Background Gold weights are effective for upper eyelid loading in patients with lagophthalmos. Complications include poor cosmesis, migration, extrusion, allergy and astigmatism. The authors looked at indications for revision of primary gold weights inserted using a high pretarsal placement and outcomes following correction.

Methods A retrospective review of 107 consecutive primary gold weight implants in 95 patients with lagophthalmos in a single centre over a 5-year period. Implant placement utilised a combined high pretarsal placement, levator recession and fixation. Revision surgery included repositioning, removal or exchange. Blinded assessment of eyelid parameters, including cosmesis, was performed by an independent reviewer using photographs from each revision case taken preoperatively and 6 months postoperatively.

Results Mean follow-up 2.5 years (range 1–5) with 15/107 (14%) eyelids revised, the majority within 12 months of the primary procedure. Five eyelids required up to 3 further revisions, giving 21 revisions in total. Indications included prominent implants in 15/21 (71%) revisions; poor eyelid contour in 14/21 (67%, 9 drooped and 5 flattened eyelids); extrusion in 2/21 (10%); persistent erythema in 8/21 (29%, 5 gold allergies and 1 extrusion). Revisions consisted of platinum chain exchange (6), replacement (3), repositioning (8) and removal (4). Following final revision, eyelid contour returned to normal and five eyelids demonstrated mild prominence.

Conclusion High pretarsal placement was successful in treating lagophthalmos, with a complication rate of 1 in 6 requiring a revision procedure, the majority within 12 months. Main indications were unsatisfactory cosmesis from prominence of implant and poor eyelid contour.