Abstract
Various surgical procedures for correction of upper eyelid retraction have been reported, many of which have had favorable results. However, most of these reports are concerned with the correction of upper eyelid retraction in patients with thyroid ophthalmopathy, and few have focused on upper eyelid retraction caused by overcorrection during ptosis surgery. Corrective surgery for upper eyelid retraction resulting from ptosis surgery is often difficult because of the extensive irregular contracture caused by scar tissue. However, as this is a repeat surgery following ptosis surgery, it is important to ensure good postoperative evaluation indices, particularly favorable symmetry, appropriate palpebral fissure width, appropriate crease height, and natural-looking parabolic eyelid margins. Here, we report the lengthening of the upper eyelids using a half-thickness tarsal flap to address upper eyelid retraction secondary to ptosis surgery. By using a half-thickness tarsal flap, the anatomy of the levator insertion onto the tarsal plate is retained, so that good eyelid contour can be obtained, and the results are quantitatively reproducible. Therefore, this technique can be considered for the treatment of upper eyelid retraction and has a potentially wide range of applications.
Level of Evidence: Level V, therapeutic study.
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References
Putterman AM (1981) Surgical treatment of thyroid-related upper eyelid retraction. Graded Muller’s muscle excision and levator recession. Ophthalmology 88:507–512
Harvey JT, Corin S, Nixon D, Veloudios A (1991) Modified levator aponeurosis recession for upper eyelid retraction in Graves’ disease. Ophthalmic Surg 22:313–317
Harvey JT, Anderson RL (1981) The aponeurotic approach to eyelid retraction. Ophthalmology 88:513–524
Levine MR, Chu A (1991) Surgical treatment of thyroid-related lid retraction: a new variation. Ophthalmic Surg 22:90–94
Looi AL, Sharma B, Dolman PJ (2006) A modified posterior approach for upper eyelid retraction. Ophthal Plast Reconstr Surg 22:434–437
Hintschich C, Haritoglou C (2005) Full thickness eyelid transsection (blepharotomy) for upper eyelid lengthening in lid retraction associated with Graves’ disease. Br J Ophthalmol 89:413–416
Grove AS Jr (1980) Eyelid retraction treated by levator marginal myotomy. Ophthalmology 87:1013–1018
Mourits MP, Sasim IV (1999) A single technique to correct various degrees of upper lid retraction in patients with Graves’ orbitopathy. Br J Ophthalmol 83:81–84
Mourits MP, Koornneef L (1991) Lid lengthening by sclera interposition for eyelid retraction in Graves’ ophthalmopathy. Br J Ophthalmol 75:344–347
Schwarz GS, Spinelli HM (2008) Correction of upper eyelid retraction using deep temporal fascia spacer grafts. Plast Reconstr Surg 122:765–774
Fenton S, Kemp EG (2002) A review of the outcome of upper lid lowering for eyelid retraction and complications of spacers at a single unit over five years. Orbit 21:289–294
Kohn R (1983) Treatment of eyelid retraction with two pedicle tarsal rotation flaps. Am J Ophthalmol 95:539–544
Putterman AM, Urist MJ (1974) A simplified levator palpebrae superioris muscle recession to treat overcorrected blepharoptosis. Am J Ophthalmol 77:358–366
Cho IC, Kang JH, Kim KK (2012) Correcting upper eyelid retraction by means of pretarsal levator lengthening for complications following ptosis surgery. Plast Reconstr Surg 130:73–81
Anderson RL, Dixon RS (1979) Aponeurotic ptosis surgery. Arch Ophthalmol 97:1123–1128
Mehta JS, Franks WA (2002) The sclera, the prion, and the ophthalmologist. Br J Ophthalmol 86:587–592
Martin JJ Jr (2013) Ptosis repair in aesthetic blepharoplasty. Clin Plast Surg 40:201–212
Frueh BR, Musch DC, McDonald HM (2004) Efficacy and efficiency of a small-incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis. Ophthalmology 111:2158–2163
Dortzbach RK, Kronish JW (1993) Early revision in the office for adults after unsatisfactory blepharoptosis correction. Am J Ophthalmol 115:68–75
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Shinsuke Kinoshita, Hisaki Ukyo, and Shunsuke Osawa declare that they have no conflict of interest.
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Written informed consent to undergo the procedure described here was obtained from both patients included in this report. Additional informed consent was obtained from the patients to allow identifying information concerning their cases to be published.
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Kinoshita, S., Ukyo, H. & Osawa, S. Correction of eyelid retraction using a half-thickness tarsal flap for lengthening of the eyelid following ptosis surgery. Eur J Plast Surg 41, 591–596 (2018). https://doi.org/10.1007/s00238-018-1420-5
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DOI: https://doi.org/10.1007/s00238-018-1420-5