiologies of lagophthalmos.

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Conclusion

Upper eyelid weight implantation is a safe, effective, and relatively simple surgical option for managing lagophthalmos, particularly in patients without expected recovery of eyelid function. Compared to traditional procedures such as tarsorrhaphy, it offers superior functional and aesthetic results. Careful patient selection, appropriate implant weight determination, and multidisciplinary collaboration are essential for achieving optimal outcomes.

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Additional Authors

First name	Last name	Base Hospital / Institution
Monika	Ilavská	Medilux Eye Center

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