Lagopthalmos - Golden Weight
Persistent facial paralysis It may cause eye closure, resulting in dry eye, stinging and injections. It is a priority to protect the eyelid as it remains open as a result of not closing. Open upper eyelid (lagophthalmus) as a result of eye muscle failure due to facial paralysis or lower eyelid ptosis (ectropion) or the eye cannot be closed as a result of both being together. When facial paralysis causes the eyelid not to close, it may be necessary to intervene in the upper eyelid weight, lower eyelid surgery or both. Facial paralysis surgeryIt is one of the options.
Golden weight on the eyelid
In such a situation Approximately 1 gram weight of weight to facilitate eye closure is placed under local anesthesia to ensure blinking and closure of the eye. Before the surgery is performed, rehearsing with different weights is important in the success of the surgery. In my clinical practice, I decide the amount of weight to be selected (0.8 grams, 1 gram, 1.2 grams etc.) by rehearsing with different weights during the preoperative examination. I think this is what affects the comfort of the patient the most. Below you can see the proof weights I use, and examples of gold and platinum weights in different sizes from my practice. It is a relatively easy procedure that takes less than 1 hour, can be performed even with local anesthesia, has a high success rate.
Why is the treatment of non-closing eyelid important?
One of the most important consequences of permanent facial paralysis that needs to be intervened quickly is the inability to close the eye. The elimination of blinking and the openness of the eye make the eye vulnerable to damage due to two reasons: (1) each blink enables the eyeball to be cleansed and moistened with tears (2) the eye is not closed, leaving the eye open to trauma, especially while sleeping. Dry eye, stinging and eye infections are common in facial paralysis. In some facial paralysis patients, the eye becomes active again. However, it is important to ensure that the eye can 'close' in patients with facial paralysis in which the function of the eye does not return. Surgical placement of a gold weight on the upper eyelid is a frequently used method to prevent problems that may arise by making it easier for the eye to 'close'. The use of gold weight reduces the patient's dry eye and the use of eye drops.
How is the surgery done?
It is a procedure that can be performed even under local anesthesia, not exceeding one hour. It is an outpatient procedure that does not require hospitalization. There are different sizes of weights between 0.8 grams and 1.4 grams according to the needs of the person and the eye weight that provides the most comfortable and natural eye closure is found in the preoperative interview with trial. Using the existing fold lines of the upper eyelid skin, a pocket is opened so that it is under the skin and muscle, and the golden weight is fixed here with stitches. Afterwards, the opened pocket is closed with cosmetic stitches and an aesthetic scar is provided.
In most patients, placing weight on the upper eyelid ensures blinking and adequate eye closure. However, in a small group of patients, additional procedures may be required depending on the position of the lower eyelid and sagging due to facial paralysis. Lower eyelid reconstruction may be required to achieve optimal results.
Who are good candidates for eyelid weight insertion?
Patients with natural and insufficient eye closure and blinking problems. Patients susceptible to dry eye, stinging and secondary infections due to these conditions.
Is it always enough to place a golden weight on the eyelid?
Unfortunately, sometimes in addition to placing the upper eyelid weight lower eyelid low (ectropion) surgery you may need to do it together.
Frequently asked questions about putting gold weight on the eyelid
Question-1: How is the healing process after gold implantation surgery?
Answer-1: The procedure is done on an outpatient basis, takes less than an hour in total, and the patient can return home on the same day. Immediately after the procedure, the patient can close his / her eye and the function gets better within weeks. Although it is accompanied by some swelling and bruising, it decreases and improves over time and does not last longer than a week.
Question-2: Will it be noticeable when a golden weight is placed in my eye?
Answer-2: There is some swelling in the area of the weight placed in the eye. The goal during the procedure is to be as unnoticeable as possible by placing it in line with the curve of the upper eyelid. Platinum weights are less noticeable compared to gold weights.
Question-3: Why are eyelid weights made of gold?
Answer-3: Gold is preferred because it is MR compatible. In addition, it is an ideal substance due to the low possibility of skin irritation and allergy.
Question-4: What are the dangers of inadequate eye closure?
Answer-4: Each blink moisturizes the eyeball and prevents it from drying. Again, the ability to close the eye protects the eye from foreign objects and impacts. Insufficient blinking can hinder the hydration of the eye and lead to dry eyes and sore eyes. May require use of tear drops.
Question-5: What are the undesirable side effects associated with this surgery?
Answer-5: Adverse effects associated with this surgery: In the early period: bleeding, infection. In the long term: the rejection of the gold weight by the body, its infection, the formation of a capsule around it in the long term due to micro-movements and the formation of it.