Complications Associated with the Surgical Techniques of Upper Eyelid Loading: A Clinicopathologic Study of 7 Explanted Gold Weight Lid Loads

Loading of the upper eyelid with gold weights is a well-established procedure for the correction of paralytic lagophthalmos. Only a few studies show the impact of the implant on the surrounding tissues. The aim of this case series is to present clinicopathological correlations in patients requiring implant removal due to post-surgical complications. There were 7 patients (2 men, 5 women aged 24 -79 years) from a sample of 64 with unresolved facial nerve palsy and exposure keratopathy treated with upper gold-weight lid-loading from 2009-2014. Causes of implant removal were: swelling and reddening of the eyelid followed by weight extrusion in 5 cases, 1 excessive ptosis, and 1 unsatisfactory cosmesis. The mean implant weight was 1.5 ± 0.3 g. Complications occurred within 5-92 months. All weights were surrounded by fibrous capsules with lymphocytic infiltrates CD3, CD4, CD8, and CD20 positive. We conclude that complications related to operation technique mimicked an allergic reaction to gold.