Gold Weight Implantation for Paralytic Lagophthalmos: A Case Report

Paralytic lagophthalmos is the inability to close the eyelids due to facial nerve dysfunction, resulting in ocular surface exposure and risk of corneal injury. In chronic cases with no prospect of nerve recovery, surgical eyelid reanimation is necessary to restore corneal protection and visual comfort. We report a 51-year-old woman with a 2-year history of right-sided facial nerve paresis following severe orbital cellulitis, sinusitis, and odontogenic infection. She developed chronic paralytic lagophthalmos with exposure keratopathy, despite maximal medical therapy. Examination revealed a 4 mm lagophthalmos, punctate corneal staining, scleral show, and reduced visual acuity. The patient underwent a combined surgical approach: upper eyelid gold weight implantation and lower eyelid tarsal suspension to the medial orbital rim. A 1 g 24-karat gold weight (dimensions: 20 × 5 × 1 mm), with one hole on each side, was implanted into the pretarsal space of the upper eyelid and anchored to the tarsus. The lower lid was elevated via canthopexy to reduce corneal exposure. One month postoperatively, the patient achieved full eyelid closure, with complete resolution of corneal staining and improved visual acuity from 20/40 to 20/25. No complications such as implant extrusion, infection, or persistent ptosis occurred after 1 year of follow up. The cosmetic result was satisfactory and the patient reported significant relief of symptoms and improved quality of life. Gold weight implantation, combined with lower eyelid support, offers an effective, safe, and cosmetically acceptable solution for rehabilitating chronic paralytic lagophthalmos. Timely surgical intervention can prevent permanent corneal damage and restore ocular surface integrity.