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Thin-Profile Platinum Eyelid Weighting: A Superior Option in the Paralyzed Eye

Silver, Amanda L. M.D.; Lindsay, Robin W. M.D.; Cheney, Mack L. M.D.; Hadlock, Tessa A. M.D.

Plastic and Reconstructive Surgery: June 2009 - Volume 123 - Issue 6 - p 1697-1703
doi: 10.1097/PRS.0b013e3181a65a56
Reconstructive: Head and Neck: Original Articles

Background: A devastating sequela of facial paralysis is the inability to close the eye. The resulting loss of corneal protection can lead to exposure keratitis, corneal ulceration, and potentially permanent vision loss. Methods to address lagophthalmos historically have included tarsorrhaphy, lid weighting, levator palpebrae superioris lengthening, chemodenervation to yield protective ptosis, and the placement of magnetic eyelid springs. The gold eyelid weight, introduced nearly 50 years ago, continues to enjoy immense popularity, despite high complication rates and nearly uniform visibility under the skin. The authors hypothesized that a commercially available, thin platinum weight would combat the visibility of the thicker gold weights and herein compare complication rates and visibility rates with literature-reported data for gold weights.

Methods: Beginning in 2004, 100 consecutive patients presenting to the authors’ Facial Nerve Center with paralytic lagophthalmos requiring intervention were treated with thin-profile platinum eyelid weights. Ninety-six percent of cases were performed under local anesthesia in the office setting.

Results: Median follow-up was 22 months. In 102 weights placed, there have been six complications (5.9 percent): three extrusions, two capsule formations, and one case of astigmatism. All of the extrusions involved irradiated patients with parotid malignancies.

Conclusions: The authors report the first large series of thin-profile platinum eyelid weight implantations for the treatment of lagophthalmos. This implant significantly reduces both capsule formation phenomena and extrusion compared with gold weights and should be considered as alternative to the more conventional gold implants.

Boston, Mass.

From the Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School.

Received for publication September 15, 2008; accepted November 6, 2008.

Disclosure: There was no funding for this work. None of the authors has any commercial associations or financial disclosures in relation to the content of this article.

Tessa A. Hadlock, M.D., Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, Mass. 02114,

©2009American Society of Plastic Surgeons