Problem: I am suffering from painful dry eyes due to Lagophthalmos. My oculoplastic surgeon recommends a gold implant placed in the upper eyelid of each eye. Symptoms: - Pain in both eyes, right eye hurt me most - Unable to 100% close eyes unless I try hard - Also have droopy right upper eyelid - Unable to wink with right eye, however can wink with left Treatments: Lubricating ointment & eye drops before bed and 6+ times per day What alternative options exist? Thank you, I need help
Lagophthalmos is Causing Painful Dry Eyes. Doctor Wants to Do Gold Implant.
Doctor Answers 5
Much depends on why you have lagophthalmos.
There is absolutely no substitute for a personal consultation. So this will address this issue generally. Gold weights are primarily used when lagophthalmos is caused by a peripheral facial nerve injury such as a brain stem tumor, bells palsy or stroke. Gold weights are unsightly because of their bulk. So in aesthetic situations, other solutions are sought. If your lagophthalmos is the result of prior cosmetic eyelid surgery, other approaches are typically tried first. This might include vertically lengthening the lower eyelid with a posterior spacer graft to help the eyes close better. Canthal surgery may also be indicated. When the force generation of the upper eyelid is adequate but the eyelid is vertically short, upper eyelid lengthening procedures may be appropriate. I would get several other opinions before having a gold weight. If your issues are related to aesthetic surgery, you may find it necessary to travel to the United States to get appropriate care.
Gold Weight Implant for Lagophthalmos
Lagophthalmos is a not too uncommon medical condition of the upper eyelids. Common causes include post surgical, as well as other neurologic conditions. The eyelids are extremely important to protect the eyes, keep them moist and prevent irritation. With lagophthalmos this protective mechanism is compromised. Treatment options include artificial tears and lubricating ointments. Gold weight implant is an excellent option to help protect the eye by providing greater ability for the eyelid to close. The important thing is to obtain a weight that is correct for your particular eyelid and condition. Often times 1 mg is utilized, but careful measuring can determine whether its more or less of this weight required for satisfactory treatment. Implantation of the gold weight is quite easy. There is a slight bulge to the eyelid that sometimes can be subtly visible and is somewhat of a downside. The good news is that gold weights can be removed quite easily as well.
Additionally, sometimes lagophthalmos is a temporary problem that with time will get better but this depends on the underlying cause of the problem.
There are many cuases of lag. It can be paralytic in nature from a facial nerve injury and it could be from over-resection of tissue during eye surgery. They are usually treated differently. A full exam is key.
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Lagophthalmos (unable to close eyes)
The question why you have lagophthalmos. Did you prior surgery? They are various surgical and nonsurgical options to treat lagophthalmos. Gold weight is one. Another is to inject (reversible) restylane into upper lid to act as gold weight. If the problem is lower eyelid, then lower eyelid surgery might be needed. If you had recent surgery and the muscle is weak, then the lagophthalmos might resolve after the muscle recovers. Recommend discussing rurther with your surgeon or obtain second opinion.
Seek another opinion
Gold weights are usually reserved for patients with injury to the facial nerve, which closes the eyelids. This would be an unusual solution to lagophthalmos due to cosmetic surgery. I recommend you seek a consultation with a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery. Eric Cole MD is located in Sequim and is well qualified to give you a second opinion.