Gold or platinum eyelid weights for facial palsy: what they do, and the risks

A gold or platinum eyelid weight is a tiny implant placed in the upper lid so that gravity helps the eye close when the facial nerve no longer can. It is used for facial palsy that has not recovered, to protect the cornea. This article explains why the eye will not close, when a weight is considered, how gold and platinum compare, what the operation involves, the alternatives, and the signs that need same-day care.

Why does the eye not close in facial palsy?

The eye does not close because the facial nerve, the seventh cranial nerve, stops driving the orbicularis oculi, the ring of muscle that squeezes the lids shut. The muscle that lifts the upper lid, the levator, is supplied by a different nerve and keeps working, so the lid opens normally but cannot come down fully.

The medical name for this is lagophthalmos, an eye that cannot close completely. The cornea, the clear window at the front of the eye, then dries and is exposed, especially at night and when blinking is weak. The Bell palsy review in StatPearls puts corneal exposure keratopathy, damage to the surface from exposure, at about 40% of patients with Bell palsy, which is why protecting the surface is the first priority from the first day. If you want the fuller picture of this problem, the article on lagophthalmos covers the causes beyond facial palsy.

When is an eyelid weight considered?

A weight is considered when the palsy is not expected to recover well, or has not recovered, and drops, ointment and taping are no longer enough to keep the cornea safe. It is not a first step for a new Bell's palsy, because most cases of that kind recover and the eye can usually be protected with lubrication in the meantime.

StatPearls notes that periocular procedures are more often used for long-term flaccid facial paralysis, and EyeWiki says surgery is generally considered when there is limited likelihood of functional improvement in the facial nerve. In practice that means a surgeon looks at the cause, how long the palsy has lasted, whether any movement is returning, and how the cornea is faring. A palsy from a tumour operation or an injury to the nerve is judged differently from Bell's palsy. The article on Bell's palsy and the eye sets out how the eye is protected while recovery is awaited.

How does a gold weight help the eyelid close, and what does the operation involve?

The weight adds a small load to the upper lid, so the lid is pulled down by gravity when the levator relaxes, as it does when you look down or blink. It does not move the lid on its own and it does not restore a smile or any facial movement. It helps the lid come down when you are upright, so it works less well lying flat, and the lid may still gape slightly in sleep.

The implant is chosen by weight, matched to the lid so that it helps closure without pulling the lid down when open. EyeWiki gives the usual range as about 1.0 to 1.8 grams, and the surgeon decides the figure for the individual lid. A weight cannot help the lower lid, which can sag or turn out when the nerve is weak, and a surgeon who treats the whole eye looks at both.

The surgeon makes a small cut in the natural upper lid crease, places the weight over the tarsal plate or just above it, fixes it with fine stitches and closes the skin.

Local anaesthetic is commonly used, and many people go home the same day, though the papers cited here do not give a standard. Swelling and bruising are expected for the first days, the eye may feel tight or gritty at first, and lubricant is usually continued for a time. The surgeon will say when to return, how to clean the wound and what changes need an earlier visit. Light activity is often resumed soon, but the timetable depends on the person and the surgeon. The article on dry eye after eyelid surgery explains why the surface can feel dry in the early weeks.

Is a platinum chain better than a gold weight?

Platinum chains are lower in profile and appear to give fewer problems than solid gold weights in the larger comparisons, but both work and both can cause trouble. A 2018 review of eyelid loading in facial palsy concluded that platinum has distinct advantages over gold, and that placing the weight in a supratarsal position, above the tarsal plate, is preferred to placing it on the plate itself.

The clearest data come from a single British centre over ten years. In 136 patients, 127 eyelids had a gold weight first, and 40.9% of them needed further surgery: the gold was exchanged for platinum, repositioned or removed. Only 22.2% of the 27 eyelids that had a platinum chain first needed revision. Gold weights were more likely to be prominent under the skin and to migrate. The same series found gold allergy in 7% of patients, so allergy is a reason the metal is sometimes changed.

Platinum is not free of reaction either. One case report describes an elderly woman whose platinum weight caused persistent swelling and skin discolouration from the eighth day, with no infection, and which settled quickly once the weight was removed. The tissue showed an inflammatory reaction to the metal. Platinum reactions are described as less common than those to gold, but they are possible.

What do the results and risks look like?

A 2025 systematic review of 26 studies and 1,205 patients found that gold or platinum weights achieved complete or near-complete closure in 83 to 92% of cases, with remaining lagophthalmos under 1 mm. Complications ran from 5 to 15%, mainly extrusion, where the implant works its way out through the skin, or migration, where it shifts position. Satisfaction averaged 7.9 out of 10.

These are pooled figures from studies of different designs, so they describe what has been reported, not what any one person can expect. Other described problems include a visible lump or the outline of the weight, a lid that droops (ptosis) from the extra load, infection, and a need to change the weight if the palsy recovers or the lid changes with time. Because the weight sits in the tissue for years, reviews mention revision as part of the long-term picture rather than as a failure.

Magnetic resonance imaging is a reasonable worry for people who may need scans for the underlying nerve problem. Laboratory tests on pure gold, pure platinum and a platinum and iridium alloy found no heating or movement in 1.5, 3.0 and 7.0 tesla scanners, with gold producing the least image distortion. These were bench tests, not people, so tell the radiographer you have an eyelid implant and carry any card you are given.

What are the alternatives to an eyelid weight?

The alternatives are lubricating drops and ointment with taping at night, a temporary botulinum toxin injection that deliberately lowers the upper lid, a tarsorrhaphy, tightening of the lower lid, and in selected cases fat grafting or a muscle procedure. Which is suitable depends on how long recovery is expected to take.

• Drops, ointment and taping. The first-line protection, and the NHS advises eye drops and ointment, with surgical tape to keep the eye closed at bedtime.
• Botulinum-induced ptosis. Toxin in the lid-lifting muscle lowers the lid for some weeks, as a temporary measure while waiting for recovery. It is not permanent, and it blocks the view until it wears off.
• Tarsorrhaphy. The lids are stitched partly together to narrow the opening, temporarily or permanently. A 2018 review advises that disfiguring tarsorrhaphies be kept for special situations.
• Lower lid tightening. A sagging lower lid is treated as retraction and supported. The article on ectropion explains the turned-out lid.
• Other options. The 2025 review also covers fat grafting and a müllerectomy, which shortens a small lid-lifting muscle, and a scleral lens can help a stubbornly dry surface.

Sleeping with the eyes slightly open is a related problem in people whose lids otherwise work; the article on nocturnal lagophthalmos explains it. A broader view of how the lids shape the way the eyes look and feel is in what makes eyes look tired, and the rest of this section of the site is at eyelid conditions.

When does a problem with the eye or the weight need same-day care?

Eye pain, a red eye, blurred or falling vision, or light sensitivity in a person with facial palsy needs same-day assessment by an eye doctor, because these can mean a corneal ulcer, which can threaten sight. The same goes for a weight site that becomes hot, red, swollen or discharging.

A weight that you can see poking through the skin, or an eyelid that has suddenly drooped, should also be reviewed promptly rather than watched. Do not wait for the next scheduled visit, and do not remove or push on an implant yourself.