Valeria Sansone , James Boynton and Cynthia Palenski disease

All since 1951, it is now a weekly with 48 issues per year. Article abstract-Upper eyelid gold-weight implants are widely used in the correction of lagophthalmos in many neuromuscular conditions, most commonly facial palsy. The paralytic lagophthalmos that occurs in facioscapulohumeral muscular dystrophy (FSHD) is common and can cause severe ocular complications. It is not usually considered for surgical correction. Upper lid loading with 24K gold implants and reconstructive lower lid surgery in a 64-year-old woman with FSHD corrected eyelid deformity and exposure keratitis. Surgical treatment also markedly improved facial appearance. This treatment may merit wider use in FSHD. Paralytic lagophthalmos describes incomplete closure of the eyelids as a result of paralysis of the seventh cranial nerve, usually from lesions affecting the nuclear or peripheral portion of the nerve. Facial paralysis with resultant paralytic lagophthalmos and ectropion can occur from many causes, including Bell's palsy, tumors, trauma, injury, or vascular accidents affecting the facial nerve.' There is significant variability in the onset and extent of facial nerve regeneration. The degree of recovery of facial nerve function after paralysis is influenced by the cause of the palsy, the degree of neural injury, the age of the patient, and the clinical setting. Whatever the cause, the ocular complications of inadequately or improperly managed facial paralysis range in severity from corneal irritation and punctuate keratopathy to cor-neal ulceration, perforation, and blindness. Traditional medical therapy has included emol-lient ointments and eye drops, as well as taping and pressure patches.lf2 However, these are of short-lasting benefit and the frequency of application is such that these measures are often abandoned by the patients. This has led to use of surgical procedures in the management of facial paralysis. Partial or complete tarsorrhaphy has been the standard procedure of ophthalmologists for corneal pr~tection.~ However, this does not improve active eyelid closure, it often restricts the visual field, and it is usually cosmetically displeasing to the patient. Such complications led to the development of a number of alternative surgical techniques to tarsorrhaphy. One of the earliest approaches to repair upper lid ectropion due to paralytic lagophthalmos was the palpebral spring described by Morel-Fatio and Dalardrie: and was later modified. The spring, a stainless wire, is implanted in the lateral canthal area so that it forces the eyelid to close. When the eye is open, the levator palpebrae superioris muscle counteracts the force of the spring and holds the eyelids …