A technique for lid loading in the management of the lagophthalmos of facial palsy.

Weighting of the upper lid with gold, to provide closure and cosmetic improvement in a lagophthalmos due to facial palsy, has found increasing acceptance among plastic surgeons and ophthalmologists since it was described by Smellie9 in 1966. The technique we have developed after a 4-year experience with this procedure has proved to be good, and it can be easily modified as the clinical circumstances change. The availability of a standardized gold weight* will make it possible to extend the usefulness of the procedure. Paralysis of the orbicularis oculi limits the ability of the lids to close. In younger patients, the elasticity of the skin assists in closure. The older the patient, the more lax the skin and the greater the need for therapy. The addition of a gold weight to the upper lid assists in replacing orbicularis function. We have found that variations in the weight and thickness of the eyelid tissues, and in the strength of the levator palpebrae muscle, cause considerable individual variation in the amount of gold necessary to achieve a satisfactory result.