A comparison of temporal muscle transfer and lid loading in the treatment of paralytic lagophthalmos.

Temporal muscle transfer (n = 78) and lid loading with a gold plate (n = 52) were compared in the treatment of paralytic lagophthalmos. Three sizes of gold plate (1.0, 1.2 and 1.4 g) were used. Lid loading was inferior to temporal muscle transfer in improving functional ability to close the eye, but it did protect the cornea from irritation. There were no significant differences among the sizes of plate, but there was most relief from corneal irritation when the 1.4 g gold plate was used. The plate had to be removed in 25% of the patients, but this did not make the condition worse than before lid loading. Lid loading has the advantage that patients can close their eyes without conscious effort. We therefore recommend lid loading as the first choice for correction of paralytic lagophthalmos, and that temporal muscle transfer should be undertaken after plate removal in only those patients for whom lid loading has not given a satisfactory result.