Lash Ptosis Research Articles

Ocular manifestations of ectodermal dysplasia

PurposeThe ectodermal dysplasias (EDs) constitute a group of disorders characterized by abnormalities in two or more ectodermal derivatives, including skin, hair, teeth, and sweat glands. The purpose of the current study was to evaluate ocular manifestations in pediatric patients with ED.MethodsRetrospective case series including consecutive ED subjects who were treated in the ophthalmology department at the Children’s Hospital of Philadelphia over a 12-year period (2009–2020). Main Outcome Measures were ocular and ocular adnexal abnormalities.ResultsThirty subjects were included: 20 males (67%), mean age of 4.5 years (range 0.3–18). Patients with different subtypes were included, with the hypohidrotic ED and ectrodactyly-ectodermal dysplasia-clefting variants being most prevalent. Most common findings were: lacrimal drainage obstruction in 12 (40%) including punctal agenesis in 10 (33%), refractive errors in 13 (43%) and amblyopia in 6 (20%). A new finding of eyelid ptosis or eyelash ptosis was demonstrated in 11 subjects (37%), mostly associated with TP63 or EDA1 genes variants.ConclusionEctodermal dysplasias are associated with various ocular pathologies and amblyopia in the pediatric population. We report a possible genetic association between lash ptosis and EDA1 gene, and eyelid ptosis and TP63 or EDA1 genes variants.

Effects of Upper Eyelid Blepharoplasty on Contrast Sensitivity in Dermatochalasis Patients

Objectives:To evaluate the impact of upper eyelid blepharoplasty on contrast sensitivity in dermatochalasis patients.Materials and Methods:Best corrected visual acuity, ophthalmologic examination, eyelid examination, lash ptosis, contrast sensitivity using sine-wave contrast sensitivity chart, keratometric parameters, and corneal aberrations of 34 eyes of 34 patients who underwent upper eyelid blepharoplasty due to dermatochalasis in our clinic between the years 2014 and 2018 were evaluated preoperatively and at postoperative 3 months.Results:Twenty-three (68%) of the patients were females and 11 (32%) were males. Mean age was 63.1±7 (52-81) years. Mean best corrected visual acuity was 0.036±0.06 (0-0.15) logMAR preoperatively and postoperatively (p>0.05). Contrast sensitivity values of the patients at the frequencies of 1.5, 3, 6, 12, and 18 cycles per degree were 44.38±19.5, 59.03±27.2, 41.44±34.1, 15.15±19.3, and 5.15±4.26 preoperatively and 44.80±20.9, 76.85±33.4, 63.21±46.4, 28.21±31.1, and 10.5±9.5 postoperatively, respectively. The difference between contrast sensitivity values was statistically significant at the frequencies of 3, 6, 12, and 18 cpd (p=0.005, =0.001, <0.001, and <0.001, respectively). Although lash ptosis of the patients improved significantly after the surgery, there was no correlation between lash ptosis improvement and change in contrast sensitivity (p>0.05). Keratometric values and corneal high order aberrations did not change significantly after the surgery (p>0.05).Conclusion:Contrast sensitivity significantly increases after upper eyelid blepharoplasty, especially at higher spatial frequencies which are known to deteriorate due to age-related changes in the lens and retina in older adults. Our results show that blepharoplasty may have additional functional indications for elderly dermatochalasis patients in terms of improving the functions such as performing daily tasks and reading.

Recognising meibomian gland inversion in patients with facial palsy to improve the ocular surface

ABSTRACT Background: Facial nerve palsy (FNP) is known to worsen Meibomian gland dysfunction on the affected side. Chronic Meibomian gland dysfunction leads to a variant of upper eyelid marginal entropion associated with excessive tarsal curling, termed Meibomian gland inversion (MGI). Surgical correction with grey line split, tarsoplasty and anterior lamellar repositioning (GLS surgery) appears to further improve the ocular surface in these patients who have previously undergone upper eyelid loading. Methods: Retrospective, 3 year, non-comparative, single-centre study of patients with FNP identified as having MGI and treated by GLS surgery under the supervision of a single surgeon. We present specific examination findings and a useful test (cotton tip test) to determine suitability for GLS surgery. We assessed changes in symptoms and CADS (Cornea, static Asymmetry, Dynamic function and Synkinesis) score, along with cosmetic grading of lash loss and contour and report complications. Results: 23 patients with acquired FNP underwent GLS surgery for MGI with or without lash ptosis. 17 out of the 23 patients (74%) demonstrated an improvement in their CADS score after GLS surgery. Seven patients had insufficient records with scores missing and no conclusion could be reached for this group. Improvement of corneal staining, static and dynamic symmetry were all statistically significant. No patient worsened. The cosmetic outcome including lashes, lid contour and lid margin appearance is acceptable. Whilst it is possible to achieve minimal difference between the operated and unoperated eyelids, many patients will have a small difference. Conclusion: We report outcomes of MGI treatment and useful diagnostic features.

Primary Lash Ptosis.

Lash ptosis is often an overlooked sign that may coexist with congenital and acquired blepharoptosis. This is a report of case series of patients presented in an oculoplastic clinic with visual field loss associated with lash ptosis. On examination, the primary pathology was attributed to lash ptosis dehiscence. All patients underwent anterior lamellar repositioning and were followed for an average of 15 (10-24) months. All patients had resolution of visual field loss and heaviness of eyelids. Lash ptosis is associated with abnormalities such as floppy eyelid syndrome. However it may be a primary condition, with no background eyelid pathology and no external explanation for the eyelash ptosis. The condition might result from anatomical changes in the orbicularis oculi, Riolan's muscle, and tarsal plate. Patients in this series complained of upper lid visual field restriction. Anterior lamellar repositioning resulted in complete resolution of complaints. Additional studies are needed to learn about the pathophysiology of this entity.

CO2 Laser Lash Tilt Technique for the Treatment of Mild to Moderate Lash Ptosis and Augmentation of Upper Eyelid Blepharoplasty Results.

To assess the safety, efficacy, and patient satisfaction of a newly described technique for the treatment of mild to moderate lash ptosis performed as augmentation to upper eyelid blepharoplasty. Patient medical records for 27 consecutive cases of upper eyelid blepharoplasty between January 2016 and June 2017 and 19 consecutive cases of upper eyelid blepharoplasty with the laser lash tilt procedure between July 2016 and January 2017 performed by the senior author were retrospectively reviewed. Lash position in preoperative and postoperative photographs was graded in a randomized masked fashion on a 4-point scale by 5 oculoplastic surgeons. There was a significant improvement in mean lash position scores for the control group (0.52 ± 0.34, p < 0.001) with mean lash score improving from 1.14 ± 0.46 before surgery to 0.62 ± 0.46 after blepharoplasty alone. There was also significant improvement in mean lash position scores for the laser lash group (0.98 ± 0.52, p < 0.01) with mean lash score improving from 1.66 ± 0.62 before surgery to 0.68 ± 0.50 after blepharoplasty with laser lash treatment. The improvement in lash position seen in the laser lash group was significantly greater than the improvement seen in the control group (p = 0.001). There were no complications and all patients were satisfied with their results. Compared with upper eyelid blepharoplasty alone, the addition of the CO2 laser lash tilt technique provides a significant improvement in the upward tilt of the eyelashes as they emerge from the eyelid margin.

Eyelash Ptosis in Unilateral Myogenic and Aponeurotic Blepharoptosis

The purposes of this study were to compare lash ptosis (LP) with contralateral eyelid in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis before and after the ptosis repair and to assess the correlation between postoperative eyelid height and LP symmetry. Patients older than 5 years were included from June 2015 to April 2017. Eyelid examination, LP grading (0-3), and photography were performed before and at least 6 months after ptosis repair. Success of ptosis repair (levator resection) was defined as margin reflex distance 1 within 0.5 mm of the contralateral eyelid; LP improvement, as at least 1 grade improvement at the last follow-up; and LP symmetry, as 2 eyelids being within 1 grade. There were 58 patients with MP and 20 with AP, with mean age of 19.2 and 49.5 years and median follow-up of 10 months. Lash ptosis was observed in 89.5% of ptotic and 33.3% of control eyelids. Mean LP grade was significantly higher in the MP (1.5) than in the AP (1.1), which significantly improved to 0.6 and 0.4, respectively. However, it persisted in 50.9% of MP and 31.2% of AP postoperatively. Lash ptosis symmetry was observed in 97.4% of patients, which was not correlated with margin reflex distance 1 symmetry. Lower levator function was the only significant factor correlated with LP. Lash ptosis was significantly worse in MP than in AP. Lower LF was correlated with more severe LP. Ptosis repair resulted in significant improvement of LP and its symmetry with the contralateral eyelid. Lash ptosis symmetry did not correlate with eyelid height symmetry postoperatively.

Effects of upper lid blepharoplasty on visual quality in patients with lash ptosis and dermatochalasis.

To assess the effects of upper lid blepharoplasty on visual quality. Seventy-three eyelids of 39 patients were subjected to upper lid blepharoplasty. Pre- and post-operative contrast sensitivity, visual acuity, vertical palpebral aperture and the degree of lash ptosis were measured. The mean log contrast sensitivities under photopic (P=0.017) and scotopic conditions (P=0.009) were improved after surgery, and these differences were significant. The degree of lash ptosis was also decreased after blepharoplasty (P<0.001). In our study, a significant increase in contrast sensitivity was found after surgery. These results suggest that upper lid blepharoplasty can be helpful for improving visual quality.

Combined medial canthopexy and lateral tarsal strip for floppy eyelid syndrome

PurposeTo describe the eyelid condition known as “floppy eyelid syndrome” and to present the results of our experience treating patients with floppy eyelid syndrome. MethodsA retrospective analysis of 16 patients from 2009 to 2013 who underwent combined medial canthopexy and lateral tarsal strip by two surgeons (HBL and WRN) for the treatment of floppy eyelid syndrome (FES). Age, gender, presence of obstructive sleep apnea (OSA), papillary conjunctivitis, punctate keratopathy and lash ptosis were recorded pre-operatively. Outcomes assessed included improvement in upper eyelid laxity, operative complications, post-operative symptomatic relief and delayed recurrence of FES. ResultsA total of 18 procedures (on 36 eyelids) were performed on 16 patients over the 4-year period. All patients (18/18) had relief of symptoms and good functional results, defined as improvement in lid laxity and resolution of symptoms. Average follow up was 124days. 8 of 16 patients (50%) had a pre-existing diagnosis of OSA. The remaining 8 patients were referred for sleep study and 2 were subsequently diagnosed with OSA. Two patients experienced some degree of FES recurrence without return of symptoms. There was one complication reported in which a partial dehiscence of the lateral canthal tendon occurred which did not require operative revision. ConclusionsCombined medial canthopexy and lateral tarsal strip are a safe and effective technique for the treatment of floppy eyelid syndrome. There is a strong association of FES and OSA and it is important to have any patient diagnosed with FES evaluated for OSA.

Lash ptosis as a complication of patching for treatment of amblyopia

Lash ptosis as a complication of patching for treatment of amblyopia

Lash ptosis as a characteristic sign of floppy eyelid syndrome.

To find a correlation between the floppy eyelid syndrome and the clinical sign of lash ptosis and loss of eyelash parallelism and develop an algorithm for early diagnosis. This is a prospective case-control study including 97 consecutive patients diagnosed with floppy eyelid and 81 healthy sex- and age-matched controls. The study was conducted in Professor Pashev Eye Hospital, Sofia between January 2011 and December 2012. The clinical sign of lash ptosis and loss of eyelash parallelism was investigated in two stages. The condition was graded using a specially designed algorithm. Lash ptosis and loss of eyelash parallelism was documented in all 97 (100%) patients with floppy eyelid and only in 8 patients (9%) in the control group. Statistical analysis of the results showed a very strong association between this sign and the floppy eyelid syndrome (p <0.0001), and a correlation between the degree of lash ptosis and stage of the disease (p < 0.001). The clinical sign of lash ptosis and loss of eyelash parallelism is characteristic for the syndrome. Recognizing this sign during a routine eye examination can facilitate a timely diagnosis of the frequently overlooked and improperly treated disorder of floppy eyelid.

What Causes Increased Contrast Sensitivity and Improved Functional Visual Acuity After Upper Eyelid Blepharoplasty?

The objective of this study was to report the cause of increased contrast sensitivity and improved functional visual acuity after upper eyelid blepharoplasty. Twenty-two eyelids of 16 patients with dermatochalasis and involutional ptosis were prospectively studied. Contrast sensitivity, corneal topography, high-order aberration (HOA), and degree of lash ptosis were examined and recorded before and at 1 month after upper eyelid blepharoplasty. A Wilcoxon signed rank test was performed to compare the difference. The contrast sensitivity of patients significantly increased in every spatial frequency and light condition. Corneal topography showed no difference before and after blepharoplasty. Ocular HOA, especially total HOA, third-order, fourth-order, trefoil, coma, and second astigmatism decreased significantly after surgery (P = 0.008, 0.011, 0.028, 0.033, 0.038, and 0.049, respectively). The degree of lash ptosis also decreased after blepharoplasty (P = 0.046). In our study, increased contrast sensitivity and improved functional visual acuity after upper eyelid blepharoplasty were caused by changes in ocular HOA and the degree of lash ptosis after surgery. There were no changes in corneal topography or astigmatism.

Lash Ptosis and Associated Factors in Asians

Lash ptosis (LP) is one of the important factors to be considered in blepharoplasty or correction of ptosis, but LP is an often overlooked symptom. We evaluate normal variations in the degree of LP to analyze the relationship between LP and its associated factors in Asians. One-hundred and sixty patients without ptosis and 16 patients with acquired ptosis were included in this study. We measured the degree of LP, marginal reflex distance 1, levator function, and presence or absence of a double fold. A significant difference was observed in LP rating between the nonptosis and acquired ptosis groups (P = 0.00), along with a significant correlation between LP rating and marginal reflex distance 1 (r = -0.272, P < 0.01), levator function (r = -0.170, P < 0.01), and absence or presence of double fold (r = -0.233, P < 0.01). Our results may be beneficial in the design of a basic plan for Asian patients with LP at the time of upper eyelid surgery, such as blepharoplasty or correction of ptosis.

Floppy Eyelid Syndrome as a Subset of Lax Eyelid Conditions: Relationships and Clinical Relevance (an ASOPRS Thesis)

To better define the wide spectrum of lax eyelid conditions, especially the subtype referred to as floppy eyelid syndrome, and to clarify its relationship with associated ophthalmic findings. A case-based retrospective review of all patients seen at UNC Department of Ophthalmology with a diagnosis of floppy eyelid syndrome or lax upper eyelid was performed. The period of review was from March 2002 to March 2007. A literature review was also performed using the term "floppy eyelid syndrome" and "lax eyelid syndrome" as the keywords in a PubMed search. Charts and cases were reviewed for the following information: age, sex, presence or absence of obesity, presence or absence of upper eyelid laxity, presence or absence of lower eyelid laxity, symmetry or asymmetry of eyelid laxity, sleeping position preference, diagnosis of obstructive sleep apnea (OSA), history of eye rubbing, diagnosis of keratoconus (KCN), lash ptosis, history of spontaneous eyelid eversion, papillary conjunctivitis, systemic hyperlaxity, diagnosis of meibomianitis, signs of anterior segment inflammation, and smoking or excessive sun exposure history. From our UNC case review, 14 patients involving 17 eyelids were identified. From the literature review, 72 articles were recovered and evaluated to yield a total of 324 reported cases through February 2007. From the combined data (n = 338), the overall minimum prevalence of sleep apnea in patients with lax eyelid condition was 16% compared with an estimated 9% to 24% in the general population. Of patients with lax eyelid syndrome, those identified with OSA had significantly more individuals with obesity (76% vs. 20%) and male gender (89% vs. 61%) than the group without OSA. The prevalence of KCN in patients with lax eyelid syndrome was a minimum of 6.8%, which is considerably higher than the estimated prevalence in the general population of 0.6%. However, KCN appears to show a significant association with the patient's side of sleeping preference. Eyelid laxity can result from a number of involutional, local, and systemic diseases but is frequently of unknown etiology. When it is consistently associated with papillary conjunctivitis and dry eyes it can be referred to as lax eyelid syndrome (LES). A number of specific subsets of LES can be identified. One such subset, occurring primarily though not exclusively in males and associated with obesity, has been defined as the floppy eyelid syndrome (FES). OSA has been associated with FES where it occurs with greater frequency than in the general population, but no greater than seen in obese males without FES, and therefore appears to represent an epiphonomenom only. However, given the demographics of FES, this condition offers some predictive value for OSA and should alert the physician to evaluate the sleep habits of all such patients. Keratoconus also shows some association with FES and with LES. However, data suggest that the causative factors are sleep preference for the involved side and nocturnal eyelid eversion, rather than any underlying physiologic or anatomic relationship.

The Associations of Floppy Eyelid Syndrome: A Case Control Study

To describe the demographic features of a large series of patients with floppy eyelid syndrome (FES) and to investigate the associations of the condition with keratoconus, obstructive sleep apnea-hypopnea syndrome (OSAHS), and a variety of upper and lower eyelid features. Case control study. The test group comprised 102 patients with FES. A control group of 102 patients were recruited from a diabetic retinopathy clinic and matched on a 1:1 basis on age, gender, and body mass index (BMI). A full medical and ophthalmic history was taken. Patients also underwent a full ocular examination, including an assessment of upper and lower lid laxity and upper lid levator function. Keratoconus grading was made using the Oculus Instruments Pentacam imaging system (Oculus Optikgerate GmbH, Wetzlar, Germany). Patients were screened for OSAHS using the Epworth daytime somnolence score. Matched statistical analysis of dichotomous data was made using Mantel-Haenszel methods for odds ratios and McNemar's test. Analysis of continuous data was performed using a matched t test and tests for symmetry of larger tables were made using the McNemar-Bowker test. The significance of association of FES with keratoconus, OSAHS, smoking history, medial and lateral canthal laxity of the upper and lower lids, levator function, lash ptosis, and dermatochalasis. Significant associations were found between FES and OSAHS (P = 0.0008), keratoconus (P<0.0001), lash ptosis (P<0.0001), dermatochalasis (P = 0.02), upper lid medial canthal laxity (P = 0.02), upper lid distraction (P = 0.001), palpebral aperture (P = 0.004), and levator function (P = 0.005). Floppy eyelid syndrome seems to be a condition strongly associated with OSAHS and keratoconus. As well as providing a platform for an etiologic hypothesis for the condition, these findings should also encourage clinicians to be aware of these associations and to direct further treatment. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Lash Ptosis in Congenital and Acquired Blepharoptosis

To determine the prevalence of lash ptosis (LP) in eyes with congenital and acquired blepharoptosis. We retrospectively graded photographs of 228 eyes from 174 patients with congenital or acquired blepharoptosis for LP. We used a 4-point rating scale for LP, in which 0 indicates no LP; 1, minimal; 2, moderate; and 3, severe. A prospective evaluation of LP in 30 eyes from 15 patients without blepharoptosis (control eyes) was also performed. A total of 107 eyes (in 87 patients) demonstrated congenital blepharoptosis and 121 eyes (in 87 patients) had acquired blepharoptosis. A moderate to severe rating of LP (rating, >/= 2) occurred in 60.7% of eyes with congenital blepharoptosis, 28.9% of eyes with acquired blepharoptosis, and 6.7% of control eyes. Lash ptosis (rating, >/= 1) was present in 91.6% of eyes with congenital blepharoptosis, 83.5% of eyes with acquired blepharoptosis, and 33.3% of control eyes. The mean LP rating was 2.1 for eyes with congenital blepharoptosis, 1.3 for eyes with acquired blepharoptosis, and 0.6 for control eyes. Lash ptosis was common in the patients with blepharoptosis. Moderate to severe LP occurred more commonly in all forms of blepharoptosis compared with normal eyes, with more frequent and more severe LP demonstrated in eyes with congenital blepharoptosis.

Prevalence of Floppy Eyelid Syndrome in Obstructive Sleep Apnea–Hypopnea Syndrome

To determine the prevalence of floppy eyelid syndrome (FES) in obstructive sleep apnea-hypopnea syndrome (OSAHS) and to develop a method to measure eyelid laxity. Masked cross-sectional (prevalence) study examining patients referred to the Mayo Sleep Disorders Center. Fifty-nine subjects were examined before undergoing polysomnography. Forty-four subjects had OSAHS, and 15 did not have it. Subjects underwent slit-lamp examination and eyelid laxity measurements, followed by polysomnography. Presence of FES as defined by subjectively easy eyelid eversion, tarsal papillary conjunctivitis, and lash ptosis; force required to displace the upper lid 5 mm, as measured by a strain gauge device; number of apnea or hypopnea episodes per hour (apnea-hypopnea index [AHI]); presence of OSAHS, as defined by an AHI of > or =5; and abnormalities on electrocardiography. One patient with OSAHS was found to have FES, yielding a prevalence of 2.3% (95% confidence interval [CI]: 0.1%-12.0%). One patient was referred to the Sleep Disorders Center due to a diagnosis of FES; if this patient were included, the prevalence would be 4.5% (95% CI: 0.5%-15.1%). Subjectively easy lid eversion was more common in OSAHS patients than in non-OSAHS patients. When adjusted for age and body mass index, there was a trend for association between subjectively easy lid eversion and OSAHS, but this did not reach statistical significance. Subjectively easy lid eversion was associated with AHI. Force required to displace the upper lid 5 mm was lower in lids with subjectively easy eversion, but was not associated with OSAHS or AHI. Intraclass correlation among 3 strain gauge measurements was good for both right (82%) and left (83%) lids. There were no statistically significant differences in frequency of electrocardiographic abnormalities among the various groups. The prevalence of FES among OSAHS patients is low. Patients with subjectively easy upper lid eversion are at risk for OSAHS. By recognizing the potential for OSAHS in these patients, the ophthalmologist may play an important role in initiating their evaluation and treatment.

Lash Ptosis Caused by Latanoprost

To report a case of lash ptosis caused by latanoprost. Observational case report. Retrospective chart review. A 61-year-old, ocular hypertensive man who was using latanoprost OU presented with trichomegaly and bilateral lash ptosis. The lash ptosis had not resolved 6 months after stopping latanoprost, and anterior lamellar repositions were performed. At last follow-up, 8 months after surgery, the lids were in a normal position, but the trichomegaly had reduced only slightly. Lash ptosis should be considered as a possible complication of latanoprost therapy.

Ocular Manifestations of Congenital Lamellar Ichthyosis

To describe the ophthalmic manifestations in a series of children with congenital lamellar ichthyosis. These cases presented with varying types of eyelid abnormality associated with the systemic disease. The clinical features and ophthalmic management were studied. The case histories of three children presenting to the oculoplastic clinic were reviewed. All were diagnosed with congenital lamellar ichthyosis and under the care of the Dermatology department. Family history and pedigree analysis was performed to determine mode of genetic inheritance. Ocular examination for visual acuity, eyelid and eyelash malposition, lid function and closure were carried out. Corneal examination including tests for exposure was also done. All three patients had eyelid position abnormalities from the systemic disease. There was no clinical evidence of conjunctival involvement. One patient required full thickness skin grafts to treat corneal exposure secondary to lower lid ectropion. One had mild lower lid ectropion but without corneal exposure. The third case had the unusual finding of inward turning of the anterior lamella of the upper eyelid with a marked lash ptosis and only mild ectropion of the lower lid. Congenital lamellar ichthyosis is a heterogeneous disorder with phenotypic variability. The most common eyelid abnormality is cicatricial ectropion of the upper and mainly lower eyelids. Most cases are managed conservatively although in severe cases secondary corneal exposure may require surgical correction. In this condition, to the best of our knowledge, the tendency for the eyelids to turn inwards has not previously been described.

Modified Hughes flap: Division at 7 days

To report the outcome of early division of the tarsoconjunctival pedicle of a modified Hughes flap at 1 week after the primary operation. Noncomparative, interventional, prospective case series. Twenty-nine eyelids of 29 consecutive patients operated using the modified Hughes flap and full-thickness skin graft for lower eyelid reconstruction after Mohs micrographic surgery, over a 4-year period. In all patients, the pedicle of the Hughes flap was divided 1 week after the primary operation. Postoperative lower eyelid flap viability and lower eyelid contour complications. Twenty-nine eyelids of 29 patients (mean age: 69+/-11 years) were operated using the modified Hughes flap. The mean follow-up period was 14+/-6 months (range: 6-23). There were no cases of lower eyelid retraction, flap ischemia, or necrosis after division. Postoperative complications included lower eyelid margin erythema in 2 patients (6.9%), upper eyelid lash ptosis in 3 patients (10.3%), and upper eyelid lateral retraction in 1 patient (3.4%). Early division of the tarsoconjunctival pedicle of a modified Hughes flap at 1 week does not compromise the viability of the reconstructed lower eyelid and results in a good functional and cosmetic outcome.

Donor site morbidity in free tarsal grafts

Purpose To determine if harvesting free tarsal grafts from the upper eyelids is associated with significant morbidity. Design Prospective case series. Methods Consecutive patients managed with free tarsal grafts by three of the authors (D.S., D.G., R.G.) over a 4-year period. Results Ninety-one eyelids in 75 patients were operated on using the free tarsal graft for various eyelid pathologies. Mean follow-up period was 14.83 ± 8.45 months (range, 4 to 42 months). Contour peaking in donor upper eyelid appeared in two eyelids (2.2%), lash ptosis in four eyelids (4.4%) of three patients, and donor site infection in one eyelid (1.1%). Four patients (5.3%) complained of a transient ocular discomfort. There were no cases of postoperative changes on the eyelid height, entropion, or keratopathy in the donor site eye. Most of the donor site complications were mild or transient and required no further surgery. In three patients who underwent subsequent surgery to treat preexisting ptosis or retraction of the donor eyelid, the results were less predictable and further procedures were required. Conclusion Free tarsal grafts harvested from the upper eyelids, with preservation of at least 4 mm of the tarsal plate inferiorly, do not lead to significant donor site morbidity. However, subsequent procedures to alter the position of the donor eyelid may be less predictable.