What is upper eyelid weight surgery?
Loss of the ability to close the eye is a common consequence of most types of facial paralysis. Inability to blink, or close the eye leads to irritation, discomfort, tearing, crusting, infections and eventual compromise of vision. Conservative treatment like ointments, eye drops and taping the eye closed at night may temporarily improve symptoms. Eyelid stretching exercises may also be helpful in short-term in order to encourage eye closure.
If the facial movement is not recovered or the period of inability to close the eye is prolonged, upper eyelid weight is an option to improve eye closure. Either gold or platinum weight is surgically implanted into the affected upper eyelid through a natural crease. Platinum is generally preferred over gold, because the metal is denser and therefore the implanted weight can be thinner and less visible. Platinum chains can also be sometimes used in select patients, your surgeon will discuss all potential options. Historically, surgeons implanted eyelid springs to help eye closure. Due to dense scar formation, risk of extrusion and inability to maintain eye closure long-term, eyelid springs are rarely now placed.
This procedure does not restore natural movement, but assist eye closure by relying on extra weight and gravity. The eyelid with the weight in place will appear slightly droopy compared to the unaffected side and the outline of the weight will be slightly visible as a small bump. Overall, eyelid weights are very effective in restoring eye closure and prevent eye damage from facial paralysis
When do I need upper eyelid weight surgery?
Often in patients with facial paralysis, return of eye closure with facial movement is anticipated and no further interventions are necessary once the movement comes back. However, should facial movement not return, surgical implantation of a small eyelid weight is an effective option. Your surgeon will examine your eyelids prior to eyelid weight surgery by customizing and measuring the exact weight you would need in the office. During the exam, your surgeon will tape different weight to the eyelid ensuring that a weight leading to most natural eye closure is selected.
Lower eyelids will also be assessed for retraction and ectropion, which can be corrected at the same time in order to optimize eye closure. The goal of the surgery is to produce natural eye closure and reduce the need for eye drops and lubrication. However, patients will still need to make sure the eye is well lubricated especially at nighttime, when the gravity and eyelid weight cannot close the eye as effectively because the body position is not upright.
When happens upper eyelid weight surgery?
Once you have been properly fitted with the eyelid weight. Before the surgery, Dr. Araslanova will temporarily tape weights of different sizes to the upper eyelid in order to select the one that produces the most natural eye closure. The surgery can be performed under local anesthesia in a procedure room or in the operating room in the hospital.
What are the risks of upper eyelid weight surgery?
The risks of your upper eyelid weight surgery will vary depending on whether you had eyelid surgery before. The general risks of any eyelid surgery include bleeding, infection, dry eyes, eye irritation, difficulty with eye closure, visible scarring or skin discoloration, eye muscle injury, the need for additional surgery, chronic pain, numbness, temporary blurry vision or rare vision loss and risks of general anesthesia. Risks specific to eyelid weight is need for replacement or eyelid weight readjustment, transient or permanent droopy eyelid and long-term risk eyelid weight extrusion. Preparing for surgery and following your surgeonโs instructions are useful to help minimize risks.