Management of Lagophthalmos by Custom Made Gold Implants
To assess the efficacy of custom made gold implants in the management of Iatrogenic lagophthalmos during CNS surgery. Material and methods: Interventional Study, among patients with LMN VII nerve palsy attending Ophthalmology OPD & IPD of Neurosurgery department. Twenty patients with unilateral lagophthalmos due to facial nerve paralysis were included in the present study. Patients of both sexes and at different ages were included. The etiology included was cerebellopontine angle tumor excision that is after iatrogenic facial nerve injury during surgery. Preoperative thorough history taking and informed consent were taken. Pre and post-operative photographs were taken and patients were followed up for at least minimum of 6 months. Gold Implant: The gold weights were custom made. Each lid load was a 24-carat gold plate, 16 mm long, and 5 mm in height, fashioned as a rectangle with round borders. The body of the lid load had three holes to facilitate suspension to the tarsal plate. It is smooth in surface and weighted 1.0 to 1.6 g. Preoperatively; the proper weight is selected by tapping different weights to the upper eyelid. Discussion: In our study encouraging results were achieved in all cases. The corneal inflammation was resolved and corneas became bright in appearance. Conjunctival congestion was subsided and the eyes became quiet and asymptomatic resulting in final good visual outcome in the patients. The eye inflammation episodes were reduced from 2-3 to 0-1 per month and complete resolution of symptoms was observed in 19 cases (95%). From the aesthetic point of view, 5 patients had a noticeable bulge in the upper eyelid which was accepted by all patients. Infection and inflammation were not detected in any of our cases in the follow-up period. Only one patient complained of implant migration which necessitated correction under local anesthesia. We believe that upper lid loading is a very good alternative. Conclusion: Gold implant insertion in the upper eyelid is a valuable procedure to treat lagophthalmos. The procedure is safe, effective and with low complication rate.
Published by: Dr. Sachin Daigavane, Dr. Sandeep Iratwar, Dr. Siddarth Gautam
Author: Dr. Sachin Daigavane
Paper ID: V3I1-1249
Paper Status: published
Published: January 23, 2017
Full Details
