Post Septal Weight Technique for Paralytic Lagophtalmos

Background: Left untreated, paralytic lagophthalmos may result in corneal dryness, ulcerations, and subsequent blindness. The most common non-dynamic surgical solution is upper eyelid weight placement in a superficial, pre-tarsal pocket, carrying the risk of visibility, extrusion, and entropion.^1-5 We present a technique useful in patients presenting with either primary symptoms of corneal exposure or complications of previous implants that is equally efficacious with potentially decreased risk of complications, in which the weight is inserted into a deeper, post-septal position, but requires use of a heavier weight.

Methods: 19 patients, 15 primary and 4 secondary, treated between the years 2008- 2012 with the post-septal approach, were evaluated for demographics, etiology, resolution of primary symptoms, and complications. Average weight difference between that measured in clinic versus weight used in surgery in the primary group and average weight difference between that inserted in previous surgery versus weight placed in corrective surgery were calculated.

Results: In the primary group, the average weight difference was 0.213 grams ranging from 0 to 0.4 grams and in the revision group was 0.2 grams ranging from 0 to 0.4 grams.  Symptoms resolved in all patients, neither revisions nor complications noted, with the longest follow-up of 4 years.

Conclusions: The retroseptal technique has proven to be safe, reproducible, and very useful in both primary and secondary upper eyelid surgery for paralytic lagophtalmos. It successfully addresses several common problems encountered with more superficial weight placement including visibility, exposure, and entropion, but often necessitates use of a heavier weight.