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Loss of the ability to completely or partially close the eyelid may occur in many types of facial paralysis. The inability to blink, or close the eye can cause eye irritation, discomfort, tearing, crusting, infections and eventual decrease of vision. Conservative treatments like ointments, eye drops and taping the eye closed at night may temporarily improve symptoms. Eyelid stretching exercises may also be helpful to encourage eyelid closure.
If the facial movement is not recovered or the period of inability to close the eye is prolonged, upper eyelid weight is an option to improve eye closure. Either gold or platinum weight is surgically implanted into the affected upper eyelid through a natural crease. Platinum is generally preferred over gold, because the metal is denser and therefore the implanted weight can be thinner and less visible. Platinum chains can also be sometimes used in select patients, and your surgeon will discuss your options. In the past, surgeons also used to place eyelid springs to help eye closure. However, due to dense scar formation, risk of extrusion and inability to maintain eye closure long-term, eyelid springs are now rarely used.
Upper eyelid weight surgery does not restore natural movement, but assists eye closure by relying on extra weight and gravity. The eyelid with the weight in place will appear slightly droopy compared to the unaffected side and the outline of the weight will be slightly visible as a small bump. Overall, eyelid weights are very effective in restoring eye closure and prevent eye damage from facial paralysis.
With many patients with facial paralysis, return of adequate eye closure will occur and only conservative treatment is required until the eyelid movement returns. However, should the eyelids not be able to close, surgical implantation of a small eyelid weight is an effective option. Your surgeon will examine your eyelids prior to eyelid weight surgery by customizing and measuring the appropriate weight you would need in the office. During the exam, your surgeon will tape different sized weights to the eyelid to provide the most natural eyelid closure possible.
Lower eyelids will also be assessed for retraction and ectropion, which can be corrected at the same time in order to optimize eye closure. The goal of the surgery is to produce natural eye closure and reduce the need for eye drops and lubrication. However, patients will still need to make sure the eye is well lubricated, especially at nighttime, when the gravity and eyelid weight cannot close the eye as effectively because the body position is not upright.
An eye exam will be performed to measure and document the condition of the eyes before surgery. You will need a full vision check from your Ophthalmologist prior to any eyelid surgery. Our doctor will discuss the procedure with you including risks, benefits and alternative treatments. They will review your medications including herbal and over-the-counter drugs and supplements. Many herbal products and pain relievers may increase the risk of bleeding and should be discontinued before surgery. You will sign informed consents and get your instructions for before and after surgery.
You will see your own personal physician for a medical clearance to make sure they feel it is safe for you to have surgery. Your physician may order laboratory blood tests, an EKG or a chest X-ray. You need to stop smoking as this delays healing. You should have nothing to eat or drink after midnight before your procedure. You will be told when to arrive at the surgery center before your surgery. You are signed in, change into a gown, given an IV, and talk to the nurse and anesthesiologist. You will then talk to your surgeon before you get any medications at the hospital so you can ask questions.
You are taken into the operating room, lie down on your back, and the anesthesiologist will put you to sleep with a breathing tube to make sure your airway is safe. The area to be operated on is sterilely prepared with a cleaning solution and drapes. A local anesthetic is injected to decrease bleeding and discomfort. Both eyes are usually protected with special lubricating ointment inside of special contact lenses. An incision is made in a natural skin crease of the eyelid. The eyelid weight is placed under the closing muscle of the eye, called the orbicularis oculi muscle, and held in place with sutures. The skin is closed and special tapes are placed around the incision to support the eyelids.
You are taken to the waiting room and monitored until you are awake and able to drink liquids. Because ectropion surgery is considered a minimally invasive procedure, you will most likely go home the same day. You need someone to bring you home from the surgery center to make sure you get home safely.
Upper eyelid weight surgery is usually not very painful. If you have mild discomfort you may take oral pain medicine the doctor has given you or acetaminophen (Tylenol). If you need a narcotic pain medicine you should take them with food in your stomach and start on a mild stool softener like Senna. You will frequently be given both antibiotic and moisturizing eye drops for use during the day as well as an ointment to place between your eyelids at night. Your doctor may also prescribe oral antibiotics. Keeping your head elevated will decrease eyelid swelling and pressure on the incision. Your eyelid will look droopy after the surgery due to swelling and bruising. This will slowly improve over several weeks.
You need to take it easy for at least one week. Your doctor will let you know when it is safe for you to return to normal activity. Call your doctor if you have increasing redness of the incision, fever, bleeding, pus, drainage, the incision opens or you have worsening pain. Also, let your doctor know if you have any other concerns. You will see your doctor the week after surgery and sutures will be removed. You will usually be back to normal activity within two weeks of surgery.
The risks of your upper eyelid weight surgery will vary depending on whether you had eyelid surgery before. The general risks of any eyelid surgery include bleeding, infection, dry eyes, eye irritation, difficulty with eye closure, visible scarring or skin discoloration, eye muscle injury, the need for additional surgery, chronic pain, numbness, temporary blurry vision or rare vision loss and risks of general anesthesia. Risks specific to eyelid weight are needed for replacement or eyelid weight readjustment, transient or permanent droopy eyelid and long-term risk eyelid weight extrusion. Preparing for surgery and following your doctor’s instructions are useful to help minimize risks.
The Surgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of facial paralysis. Dr. Araslanova can provide the optimal treatment for facial paralysis. Surgery to help close the eye due to facial paralysis is generally covered by your insurance. As out-of-network providers, we will check your benefits for you and let you know if there are costs are so there are no surprises. We use an individualized treatment plan to provide personalized holistic care. If you would like assistance, please feel free to contact us.