Gold weight insertion
This is Richard Allen at the University of Iowa. This video demonstrates placement of a gold weight. The patient has a history of a right 7th nerve palsy. A 15 blade is used to make an incision along the eyelid crease through the skin and orbicularis muscle. Hemostasis is obtained with the bipolar cautery. A thermal cautery is then used to dissect between the pretarsal orbicularis muscle and the anterior surface of the tarsus in order to create a pocket for the gold weight. The weight should be placed somewhat medial. A mistake I see is placing the weight too lateral. A 6-0 prolene suture is then placed partial thickness through the anterior surface of the tarsus to engage each of the holes of the weight. The upper portion of the weight should rest at the superior border of the tarsus. The weight appears to be in good position. The eyelid is then everted to inspect the posterior surface of the tarsus to make sure none of the sutures were placed full thickness. A double layer closure is then performed over the gold weight. Orbicularis muscle is closed with interrupted 7-0 vicryl suture. This double layer closure is performed to prevent exposure of the weight. The skin is then closed with a running 6-0 prolene suture. Antibiotic ointment is placed over the incision and the patient returns in one week for suture removal.