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This is a description of a new surgical technique to insert upper lid weights via a posterior, transconjunctival route. Following local anaesthetic, the upper lid was everted over a Desmarres retractor with a silk traction suture. A 5mm high central vertical incision was made through the tarsal conjunctiva and tarsal plate. Blunt dissection was then performed within the pretarsal space with Westcott scissors to create a pocket for the weight, which was then inserted into this space. Once the weight was verified as being in the correct position, the traction suture was released. No sutures were placed. Fourteen gold or platinum weights ranging in mass from 0.6 to 1.2g were implanted. All patients achieved adequate lid closure and only one had residual punctate corneal staining at six months post-op. There were no infections, implant migrations or malpositions, or any other complications, and none required revision surgery. This is a simple and easy technique which appears to be successful based on the limited numbers reported. It is not absolutely clear where the vertical incision should be in relation to the final weight position, i.e. whether it really is central or more to one side, as this will also affect the length of pocket that has to be dissected in order to insert the weight.

Sutureless transconjunctival insertion of eyelid weights: a novel technique.
Elahi E, Afshin EE, Guthrie AJ, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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