Gold weight implantation Figure

The principle is that an implanted gold weight closes the lid when the levator muscle is relaxed with blinking and voluntary eyelid closure.

Upper Lid Gold Weight

Figure 7.4 Upper lid tarsotomy.

Tarsal plate -

* f. _

m

Orbicularis muscle-

*

Figure 7.6 (a) Gold weight placed between the sutured to tarsal plate over the gold weight.

Figure 7.6 (a) Gold weight placed between the sutured to tarsal plate over the gold weight.

The technique is as follows:

• Estimate the required weight of the implant with test weights stuck to the upper lid skin close to the lashes. The correct weight allows complete closure of the upper and lower lids but no more than a slight ptosis when the eyes are open. Order the gold implant of the correct weight.

• Make a skin crease incision, deepen it to the tarsal plate and dissect inferiorly deep to the orbicularis muscle on the surface of the tarsal plate, almost to the lid margin.

• Suture the gold weight to the tarsal plate close to the lid margin (Figure 7.6a).

• Close the orbicularis muscle of the inferior wound edge to the tarsal plate with continuous 6/0 or 7/0 absorbable suture. This covers the gold weight implant (Figure 7.6b).

• Close the skin with continuous 6/0 or 7/0 suture. Prescribe prophylactic systemic antibiotics for five days.

Complications - migration or extrusion may occur over several months. Resite the implant if necessary.

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