The role of external eyelid weights in acute facial palsy: functional and aesthetic considerations

Abstract

PurposePatients with acute paralytic lagophthalmos are at high risk for ocular surface breakdown due to exposure. External eyelid weights are a temporary solution for paralytic lagophthalmos that aim to reduce exposure and optimize blink excursion. Despite easy application and high efficacy, this product is under-utilized in clinical practice with few physicians employing this treatment adjunct.ResultsOcular surface health was maintained in all patients, and overall aesthetic satisfaction was high.ConclusionExternal eyelid weights are a valuable adjunct in the treatment of facial palsy but are under-utilized in clinical practice. This article highlights the benefits of external eyelid weights as an accessible adjunct to restore eyelid function and maintain cosmesis. The device can be implemented without specialist involvement and adds a dimension of independence for general practitioners to manage ocular complications of facial palsy.

Evidence-Based Practices in Facial Reanimation Surgery

“…29,31 Preoperative evaluation using tape to secure various weights to the upper lid aids in determining the correct weight to implant or may be used as a temporizing solution. 32 Platinum is a potential alternative to gold, and has been used to decrease the visibility of the implant and was noted to carry a lower risk of extrusion, although comparative studies between metals have not been performed. 33 In addition, platinum has been associated with allergic conjunctivitis.…”

Facial Nerve Palsy and the Eye: Etiology, Diagnosis, and Management

“…53 Another temporizing measure is the use of external eyelid weights which are attached to the pretarsal upper eyelid skin using double-sided tape. 53 These external eyelid weights are manufactured with a variety of skin tones and weights, and should induce about 1 mm of ptosis with the patient upright and the eyes open in primary gaze.…”

“…28 Botulinum toxin injections can also be administered in chronic facial palsy patients beyond the acute phase as a bedside procedure in patients who are deemed poor surgical candidates, or those with a limited functional capacity. 53 Another temporizing measure is the use of external eyelid weights which are attached to the pretarsal upper eyelid skin using double-sided tape. 53 These external eyelid weights are manufactured with a variety of skin tones and weights, and should induce about 1 mm of ptosis with the patient upright and the eyes open in primary gaze.…”

“…However, contact dermatitis from the adhesive tape remains a concern. 53 Finally, some authors recommend that all FNP patients should be routinely advised to passively stretch their upper eyelids as well as their lower eyelids to prevent further skin contracture or to minimize existing lagophthalmos. [32][33][34][35][36][37][38]51 Surgical intervention remains the cornerstone of therapy for FNP patients especially if conservative measures fail and the cornea is threatened.…”

Putting the Pieces Back Together: Optimizing Function and Appearance after Orbital Surgery

“…External eyelid weights are available online and can be secured to the outside of the upper eyelid over the tarsus with two-sided tape that is included with the kit. 17,18 They come in a range of skin tones, providing a noninvasive option not only in the hospital but also after discharge. External eyelid magnets have also been used but are less common.…”