Search

PurposeMethodsResultsConclusionsThe aim of this retrospective case review is to present a novel surgical technique used in the treatment of recalcitrant lower eyelid retraction.This study was performed as a retrospective case review of 4 patients who have failed standard conservative surgical interventions for lower eyelid retraction repair. 3 patients developed lower eyelid retraction following surgical intervention for orbital trauma and 1 patient developed lower eyelid retraction in the setting of granulomatosis with polyangiitis. The surgical technique was identical in each patient and performed by an oculofacial plastic surgeon, sometimes together with an oral and maxillofacial surgeon. Follow-up results for all patients were assessed at 1 week, 1 month, and 3 months.All four patients demonstrated initial improvement in lower eyelid position, fullness, and height. A common finding was mild lateral postoperative entropion, which was easily overcome with an upper eyelid tarsoconjunctival flap. There were no surgical complications sustained in any of the cases.This retrospective case review provides a novel surgical option for the correction of recalcitrant lower eyelid retraction. The excellent vascularity provided by this flap, location, and easy access support its use. A prospective study comparing alternative solutions would be useful in comparing the buccal fat pad vascularized pedicle to alternative methods used to correct refractory and cicatricial lower eyelid retraction. [ABSTRACT FROM AUTHOR]

This study aimed to examine the changes in lower eyelid position after blepharoptosis surgery and the factors that influence the outcome. We conducted a retrospective study of 155 eyes of 89 patients who underwent blepharoptosis surgery between June 2019 and October 2022. The margin reflex distance (MRD)-1 and MRD-2 were examined preoperatively and 3 months postoperatively in two groups: one with lower scleral show (LSS) (n = 37) and one without LSS (n = 118). The clinical characteristics of the two groups were compared. Both the LSS and non-LSS groups showed significant postoperative improvement in MRD-1 scores (p <.01, p <.01, respectively). MRD-2 was significantly reduced in the LSS group, while it remained unchanged in the non-LSS group (p <.01, p =.27, respectively). There were no significant differences between the two groups in age, sex, history of hard contact lens use, preoperative levator function, use of topical steroids, history of endophthalmic surgery, or history of filtration surgery; however, the LSS group significantly used prostaglandin analogs (PGAs) (p =.03). Postoperatively, MRD-2 decreased in 13 eyes (35.1%) and was maintained in 24 eyes (64.9%) in the LSS group and was maintained in all eyes in the non-LSS group. In the LSS group, we also examined the association between postoperative MRD-2 reduction and the use of PGAs and found that more patients with MRD-2 reduction used PGAs (p =.02). Lower scleral show in PGAs-associated blepharoptosis is expected to improve after blepharoptosis surgery. [ABSTRACT FROM AUTHOR]

To compare the incidence of lower eyelid malposition following repair of isolated orbital floor fractures with that of complex orbitofacial fractures (defined as multi-wall fractures or prior orbital fracture repairs requiring revision) by oculofacial plastic surgeons via a transconjunctival or swinging eyelid approach. Retrospective review of 175 patients who underwent surgical repair of orbital fractures at our institution. The primary outcomes were the occurrence of lower eyelid malposition (ectropion, entropion, and eyelid retraction) and the need for subsequent surgical correction. Of 95 patients with isolated orbital floor fractures, 4 developed eyelid malposition (4.2%), 1 of which required surgical repair (1.1%). Of 80 patients with complex orbitofacial fractures (48 multi-wall fractures, 32 secondary revisions), 10 had pre-operative eyelid malposition and were excluded from further analysis. Fourteen of the remaining 70 patients developed postoperative eyelid malposition (20%), 3 of which required surgical repair (4.3%). The difference in the occurrence of eyelid malposition between groups was statistically significant (p =.001), but the difference in rates of those requiring subsequent repair was not (p =.182). There was no statistically significant difference in the occurrence of eyelid malposition when considering other surgical factors including lateral canthotomy, conjunctival closure, implant material, or anterior rim screws. The incidence of lower eyelid malposition following orbital fracture repair via a fornix-based approach was significantly higher for the repair of complex orbitofacial fractures than for isolated floor fractures. However, very few patients in either group required surgical repair for eyelid malposition. Surgical factors including implant material did not affect outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Orbital decompression for thyroid eye disease (TED) has been noted to improve lower lid retraction by 0.5-1 mm. We hypothesize that orbital decompression via transconjunctival approach may lead to increased reduction in marginal reflex distance 2 (MRD2) as it involves division of the lower lid retractors. The purpose of this study is to evaluate relative changes in lower lid position for patients undergoing lateral and transconjunctival orbital decompression, respectively. Methods: In this cross-sectional study, all TED patients managed with lateral or transconjunctival orbital decompression for a 3-year period were screened for inclusion. Photographs taken in the primary position preoperatively and three months postoperatively were utilized to evaluate the MRD2 from each patient. Measurements were made utilizing NIH ImageJ software standardized to a corneal diameter. Hertel measurements of proptosis were obtained pre and postoperatively. The primary outcome measure was MRD2 in operative eyes. Results: A total of 131 (86 patients) operative eyes were included in the sample. Mean change MRD2 was not significantly different between the surgical groups (p = 0.07). In multivariate modeling, mean change in MRD2 was significantly associated with change in exophthalmometry, independent of surgical approach. Conclusions: The association between decrease in Hertel measurement and decrease in MRD2 is consistent with the existing literature on the topic. It appears that transconjunctival division of the lower eyelid retractors provides no additional benefit in reducing lower lid retraction relative to change in proptosis. [ABSTRACT FROM AUTHOR]

This article describes our surgical technique for subperiosteal midface elevation in patients with paralytic lower eyelid malposition or cicatricial inferior eyelid retraction. Nineteen patients with paralytic lower eyelid malposition and 15 patients with cicatricial inferior eyelid retraction underwent a subperiosteal midface lift (n= 34). The procedure was performed under local anesthesia through three nonvisible incisions. A transconjunctival incision allows preseptal dissection to the orbital rim, followed by a subperiosteal dissection of the midface. An oral incision is useful to achieve complete subperiosteal dissection and to perform the distal periostomy, which allows complete release of the midface soft tissues. A temporal incision provides access to the temporal fascia for fixation of the elevated tissues and gives the surgeon the possibility of removing redundant skin from the scalp instead of the lower eyelid. Additional posterior lamellar grafting was performed in 24 patients. There was a statistically significant reduction in the distance from the pupil centre to the lower eyelid (margin reflex distance, MRD2) 1 month after surgery (preoperative MRD2 9.62 ± 4.52 mm, postoperative MRD2 5.28 ± 2.62 mm). The ectropion and lower eyelid retraction was resolved in all patients, except for one recurrence. Midfacial elevation is a safe and effective surgical technique in the treatment of static lower eyelid malposition after chronic facial nerve palsy or posttraumatic or iatrogenic lower eyelid retraction. [ABSTRACT FROM AUTHOR]

Retraction of the lower eyelid can be consequence of medical and surgical conditions. Various kinds of allotransplants and biomaterial have been used to correct it; we report on the surgical correction of lower lid retraction with a decellularized porcine derived membrane (Tarsys®). A 49-year-old patient with a history of adenoid cystic carcinoma in the pterygo-palatine fossa, requiring extensive surgery and repeated radiotherapy, presented with 6 mm lagophthalmus and exposure keratopathy secondary to facial nerve palsy. The lower lid malposition was corrected with a Tarsys® implant. Three months after surgery no lagophthalmos was present and substantial relief of signs and symptoms of ocular surface disease and good symmetry between right and left eye was achieved. If general condition or morbidity in potential donor sites hamper harvesting autologous graft material to support the lower lid, bioengineered xenografts can be used successfully to correct eyelid malpositions such as lower lid retraction. [ABSTRACT FROM AUTHOR]