What are the recommendations for a patient requiring a prosthesis of the upper eyelid?

Upper Eyelid Prosthesis Recommendations

For patients requiring an upper eyelid prosthesis, surgical intervention with a custom-designed implant is strongly recommended to optimize functional outcomes and cosmetic appearance.

Types of Upper Eyelid Prostheses

Gold Weight Implants

• Gold weight implants are the most established option for treating lagophthalmos (inability to close the eyelid completely) 1
• 80% of patients demonstrate satisfactory results with gold lid load implants with no complications over long-term follow-up 1
• These implants work by providing gravitational assistance to eyelid closure

Custom Eyelid Implants

• Custom-designed implants are preferred over stock gold weights when standard options fail to produce desired results 2
• Custom prostheses can address both functional and aesthetic concerns simultaneously
• These are particularly valuable for patients with non-functioning or unaesthetic existing eyelid implants 2

Silicone Prostheses

• Silicone prostheses are effective for treating deep superior eyelid sulcus, especially in anophthalmic sockets 3
• Benefits include simplicity of placement and relative harmlessness of the procedure 3
• Can address associated ptosis of the upper eyelid and laxity of the lower eyelid simultaneously

Preparatory Approach for Ptosis Correction

• For patients with anophthalmic or microphthalmic conditions with upper eyelid ptosis, a preparatory ocular prosthesis approach before surgery yields excellent results 4
• This technique involves:
  1. Modifying the prosthesis to vertically align the pupils before surgery
  2. Performing levator aponeurosis surgery via an anterior approach
  3. Making minor adjustments to the prosthesis post-surgery if needed
• This approach has shown 66% symmetrical correction with the contralateral eye 4

Surgical Considerations

• The American Academy of Ophthalmology recommends surgical treatment as the definitive approach for blepharoptosis 5
• Surgical options include:
  • Lateral canthoplasty
  • Horizontal shortening of the upper eyelid
  • Excision of the upper medial eyelid 5
• For ocular prosthesis motility, modified sphere implant techniques can provide improved movement while maintaining comfort 6

Pre-Surgical Evaluation

• Screen for obstructive sleep apnea, which frequently coexists with blepharoptosis 5
• Perform comprehensive ophthalmological evaluation to detect keratoconus, a common comorbidity 5
• Assess for obesity, which may require clinical evaluation and management 5

Post-Operative Care

• Regular follow-up is essential to evaluate healing and monitor for potential complications 5
• Watch for recurrences, which can develop rapidly 5
• Continue topical therapy as needed after surgery 5
• For non-surgical cases or as adjunctive care, use lubricating eye drops to alleviate symptoms 5
• Consider nocturnal protection measures including taping eyelids shut during sleep and using eye protectors at night 5

Potential Complications

• Giant papillary conjunctivitis can occur with ocular prostheses, characterized by papillary hypertrophy of superior tarsal conjunctiva and mucoid discharge 7
• Complications may include tarsal scarring and ptosis 7
• Contact lens-related keratoconjunctivitis can develop, ranging from mild to diffuse conjunctival injection and corneal neovascularization 7

Special Considerations

• Avoid oil-based ointments for high-risk cases 7
• For patients requiring general anesthesia during prosthesis placement, ensure proper eyelid occlusion using adhesive strips to prevent corneal injuries 7
• Patient education should emphasize avoiding eye rubbing, which can worsen the condition 5

By following these recommendations, optimal functional and cosmetic outcomes can be achieved for patients requiring upper eyelid prostheses.