Correction Of Eyelid Retraction Research Articles

Impact of COVID-19 on facial plastic surgery volumes: A large database analysis of pre- and post-pandemic trends.

During the COVID-19 pandemic, elective surgeries faced cancelations due to quarantine measures. The objective of this study was to assess facial plastic and reconstructive surgery (FPRS) volume before, during, and after the height of the pandemic on a national scale. The TriNetX Research Network identified 68,101,098 individuals aged 18+ with healthcare interactions from 2017 to 2022. Rates of common FPRS surgeries and procedures were compared during March-August of each year, aligning with the pandemic lockdown. Compared to immediately before the pandemic in 2019, the 2020 pandemic peak saw an overall surgical volume reduction of -36.8%, with specific surgeries decreasing significantly: rhinoplasty (-28.6%), septoplasty (-34.0%), rhytidectomy (-54.9%), blepharoplasty (-40.7%), brow lift (-43.8%), ectropion/entropion repair (-35.6%), repair of blepharoptosis (-45.6%), correction of lagophthalmos (-29.9%), correction of lid retraction (-36.8%), and lipectomy (-41.8%) (p < .001). The procedural volume also decreased by 28.6%, encompassing reductions in various procedures: botulinum toxin A (-18.7%), facial filler (-40.7%), dermabrasion (-62.3%), chemical peel (-36.6%), and intralesional injection (-33.3%) (p < .001). In contrast to 2020, 2021 witnessed an increase of +75.0% in total surgical and +61.3% procedural volume: rhinoplasty (+81.0%), septoplasty (+74.7%), rhytidectomy (+143.4%), blepharoplasty (+81.7%), brow lift (+64.5%), ectropion/entropion repair (+55.2%), repair of blepharoptosis (+62.7%), correction of lagophthalmos (+39.0%), correction of lid retraction (+73.0%), lipectomy (+121.2%), botulinum toxin A (+52.4%), filler (+59.6%), dermabrasion (+91.8%), chemical peel (+78.8%), and intralesional injection (+67.3%) (p < .001). In 2022, rates of total surgeries (+8.5%) and procedures (+12.8%) surpassed pre-pandemic levels from 2019 (p < .001). FPRS experienced significant pandemic-induced decreases, followed by a notable recovery in subsequent years, with certain surgeries and procedures surpassing pre-pandemic levels. 4.

Eyelid Surgery in Thyroid Eye Disease.

To review and summarize a comprehensive synopsis of surgery of the eyelid in thyroid eye disease (TED). A PubMed search for specific eyelid manifestations of TED was performed. Studies reporting surgical management of these were reviewed, along with the author's own experience. The most common eyelid manifestations of TED include eyelid retraction, blepharoptosis, entropion, and epiblepharon, with most of them requiring surgical intervention. The correction of eyelid retraction has received maximum attention, with several surgical techniques that have stood the test of time. Blepharoptosis in TED that requires surgical intervention is usually aponeurotic. Entropion and Epiblepharon are rare in TED, and may resolve spontaneously, or following orbital decompression. Retraction is the commonest eyelid manifestation of TED, with multiple surgical options available for its correction. Blepharoptosis, entropion, and epiblepharon are rare eyelid findings in TED, that may occasionally require surgical correction.

Selection of Site for Harvesting Dermal Grafts as a Spacer in the Correction of Eyelid Retraction.

Several materials can serve as spacer grafts in the repair of retracted lower eyelids. However, previous studies did not reveal any of these to be superior to the others. From our perspective, autologous dermal grafts are ideal because they are biologically compatible and abundantly available. However, the absorption of these grafts is an issue, and the thickness of the dermal grafts is crucial. We evaluated the dermal thickness at five potential donor sites using ultrasonography and the efficacy and safety of the posterior neck dermis as a spacer graft in the correction of retracted lower eyelids. In 20 healthy volunteers, the dermal thickness was assessed using ultrasonography and compared between the posterior neck, upper arm, inguinal area, intergluteal cleft, and gluteal sulcus. Between January 2018 and June 2021, eight retracted lower eyelids in eight patients were repaired using a posterior neck dermal graft. The surgical results of these grafts were also evaluated. The mean age of the volunteers was 37.8 years, and the mean body mass index was 24.45kg/m2. The intergluteal cleft provided the thickest dermis followed by the posterior neck and gluteal sulcus, which were not significantly different. The upper arm and inguinal area had the thinnest dermis without significant differences between them. The mean marginal reflex distance 2/iris ratio decreased by 0.15 (p=0.008). The mean cosmetic score (0-10) for evaluation of lower eyelid reconstruction increased by 3.38 (p=0.011). The mean Vancouver Scar Scale score for evaluation of donor site scarring was 3.21. Although the posterior neck dermis is the second thickest, it is an ideal spacer graft in the reconstruction of retracted lower eyelids. Adequate thickness, uncomplicated methods, and a closer surgical field are its advantages. Additionally, donor site morbidity is minimal, with acceptable scarring. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correction of eyelid retraction using a half-thickness tarsal flap for lengthening of the eyelid following ptosis surgery

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.

Simultaneous Aesthetic Eyelid Surgery and Orbital Decompression for Rehabilitation of Thyroid Eye Disease: The One-Stage Approach.

Aesthetic rehabilitation of thyroid orbitopathy includes orbital decompression, correction of eyelid retraction, and aesthetic blepharoplasty, performed traditionally in separate stages. To report the results of orbital decompression surgery associated with aesthetic eyelid surgery in one stage for aesthetic rehabilitation of patients affected by thyroid eye disease. Retrospective, multicentric study including 40 consecutive patients, who underwent orbital decompression surgery associated with aesthetic eyelid surgery in two centers: Genova (group 1) + Buenos Aires (group 2). Surgical techniques are described in detail. Mean patient age in the study group was 41.2, 85% of the patients were female, and minimum follow-up time was 12 months, with average follow up of 27 months. All patients underwent orbital decompression; at the same time, 26 patients (65%) underwent bilateral upper blepharoplasty and 32 patients (80%) underwent transconjunctival lower blepharoplasty. Associated upper eyelid procedures included 23 patients (58%) undergoing upper eyelid retraction repair, 9 patients (23%) undergoing associated inferior retractor recession, and 12 patients (30%) closed transcanthal lateral canthopexy. Seven patients (17%) needed strabismus surgery for the treatment of new-onset diplopia and none required further revision eyelid surgery. Shorr and Seiff suggested 4 stages of surgical rehabilitation: (1) orbital decompression; (2) eye muscle surgery; (3) correction of eyelid retraction; and (4) removal of excess fat and skin. This is the first study to suggest single-stage aesthetic rehabilitation consisting of combined orbital decompression and aesthetic eyelid surgery. This approach has high patient satisfaction and significant reduction in direct and indirect healthcare costs.

Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroid-associated Ophthalmopathy.

PurposeTo evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO).MethodsTwenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneously performed. The patients had a minimum preoperative period of 3 months of stable range of ocular motility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperative and postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performed in all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0).ResultsForty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 ± 11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 ± 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertel measurement of 17.6 ± 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle in three cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increased in all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgical session in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgical session in two cases. Margin reflex distance decreased from a preoperative average of 4.3 ± 0.8 to 3.8 ± 0.5 mm postoperatively.ConclusionsThe customized orbital decompression procedure decreased proptosis and improved diplopia, in a range comparable to those achieved through more stepwise techniques, and had favorable cosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.

Autologous Dermal Grafts as Posterior Lamellar Spacers in the Management of Lower Eyelid Retraction

To determine the safety and efficacy of autologous postauricular dermal grafts as posterior lamellar spacing material in patients with lower eyelid retraction. At a tertiary care institution, 10 eyelids of 10 patients (7 men, 3 women; mean 56 years, range 24-78) who underwent repair of lower eyelid retraction using a postauricular dermal graft between July 2008 and December 2010 were retrospectively assessed. Data collected included patient demographics, etiology of retraction, and surgical history. Outcome measures included preoperative and postoperative eyelid position and surgery-related complications. Postoperative results were favorable: mean preoperative inferior scleral show was 3.3 ± 2.6 mm compared with 0.3 ± 1.2 mm postoperatively, p = 0.004 (paired t test). Mean follow up was 39.2 weeks (range 12-94). Complications included keratinization of the graft with vellus hair growth (n = 1) and ectropion (n = 1), both corrected with minor surgical interventions. One patient achieved overcorrection but declined further treatment. No donor site complications were encountered. These data suggest postauricular dermal grafts are effective posterior lamellar spacers in the correction of eyelid retraction. They have adequate rigidity whilst maintaining sufficient pliability to mold to the globe. Resorption, common to acellular dermis matrix allografts and xenografts, was not encountered. Donor site complications were not encountered. Complications shared with other material include overcorrection and ectropion. Complications unique to autologous dermis include keratinization and hair growth.

Reconstruction of Lower Eyelid Retraction or Ectropion Using a Paranasal Flap

This report aims to describe a paranasal flap technique for reconstruction of lower eyelid retraction and ectropion. After the contracture of the lower eyelid skin or conjunctiva had been thoroughly released, the ipsilateral upper pedicle paranasal flap was designed according to the size of the lower eyelid skin wound. After dissection of the flap, the subcutaneous tissue of the flap was trimmed according to the depth of the wound, the flap was rotated to cover the defect, and an anchor was fixed to the distal aspect of the outer canthus. The secondary defect of the donor area was sutured directly. In this study, 67 patients with lower eyelid defects resulting from correction of eyelid retraction and ectropion were reconstructed using paranasal flaps between April 2004 and October 2009. The sizes of the paranasal flaps ranged from 0.6×2.2 to 1.5×3.5 cm. At the follow-up assessment, the patients could close their eyes easily and completely without lagophthalmos, and neither the upper lips or the nasal ala showed any anatomic deformities. The features of the paranasal flaps, such as skin color, texture, and contour of the repaired tissue, were a good match with the surrounding skin. The suture lines of the donor areas were sheltered well. Paranasal flaps were used for effective reconstruction of lower eyelid retraction or ectropion, with achievement of good eyelid function and a good color, contour, and texture match with the surrounding skin. Overall, the functional and cosmetic results were satisfactory. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Surgical Correction of Lid Retraction with a Silicone Sponge in Congenital Fibrosis of the Extraocular Muscles

A 5-year-old boy who was diagnosed with congenital fibrosis of the extraocular muscles (CFEOM) presented with bilateral lower eyelid retraction after strabismus surgery. To correct the lower eyelid retraction, a silicone sponge was used as a spacer; it was sutured to the inferior border of the tarsus and the lower eyelid retractor. At the 3-month postoperative visit, both lower eyelid margins were at the inferior corneal limbus. No complications or recurrence was noted at 1 year after surgery. The silicone sponge served as a good spacer for correction of lower lid retraction after strabismus surgery in a child with CFEOM.

Correction of Exophthalmos and Eyelid Deformities in Patients With Severe Thyroid Ophthalmopathy

Conservative therapy in cases of severe thyroid ophthalmopathy has not given satisfactory results. Because of this, surgical treatment, that is, orbital decompression, is now being used with increasing frequency. Since the end of 1986 until the end of 2006, 103 patients with severe thyroid ophthalmopathy have been treated by personal 3-wall orbital decompression combined with removal of the periorbital, intraorbital, and retrobulbar fat, as well as with correction of eyelid retraction and deformities. After operation, all patients showed a significant reduction of exophthalmos (5-11 mm; 7.2 mm on average), reduction of intraocular pressure, marked improvement in ocular muscle function, and considerable reduction or disappearance of subjective symptoms. There was an improvement in vision in 68% patients who had impaired vision before the operation. There were no cases of subsequent impairment of ocular motility. Mild relapse of exophthalmos was recorded in 3 cases only, and only 1 patient required unilateral reoperation. Strabismus surgery had to be performed in 6 patients due to unsatisfactory correction of double vision. It can be concluded that this method of orbital decompression gives constantly very good functional and aesthetic long-term results and allows rapid recovery.

Management of exposure keratopathy associated with severe craniofacial trauma

We describe a case of severe craniofacial trauma with resultant exposure keratopathy that was refractive to traditional treatment measures including aggressive lubrication, tarsorrhaphy, platinum lid weight implantation, punctal plugs, correction of lid retraction, amniotic membrane application, and multiple bandage contact lenses. Through combined Boston scleral lens placement and traumatic cataract extraction with intraocular lens (IOL) implantation using scleral lens IOL power calculations, we were able to maximize patient comfort and attain superior visual acuity. To our knowledge, calculation of IOL power through a scleral lens has not been described.