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Late outcomes of gold weights and platinum chains for upper eyelid loading
  1. We Fong Siah1,
  2. Sonali Nagendran1,2,
  3. Petrina Tan1,
  4. Syed Mustafa Ali Ahmad3,
  5. Andre S Litwin1,
  6. Raman Malhotra1
  1. 1 Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
  2. 2 Western Sussex Hospitals NHS Trust, Worthing, West Sussex, UK
  3. 3 Imperial College London, London, UK
  1. Correspondence to Raman Malhotra, Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex RH19 3DZ, UK; raman{at}


Aim To identify late outcomes of gold weights (GWs) and platinum chains (PCs) for upper eyelid loading in the management of lagophthalmos.

Methods A retrospective case series of upper eyelid GWs and PCs at a single centre over a 10-year period (2004–2013). Two independent, blinded assessors graded standard photographs for any weight-related morbidity (poor upper eyelid contour, weight prominence and migration).

Results Primary upper eyelid loading (high-tarsal technique) was performed in 154 eyelids of 136 patients (facial nerve palsy, n=99; non-paralytic, n=37). A total of 127 eyelids of 110 patients had primary GW insertion. Of these, 40.9% (52/127) had revision surgery: exchange of GW for PC (58%), GW repositioning (25%) and removal of GW (17%). Only 22.2% (6/27 eyelids) with primary PCs required revision surgery. In those not requiring revision surgery, photograph grading showed that both GWs and PCs had weight-related morbidity at late follow-up (median=37.5 months, range 12–110 vs median=33.5 month, range 15–106). GWs had significantly higher rate of weight prominence (p=0.001) and migration (p<0.001) compared with PCs. All PC revisions required one procedure only compared with 10% of GWs revisions requiring two or more procedures. Incidence of gold allergy was 7% (8/110 patients). There was no association between the choice of weight material, physical weight or suture material and eyelid morbidities.

Conclusion GWs were found to be associated with higher complications and twice more likely to require long-term revision surgery compared with PCs. Despite weight fixation at a high-tarsal location, prominence of PCs can still occur.

  • Lagophthalmos
  • Gold weights
  • Upper eyelid loading
  • Platinum chains

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  • Contributors Research design and manuscript preparation: WFS, SN, PT, SMAA, ASL and RM. Data acquisition and/or research execution: WFS, SN, PT and SMAA. Data analysis and/or interpretation: WFS and RM.

  • Competing interests None declared.

  • Ethics approval Local institutional review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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