Temporal galeal fascia cover of custom-made gold lid weights for correction of paralytic lagophthalmos: long-term evaluation of an improved technique

Background: Chronic paralytic lagophthalmos is a condition that is often conservatively treated with ophthalmic ointments and eye drops, but usually requires definitive surgical correction. Purpose: An effective modification of the gold lid loading technique is described, which we have found to be the simplest and most reliable method for lid reanimation. Material: After empiric evaluations with lead fisherman's weights ‘glued’ to the eyelid, a custom-made gold lid weight is made by a jeweller on the basis of the tarsal dimensions of the individual patient, and then sutured to the tarsus under local anaesthesia and covered with a fine sheet of temporal galea. Other ancillary procedures (lower lid suspension, lateral tarsal strip, lateral tarsoplasty) are added as required. Methods: Between 1990 and 1996, 27 patients underwent this type of surgery, of whom 24 were re-evaluated after a mean follow-up period of 73.2 months (range 36–96 months), 14 of these for a minimum of 5 years. Results: None of the gold weights was extruded, all 24 patients experienced marked improvement of their dry-eye symptoms and expressed a high degree of satisfaction. Six patients underwent further minor surgery (lateral McLaughlin tarsorrhaphy) in order to improve relative underaction. Two patients had ptosis (less than 2 mm of asymmetry) of the affected side but refused further correction. Conclusion: The use of custom-made gold lid weights and a protective galeal layer is a simple, reliable and successful means for permanently rehabilitating paralysed eyelids.