Placement of an eyelid weight as an upper lid spacer for lagophthalmos
Reviewed by Anjali Gupta

Upper lid loading with a weight is a well described procedure for the treatment of lagophthalmos and exposure keratopathy. The authors describe a modification of this procedure whereby the levator aponeurosis is recessed in combination with supratarsal weight implantation. The implant becomes a ‘spacer’ between the recessed levator aponeurosis and tarsus. It addresses both lagophthalmos and eyelid retraction caused by weakened orbicularis tone, in addition to addressing the visible and palpable weight contour with pretarsal placement. A retrospective case review was performed on consecutive patients undergoing this procedure modification with gold or platinum weights to assess outcomes. Sixteen eyelids of 14 patients were included in the study. Some of the included patients had concomitant procedures: lower lid tightening +/- mid face lift (six eyelids), direct brow lift (three eyelids) and lateral tarsorrhaphy (two eyelids). The average change in lagophthalmos was -3.5mm (SD 1.8) and the average change in MRD1 was -1.2mm (SD 1.3). Both these results were significant. One eyelid required revision. No patients had infection, implant migration or extrusion, with an average of 11.5 months follow-up. 

Placement of an eyelid weight as an upper lid spacer for lagophthalmos.
Mokhtarzadeh A, Lee EW, Barahimi BI, et al.
CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY
2015;43:766-8.