Gold weight implants in the management of lagophthalmos in facial palsy.

The otolaryngologist plays an essential role in the diagnosis and management of a facial palsy. We present one of the largest cohort prospective studies in the UK of 22 patients with gold weight implants, including ancillary oculoplastic techniques, and their outcomes. Facial paralysis places the eye at risk and protection and lubrication of the eye is paramount in the management of these patients. If recovery of facial function is likely to be delayed or negligible, gold weight loading of the upper lid has been shown to be effective in providing a dynamic solution to lagophthalmos. Following surgery, complete eye closure was possible in the upright position in 18 patients (82%). Two patients had their weights removed secondary to infection (9%). At long-term follow up, four patients judged their vision to have deteriorated (29%). Two of these, after investigation by the ophthalmologists, were found to have pressure astigmatism and removal corrected the visual problems. Overall patient satisfaction with the procedure is high and all reported improvement in eye closure following the operation. An algorithm for the management of the eye in patients with facial palsy is outlined.