title: Blink lagophthalmos and dry eye keratopathy in patients with non-facial palsy: clinical features and management with upper eyelid loading.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective, noncomparative case series.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.
authors.forename: Vikesh
authors.initials: V
authors.lastname: Patel
authors.forename: Sheraz M
authors.initials: SM
authors.lastname: Daya
authors.forename: Damian
authors.initials: D
authors.lastname: Lake
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001767:Blinking / Q000502:physiology*; D002648:Child; D003316:Corneal Diseases / Q000503:physiopathology*; D015352:Dry Eye Syndromes / Q000503:physiopathology*; D005141:Eyelid Diseases / Q000503:physiopathology / Q000601:surgery*; D005158:Facial Paralysis / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006046:Gold; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012189:Retrospective Studies
chemical_list: D006046:Gold