Chronic Dry Eye & Gold weight implant

[shanku]

Hello & Greetings everyone! First post here...

My Back Ground:
Suffering with chronic Dry Eye/MGD/blepharitis/rosacea(facial) for last 5 years. My dry eye nightmare started with a severe sinus infection which turned into eye infection back in the spring of 2007 (from abnormal pollen levels). Also, have 3-4mm lagophthalmos, moderate Bell's phenomenon, proptosis, eye lid retraction and HypoThyroid. Had Sinus surgery last year after lot of suffering and they are much better now. Have had evaluation for Graves & Sjogren's disease and allergy testing; allergy testing(IDAT) was positive on many items; Am drinking 16-18 glasses of water for a while now. Underwent minor salivary gland biopsy for Sjogren's & pathologist observed chronic salivary gland inflammation.

For last couple of months, I am having corneal pitting/abrasions/scarring.  So, my Ophthalmologist and Oculoplastic surgeon is suggesting Gold weight implant or tarsorrhaphy to address my eyelid abnormalities so that Cornea do not get dried out any further & therefore avoid corneal ulcers etc.

My question are  -

a) with Gold weight implant how much is the success rate? what are the risks? What is the worst case scenario?

b) for eyelid closure problems, I read that some kind facial nerve paralysis is responsible? Will it be good to also investigate what's behind this facial nerve issue? Which specialist will be suitable for that - ENT surgeon? I have recently had an Brain MRI for Grave's disease and the Oculoplastic surgeon did not notice any eye muscle enlargement. Will this MRI be useful to detect any nerve issues?

Thanks in advance!
           

[alabamajane]

HI,
Not sure if my info/experience is any help and certainly not medical advice as I am not a Dr.. but I just had AN surgery and had to have my facial nerve severed.. so I have facial paralysis and had to have a gold weight implant because eyelid does not close on it's own. I did not have any "issues" with that surgery, it was secondary to the AN surgery,, done 4 days later when they went in to graft a nerve to my facial nerve. I just have to use eye drops during the day and at night. The eyelid still does not close like when I am blinking, but does when I lay down.. no other real issues with it I guess.. It does bother me in windy situations and cold air, dusty etc.. and it is hard to remember not to rub that eyelid as you can feel the weight... not really sure about the MRI's usefulness in detecting nerve issue either,,,unless MRI is done to determine an AN which can involve facial nerve as mine did,, but you usually have some hearing indication or balance issues before facial issues with AN...like I said,, my opinions here,, not medical..

As for the grave's disease, seems like Dr would do thyroid blood testing to determine that issue.. it is hyperthyroid that leads to Grave's disease (overactive) ,, my husband has just been diagnosed with it, by simple blood work , testing T4 and T3 and TSH levels.. I had HYPOthyroid (underactive) several years ago causing thyroid nodules and eventually cancer so thyroid has been removed. I know the Grave's can impact your eyes too,, my husband's has not so far although he is early in diagnosis. His symptoms were extreme weight loss, fatigue and shaky hands and rapid heart beat.

Hope this helps any,, good luck in getting diagnosis and relief.. Jane

[shanku]

Hi Jane,
            Thanks for your response. I am glad to hear that your implant is helpful & working for you and sorry to hear that your hubby has GD. My Thyroid usually hypo but at times spikes to hyper because of over medication. I was evaluated for GD using blood work and MRI. but they did not notice anything significant. But I do exhibit exposure keratitis, proptosis along with  lagophthalmos which is are characteristic of GD.

Shall ask my ENT and Eye doctors whether I need to investigate any AN issue. I do experience heavy headed-ness and ear pain below my left ear; not sure if it is from dry eye pain or otherwise.

One thing my doctors have never explained well is - why I have lagophthalmos? is it because of facial nerve paralysis or some eye muscle weakness? I got my dry eye disease after a very severe eye infection 5 years ago. Before that I never experienced any eye issue. I never got a good answer on it.

I use Tranquil Eye Goggle during sleep for lagophthalmos for night time eye protection. I believe it is worsening my lower eyelids further and causing me more lower eyelid retraction. Unable to use tape as eyelid skin feels sore after few days.

How much noticeable are these Gold eyelid implants? do the eyelids look bulgy? Are platinum weight implants better choice? How about platinum chain implants - is that different? On Med-Dev website I see these ThinProfile Eyelid Implant which claim to be 40% thinner - is this what people usually choose these days?

As of now, I am using the external eyelid weights. I read that one member of this forum indicating that after using the external weights for a while, the normal eyelid function got restored with out needing any surgery! My surgeon indicated that weights are not helpful to restore normal eyelid position ...did anyone else had similar experience...does it vary on ones specific case?

Also, the adhesive strips that come with these external eyelid weights do not hold it in position for more than couple of hours and it rolls when I make eye squeeze. Any suggestion on how to hold/support these better?

Thanks and Appreciate. Good Luck with everything!

[alabamajane]

Not sure what type/size my eye weight is as I had no input into it...it is gold weight and 1 "something".. concerning weight or size, it is not very noticeable unless I get tired or eye does not get enough lubricant, and then it is just slightly red and does look slightly swollen ,, but don't think most people notice it when talking to me,, except that eye does not blink along with the other one..maybe your Dr can tell you more about your options as far as gold or platinum etc.. like I say,, this was unexpected for me and I did not have time to choose... good luck and I sure hope you don't get diagnosed with an AN along with all your other issues...

[shanku]

Thanks Jane. Good to know that these implants are not as visible as I thought; I earlier looked at the pictures here which looked pretty visible:

http://archfaci.ama-assn.org/content/5/2/166.full.pdf

[alabamajane]

I looked at pics too and I guess it would be that noticeable to folks if your eye was closed when talking to them.. like I said, I do notice it more if I am tired or looking down while brushing teeth  etc,, but I have never heard of the platinum chain,, so worth looking into I am sure.. good luck.

[nancyann]

I had a platinum chain in (only reason it was removed was I needed a heavier weight, the surgeon I went to didn't have the chain so I have a 1.6 gram platinum weight). I recommend having a weight put in - without it my upper lid was pushed back & my eye had a 'skeletal' appearance. It helped my eye look 'more even' and assists with blinking - my eye never fully closes, but it's alot better than not having had it done.  It could always be removed down the line if you no longer needed it...
Always good thoughts, Nancy