A Technique for Severe Lower Eyelid Retraction: The Fascia Lata Sling with Lateral Burr Hole.

Abstract

Lower eyelid retraction is a common and feared complication of both disease processes and aesthetic and cosmetic surgical procedures. A four-finger approach has been previously described to determine adequate treatment of lid retraction. In the authors' experience, they have found that even the most aggressive treatment approach-subperiosteal cheek lift with canthopexy and interpositional graft-is inadequate to address severe lower lid retraction. The authors propose a technique of a lower lid fascial sling with a lateral burr hole for support to be used when all five fingers are needed to correct the lower lid retraction. Review of 134 patients who underwent the fascia lata sling with lateral burr hole for severe lower lid retraction was performed. The fascia lata sling with lateral burr hole adequately corrected the lid retraction in all but one patient in one procedure. This patient had persistent lateral ectropion and underwent revision canthoplasty, resulting in resolution of the lateral ectropion. The fascia lata sling with lateral burr hole is a reliable procedure to correct lid retraction from a wide variety of causes.