Lidbeschwerung mit einem auf das Oberlid geklebten Bleiplättchen zur vorübergehenden Therapie des Lagophthalmus

BACKGROUND The introduction of an external lid loading with the help of a lead weight for the treatment of lagophthalmos is presented. This simple and effective approach was first described in 1993 but obviously not frequently used in the therapy for lagophthalmos. METHODS Instead of wearing a monoculus throughout the day, the patient wears an indivdually tailored adhesive lead weight; its aim is a complete lid closure, in case of a too heavy lead weight a spontaneous ptosis occurs. With the M. levator palpebrae intact, lid lifting is no problem. The effect of the lead weight is gravity dependent, so that the patient has to wear the monoculus at night. To minimise the risk of lead intoxication, we varnished the surface of the weight with nail varnish. In the case of a persistant paresis of the M. orbicularis oculi, an implantation of a gold weight can follow. A total of 152 cases with lagophthalmos have been treated with the external lid loading since 1997. RESULTS All patient could perform lid closing immediately after lead weight application. Approximately 45 % of the patients had to re-adjust the lead weight per day. Compliance was high and a partial or complete restoration of the function of the M. orbicularis oculi was observed in 60 %. In some cases the restoration of the M. orbicularis oculi was faster than in the M. orbicularis oris. CONCLUSION The external lid loading with a lead weight is a simple and effective approach in the treatment of lagophthalmos in comparison to a cosmetically unattractive monoculus. When wearing the lead weight the vision is not blurred so that car driving may be possible.