Corneal astigmatism as a special complication after lid-loading in patients with lagophthalmos

Lid-loading with precious metals, described by Illig in 1958, has become increasingly important. Because of its good functional and cosmetic results this method is superior to tarsorrhaphy. Furthermore, lid-loading can be combined with additional surgical techniques to achieve more dynamic lid-closure. In a prospective study we examined the results after lid-loading and discuss postoperative changes of the cornea. Patients and methods: Between May 1994 and June 1998, 36 patients with peripheral facial paresis and lagophthalmos were treated with a pretarsally fixed upper-lid implant. We used 99.99 % gold for the implants with a weight of 1.5 g on average. Results: In all cases we obtained sufficient postoperative lid closure which resulted in a statistically significant reduction in lagophthalmos and improved keratopathy. Postoperative complications were: pseudoptosis, remaining lagophthalmos, bulge, extrusion, migration and corneal astigmatism. Depending on the implant pressure, an astigmatism of 1–2 D developed in the vertical meridian. In all cases the initial visual acuity was reached by an ordination of cylindrical glasses. Conclusions: So far, corneal astigmatism as a complication after lid-loading has not received much attention in the literature. In our opinion, the development of astigmatism is caused by implants that are too heavy, an incorrect implant radius and individual cofactors (consistency of lid and cornea). There has been no need for an explantation in any case.