The implantation of a gold weight is currently the gold standard for treating paralytic lagophthalmos, which is the inability to close the eye fully after facial paralysis. However, certain complications are associated with this procedure. Migration and extrusion of the implant are the most common, especially in older patients, and they may occur months or years after the operation. Extrusion should be treated promptly to prevent infections. If untreated, the implant will be pushed out through the thin eyelid skin.
The implant must be repositioned by the surgeon to correct extrusion and restore eyelid function. The procedure is safe and can be performed under local anesthesia. The gold weight is removed and placed in a more superior position under the levator muscle—the muscle responsible for elevating the upper eyelid. Therefore, the implant will be covered by a thicker muscle layer, which should significantly decrease the risk of extrusion. A second protective layer of AlloDerm tissue matrix may also be placed, although not all surgeons consider this necessary.
Recovery is quick and painless. Patients should expect mild bruising and swelling for about a week after surgery. Postoperative care includes applying prescribed topical anti-inflammatory ointment and cold compresses. Lastly, repair of the skin over the implant is complete about a month after surgery.
The goal in these cases is to restore eyelid function while minimizing the risk of extrusion recurrence. Additionally, adequate eyelid closure guarantees protection of the ocular surface, which is essential for eye health.
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