Purpose

To evaluate the outcomes and post-operative complications of upper eyelid gold weight implantation in patients with facial nerve palsy/paresis and consequent lagophthalmos.

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Methods

A retrospective review of all patients with facial nerve palsy/paresis and lagophthalmos who underwent upper eyelid gold weight implantation using a high pretarsal and levator fixation technique, under the care of two oculoplastic surgeons over a 16-year period was performed. Pre- and post-operative LogMAR best corrected visual acuity (BCVA), lagophthalmos and astigmatism were compared. Post-operative complications including ptosis, induced astigmatism and gold weight exposure/extrusion were recorded.

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Results

BCVA improved following gold weight implantation. Both blink lagophthalmos and lagophthalmos on forced closure improved post-operatively. Where ptosis occurred, it was mild and did not require surgical re-intervention. One patient required gold weight repositioning. Astigmatism induced by gold weight implantation was not observed in this cohort.

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Conclusion

Upper eyelid gold weight implantation using a high pretarsal and levator fixation technique improves BCVA and lagophthalmos while carrying a low risk of post-operative complications including ptosis and induced astigmatism. The absence of induced astigmatism in this cohort is consistent with the literature, which suggests that ‘standard’ pretarsal fixation carries a greater risk of inducing astigmatism compared to high pretarsal or levator fixation techniques. Thus this technique represents a safe and reproducible approach to corneal protection in facial nerve palsy.

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Additional Authors

First name	Last name	Base Hospital / Institution
Kirsty	Veitch	University Hospital Galway
Aaron	Donnelly	Royal Victoria Eye & Ear Hospital
Elizabeth	McElnea	University Hospital Galway

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