Blink lagophthalmos and dry eye keratopathy in patients with non-facial palsy: clinical features and management with upper eyelid loading

Ophthalmology. 2011 Jan;118(1):197-202. doi: 10.1016/j.ophtha.2010.04.037. Epub 2010 Nov 20.


Purpose: To evaluate the outcome of using upper eyelid gold weight implantation for patients with non-paralytic lagophthalmos on blink (LOB) only. We highlight the features of incomplete blink and reduced blink rate in patients with non-facial palsy as an exacerbating factor in dry eye keratopathy.

Design: Retrospective, noncomparative case series.

Participants: Twelve patients (21 procedures) who underwent upper eyelid gold weight implantation for non-paralytic LOB only.

Methods: Retrospective case note review of patients who underwent upper eyelid loading for non-paralytic LOB only over a 5-year period at a single institution.

Main outcome measures: Improvement in LOB, gentle and forced closure, increased frequency of blinking (FOB), degree of corneal staining, incidence of epithelial defects or corneal ulcer, improvement in vision, and subjective improvement in ocular discomfort.

Results: Twenty-one procedures in 12 patients. Nine patients underwent bilateral surgery. Mean age was 56 (range, 8-80) years. Median postoperative follow-up was 15 months, and mean follow-up was 20.38 ± 16.61 (6-58) months. Eleven of 12 patients had an improvement in LOB and increased FOB, resulting in improvement of keratopathy and reduced ocular discomfort. One patient developed superior corneal thinning and descemetocele, requiring removal of the gold weight; 1 patient required ptosis surgery; and 1 patient developed a gold allergy and underwent platinum chain exchange.

Conclusions: We highlight the need to consider incomplete blink and reduced FOB as exacerbating factors for corneal-related disorders, including dry eye. Upper eyelid loading with gold weight implantation is a useful and predictive method of improving exposure-related keratopathy due to LOB in the absence of facial palsy.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blinking / physiology*
  • Child
  • Corneal Diseases / physiopathology*
  • Dry Eye Syndromes / physiopathology*
  • Eyelid Diseases / physiopathology
  • Eyelid Diseases / surgery*
  • Facial Paralysis / physiopathology
  • Female
  • Follow-Up Studies
  • Gold*
  • Humans
  • Male
  • Middle Aged
  • Prostheses and Implants*
  • Prosthesis Implantation
  • Retrospective Studies


  • Gold