Complications of Gold Weight Eyelid Implants for Treatment of Fifth and Seventh Nerve Paralysis

Abstract

Complications occurred in six patients after gold weights were implanted into the upper eyelid tissues for fifth and seventh nerve palsies. These complications included implant infection without extrusion (in one patient); entropion with trichiasis and presumed inflammatory reaction to the gold weight material (in one patient); upper eyelid distortion and poor eyelid contour with corneal ulceration and scarring (in one patient); significant residual lagophthalmos with exposure keratitis (in one patient); and blepharoptosis obscuring the pupillary access (in two patients). Resolution of the complications required 1. implant removal in four of six patients without reinsertion of a second weight, 2. recession of the retractors of the upper eyelids with medial and lateral canthoplasty (in four patients), and 3. permanent tarsorrhaphy (in one patient). The authors conclude that complications may be minimized by careful preoperative determination of the optimum implant size, weight, and placement within the eyelid as well as meticulous attention to the surgical technique of implantation. The use of other eyelid protective procedures is often necessary to augment corneal protection especially in patients with combined fifth and seventh cranial nerve palsies. Endogenous implant infection without extrusion of the gold weight may be distinguished from presumed inflammation due to gold allergy by clinical response to antibiotics in the former and requirements of steroids or removal of the implant in the latter.

Noninfectious inflammatory reaction to a gold weight eyelid implant: A case report and literature review

“…We have described one patient who experienced this reaction at our centre. Our literature search revealed only three articles that describe this complication, and they report on a total of six patients (5,8,9). Although a rare complication, when it occurs, the outcomes tend to be poor, because most patients will require removal of their implant.…”

“…The cause of this reaction, however, is not certain. Previous studies have examined tissue samples taken from patients who had their gold weights removed (5,8,9). Based on pathological specimens, Doyle et al (8) suggested that this complication is mediated by a type IV hypersensitivity reaction to gold.…”

“…This procedure is quite successful in improving eyelid closure and providing corneal protection. Although infrequent, various complications have been reported, including migration and extrusion of the implant (2,3), infection (4,5), induced astigmatism (6) and contact dermatitis (7). The present article describes a rare case of a noninfectious inflammatory reaction to a gold weight eyelid implant and summarizes the current literature describing this complication.…”

Uso de peso de ouro palpebral para correção do lagoftalmo em pacientes com paralisia facial

“…Pesos de platina podem ser usados em pacientes com alergia ao ouro 3 . A melhora da PF é multifatorial, mas primordialmente influenciada pela causa da paralisia, grau de lesão neural, local da lesão, idade e condições clínicas do paciente.…”

“…Complicações mais raras como diplopia monocular, astigmatismo e lagoftalmo residual também são descritos 3 . A taxa de extrusão do peso variou na literatura de 0% (8) a 10% 10 .…”