Eyelid reanimation with gold weight implant and tendon sling suspension: evaluation of excursion and velocity using the FACIAL CLIMA system.

Abstract

This study aims to analyse the efficacy of static techniques, namely gold weight implant and tendon sling, in the reanimation of the paralytic eyelid. Upper eyelid rehabilitation in terms of excursion and blinking velocity is performed using the automatic motion capture system, FACIAL CLIMA. Seventy-four patients underwent a total of 101 procedures including 58 upper eyelid gold weight implants and 43 lower eyelid tendon suspension with 27 patients undergoing both procedures. The presence of lagophtalmos, eye dryness, corneal ulcer, epiphora and lower lid ptosis/ectropion was assessed preoperatively. The Wilcoxon signed-rank test was used to compare preoperative versus postoperative measurements of upper eyelid excursion and blinking velocity determined with FACIAL CLIMA. Significance was set at p <0.05. FACIAL CLIMA revealed significant improvement of eyelid excursion and velocity of blinking (p < 0.001). Eye dryness improved in 49 patients (90.7%) and corneal ulcer resolved without any further treatment in 12 (85.7%) of those with a gold weight inserted. Implant extrusion was observed in 8.6% of the cases. Of the patients with lower lid tendon suspension, correction of ptosis/ectropion and epiphora was achieved in 93.9% and 91.9% of cases, respectively. In eight patients (18.6%), further surgery was needed to adjust tendon tension. The paralytic upper and lower eyelid can be successfully managed with gold weight implant and tendon suspension. The FACIAL CLIMA system is a reliable method to quantify upper eyelid excursion and blinking velocity and to detect the exact position of the lower eyelid.