16 Upper Eyelid Gold/Platinum Weight Placement

Liza M. Cohen and Suzanne K. Freitag

Summary

Upper eyelid loading via gold or platinum weight placement is a gravity-dependent method of enhancing dynamic eyelid closure. It is used to treat exposure keratopathy due to lagophthalmos, which is commonly the result of facial nerve paralysis. Advantages of the procedure include its simplicity, reversibility, safety profile, and improved eyelid closure and cosmesis compared to other treatments for lagophthalmos. Preoperative preparation involves appropriate patient selection and weight fitting to determine the ideal implant weight. Key steps in the procedure include making an upper eyelid crease incision, dissecting a pretarsal pocket, suturing the weight to the tarsus and levator aponeurosis, and closing orbicularis oculi muscle and skin. Placement of the weight high on the tarsus and layered closure of orbicularis and skin can prevent weight migration and extrusion. Other potential complications include poor cosmesis, allergy, infection, under- or overcorrection, and astigmatism. Postoperative upper eyelid ptosis and continued need for topical lubrication are to be expected. Overall, upper eyelid gold/platinum weight placement is a straightforward and effective procedure to improve dynamic eyelid closure in patients with lagophthalmos and mitigate exposure keratopathy.

Key words

gold weight - platinum weight - lagophthalmos - facial nerve paralysis - exposure keratopathy