Re: "Palpebral spring in the management of lagophthalmos and exposure keratopathy secondary to facial nerve palsy"

Management of Long-Standing Flaccid Facial Palsy: Periocular Considerations

Ineffective eyelid closure can pose a serious risk of injury to the ocular surface and eye. In cases of eyelid paresis, systematic examination of the eye and ocular adnexa will direct appropriate interventions. Specifically, 4 distinct periorbital regions should be independently assessed: eyebrow, upper eyelid, ocular surface, and lower eyelid. Corneal exposure can lead to dehydration, thinning, scarring, infection, perforation, and blindness. Long-term sequelae following facial nerve palsy may also include epiphora, gustatory lacrimation, and synkinesis.

[Gold weight implants for lagophthalmos correction in chronic facial nerve paralysis (late results)]

Upper eyelid weigh gold implant is the widely accepted standard for the treatment of paralytic lagophthalmos (PL).

AIM

To evaluate late outcomes of PL correction with chain gold implants.

MATERIAL AND METHODS

Chain gold implants were inserted in the upper eyelids of 70 patients with lagophthalmos due to chronic facial paralysis. A comprehensive ophthalmic examination was performed prior to surgery and then at months 1, 3, 6, 12, 24, and 36.

RESULTS

The results obtained prove the method highly effective. None of the patients developed any severe complications. Cases of implant removal were few. Some of the studied biometric parameters decreased significantly after surgery, while the upper eyelid excursion increased. The implant had no effect on the inner surface of the cornea and its peripheral thickness.

CONCLUSION

Efficacy of the proposed eyelid implant has been convincingly demonstrated; late complications have been analyzed.

A modified levine palpebral spring for the treatment of myogenic ptosis

PURPOSE

Surgical treatment of myogenic ptosis usually requires a form of frontalis suspension. Complications can include entropion, headache, contour abnormalities, and poor eyelid excursion. The Levine palpebral spring has been used successfully to augment eyelid closure in more than 2,000 patients. The authors present a modified Levine spring to correct ptosis in a patient with poor levator function.

METHODS

Interventional case report. A 55-year-old man with profound myogenic ptosis was treated with bilateral modified Levine palpebral springs. Eyelid position, contour and excursion, blink reflex, lagophthalmos, and ocular surface were evaluated.

RESULTS

The Levine palpebral spring functioned well to open both eyelids. Margin reflex distance improved from -3 mm to 3 m postoperatively. Excellent contour and excursion were observed. Orbicularis action, including blink reflex, was preserved, and ocular surface was not compromised.

CONCLUSION

The modified Levine palpebral spring is an alternative to frontalis suspension in treating select patients with eyelid ptosis with poor levator function.