Covering the gold weight with fascia lata graft in paralytic lagopthalmos patients

Loading the eyelid with a gold weight is a popular technique for improving closure of the eyelid in patients with facial palsy. Despite it being both safe and simple, placement of the weight into a submuscular pocket is not always successful. Ulceration of the skin, and extrusion and visibility of the implant, are quite common short or long-term complications. We have developed a technical refinement of lid-loading. After the implant has been sutured in the appropriate place, we cover the implant with a fascia lata graft. We have used this technique in 8 patients who had had excision of an acoustic neuroma. No implant ulcerated or migrated, and none of the patients complained that the implant was visible during follow up of between 3 months and 4 years. Tendinous grafts act as a strong barrier to the gold weight because they are durable and thick. Fascia lata is easily harvested and leaves an inconspicuous scar at the donor site. We therefore recommend the technique to avoid complications.