Eyelid Implants - FAQ's


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I have a patient who is a candidate for Eyelid Weight Implantation; what’s my next step? How do I go about ordering this product?

First you need to determine the correct Eyelid Implant Weight for your patient using MedDev’s Tantalum Weight Sizing Set.  MedDev’s Sizing Set contains a series of seven weights ranging from 0.6 gram to 1.8 gram, by 0.2 gram increments.  The weights adhere to the upper eyelid to determine the appropriate weight for optimum eyelid closure.  Once the appropriate weight is determined, MedDev offers Gold and Platinum implants in either ThinProfile (0.6 mm thickness) or Contour (1.0 mm thickness) implant designs.  Please contact our customer service support staff for additional information.

Note: Most MedDev products are in stock and available for immediate delivery.

How do I determine the correct weight implant for my patient?

The easiest way to determine the correct weight is to order MedDev’s Tantalum Weight Sizing Set.  The Standard Sizing Set consists of seven suitably contoured weights corresponding to the most common implant sizes.  These sizing weights can be temporarily applied to the patient’s eyelid to evaluate a patient’s requirements.  The sizing set also includes a supply of double-stick, hypoallergenic adhesive strips to adhere the weights to the upper lid.  Alternatively, any medical grade adhesive can be used for adhesion.  Two adhesives commonly used are Mastisol and Benzoin.

Weight sizing is done preoperatively.  The following are MedDev’s Sizing Instructions:

1. Place the EyeClose® Adhesive Strip on the concave side of the 1.0 gram sizing weight. (Note: Instructions for use of the tape are included in the adhesive tape box.)

2. With the patient sitting upright, affix the weight to the upper eyelid approximately 3.0 mm above the lash line, centered at the junction of the medial and central thirds of the eyelid (See Figure 1).  At this point the action of the levator function is maximal.

3. Note the position of the eyelid as the patient looks up and down.                              figure 1

4. Increase or decrease the sizing weight until the best result is achieved.  Because the levator seems to strengthen over time after the weight is added, the optimal weight is usually that which holds the lid about 1.0 mm lower than the normal lid as the patient looks straight ahead.

Once the appropriate weight is determined, the corresponding implant may be chosen in either Gold or Platinum and in our Contour or ThinProfile designs.

How soon after the onset of facial paralysis and lagophthalmos should the patient receive an Eyelid Implant?

If a patient is diagnosed with lagophthalmos and expectations are for prolonged or incomplete recovery, the patient is a suitable candidate for the Eyelid Implant procedure.  If the facial nerve is intact and recovery is likely, as with Bell’s palsy patients, supportive care utilizing an External Eyelid Weight in conjunction with ocular lubricants can be indicated for the first six months, during which time facial nerve function can be monitored.  If paralysis resolves after implantation of an Eyelid Weight, the procedure is easily reversed.

 

Will the eyelid close with the patient sleeping in the supine position?

The orbital septum that extends from the upper portion of the tarsal plate to the upper orbital rim is a thin sheet of fibrous tissue that attaches to the orbit just below the eyebrow.  When the eye is closed lying down, this tissue is relatively flat, preventing the Eyelid Weight from going back into the orbit.  If the weight is placed incorrectly behind the orbital septum, it can inadvertently pull the lid open, as the weight falls back towards the orbit on the surface of the levator muscle that is behind the orbital septum.

 

Have the implants been reported to extrude from the eyelid?

Pickford reported an extrusion rate of 12% among 41 patients in an article published in the British Journal of Plastic Surgery.1  These implants, however, were not designed with suture holes through which adhesions could form for secure, permanent fixation.

In response to the Pickford article, MedDev Corporation polled the surgeons who use Gold Eyelid Implants to determine their incidence of infection and extrusion.  The incidence of infection and extrusion among 168 surgeons reporting on over 2000 cases were 0.3% for infection and 2.6% for extrusion.  This low complication rate is a testament to the superior quality and design of the MedDev Eyelid Implants.

1. Pickford MA, Scamp T, Harrison DH: Morbidity after gold weight insertion into the upper eyelid in facial palsy. British Journal of Plastic Surgery, 45: pp. 460-464, 1992.

Does MRI affect Gold Eyelid Implants?

No, JW Canady published an article in the Annals of Plastic Surgery (31: 76-77, 1993) reporting on an ex-vivo study which showed no deflection of the Gold Implants at 0.5 tesla and 1.5 tesla.  The Gold Eyelid Implant is 99.99% pure gold.  There are no ferrous metals in these devices.

An additional study by Mark May published in Laryngoscope (103: August 1993: p. 93) reported no magnetic effects from the use of MRI with the Gold Eyelid Implants but did mention that the implant may become warm when bombarded with radio waves.

Why is Gold used in manufacturing Eyelid Implants?

Gold is preferred because it is a heavy, inert metal that does not corrode or cause irritation to the eyelid tissue.  Gold is also preferred because its color closely matches that of the eyelid’s fat tissues, making the implant less conspicuous in the eyelid, even in patients with thin skin.  For those few patients with Gold sensitivity we suggest Platinum as an alternative.

 

What Caret of gold is used?

MedDev’s implants are manufactured from 24K gold.  Prior to production, an independent and certified laboratory analyzes a sample from each lot of gold or platinum for purity using an Emission Spectrophotometer (E-Spec).  A broad-spectrum assay is conducted and all impurities are reported in individual concentrations.  Lot traceability is maintained for all Eyelid Implants manufactured by MedDev.  While analysis results may vary from lot to lot, no lot is accepted for production that is not at least 99.99% pure and has selected trace elements below specified limits.

 

What is the most popular eyelid weight that is ordered?

The most popular weight for Gold and Platinum Eyelid Implants are 1.0 and 1.2 grams.

For additional information, Contact Us or Call MedDev Customer Service at 800.543.2789 (M-F 8:30 am – 5 pm PST).