Reduction In Lagophthalmos Research Articles

Medial canthoplasty for the management of exposure keratopathy.

To report the surgical technique and functional outcomes of the medial canthoplasty for the treatment of exposure keratopathy. An IRB approved, retrospective review of patients who underwent medial canthoplasty for exposure keratopathy was performed. Patient demographics, reported symptoms, and clinical examination findings were collected and analyzed from pre-operative and follow-up visits. The study included 73 consecutive cases in which the medial canthoplasty was performed in patients with exposure keratopathy. The average follow-up period was 7.9 months (median: 4.7 months; range: 1-150 months). Complete or partial improvement in ocular symptoms (dryness; pain/irritation; tearing) was achieved in 95% (69/73). Clinically, 85% (41/48) of patients demonstrated a post-operative reduction in lagophthalmos and 90% (60/67) showed improvement in ocular surface findings. Complications were rare (1/73) and reversal of medial canthoplasty was not required in any case. The medial canthoplasty appears to be a safe and effective technique to narrow the palpebral fissure, provide lower eyelid support, and improve keratopathy. It is an uncomplicated procedure that may be considered for the treatment of exposure keratopathy caused by facial paralysis and lower eyelid malposition.

Rehabilitation of Eyelid Malpositions Secondary to Facial Palsy.

Objectives:To evaluate patient satisfaction and outcomes of surgical treatment of eyelid malpositions secondary to facial palsy.Materials and Methods:Consecutive patients with facial palsy who underwent surgical treatment by the same surgeon at İzmir Katip Çelebi University Atatürk Training and Research Hospital between Jan 2007 and Dec 2012 were included in the study. Ophthalmic examination findings, surgical approaches, and their outcomes were evaluated. A successful result for upper eyelid position was defined as more than 50% reduction in lagophthalmos and induction of less than 2 mm of ptosis. A successful outcome for lower eyelid position was defined as the lower eyelid residing at or within 1 mm above or below the limbus. Linear visual analog scale 1 (VAS-1) (subjective complaints) and VAS-2 (cosmetic outcome), both ranging from 0 to 10, were used to compare preoperative findings with findings at last postoperative visit.Results:The mean age of the 14 female and 21 male patients was 54.5±19.9 years. Gold weight implantation (n=31), lateral tarsal strip (n=22), tarsorrhaphy (n=15), suborbicularis oculi fat elevation (n=16), hard palate graft (n=14), and eyebrow ptosis repair (n=6) were performed. Average follow-up time was 17.9±16.9 months (range, 2-60). Surgical success rates were 90% for upper lids and 75% for lower lids. Mean lagophthalmos decreased from 7.1±2.7 mm to 1.6±1.6 mm postoperatively (p=0.000). The use of lubricating drops and gels was reduced from average preoperative daily values of 5.3±2.5 drops and 1.3±0.6 gel applications to 4.4±1.4 and 0.6±0.6, respectively (p=0.003, p=0.001).Conclusion:An individualized surgical approach tailored according to each patient’s severity of facial palsy and associated malpositions resulted in both functional and aesthetic improvements in our patients.

Mucous Membrane Graft for Cicatricial Ectropion in Lamellar Ichthyosis: An Approach Revisited

A 26-year-old woman with congenital lamellar ichthyosis presented with bilateral cicatricial ectropion of the upper and lower eyelids. There was severe exposure keratopathy with corneal perforation in the left eye. The generalized skin involvement necessitated the use of an alternative to correct the cicatricial ectropion. Mucous membrane graft harvested from the oral cavity was used to correct the cicatricial ectropion of upper and lower eyelid of both eyes. Six months after treatment, the mucous membrane graft was keratinized and a significant reduction in lagophthalmos was seen. Mucous membrane graft offers a promising alternative to correct cicatricial ectropion in lamellar ichthyosis.

“En-Glove” Lysis of Lower Eyelid Retractors With AlloDerm and Dermis-Fat Grafts in Lower Eyelid Retraction Surgery

To describe a minimally invasive surgical technique using AlloDerm or dermis-fat grafts for lower eyelid retraction. A retrospective review of all patients undergoing lower eyelid retraction surgery via a minimal invasive, "en-glove" technique from 2005 through 2009. Charts were reviewed for the type of graft (AlloDerm or dermis-fat) used, the etiology of lower eyelid retraction, and the follow-up time. Outcome measures included lower eyelid height (measured from the corneal light reflex to the lower eyelid margin, or MRD2), reduction of lagophthalmos, cosmetic appearance, complications, and need for further surgery. Presurgery and postreconstruction photographs were reviewed and graded for functional and cosmetic outcome. A total of 8 patients underwent successful lower eyelid retraction surgery using this minimally invasive technique. Etiologies included thyroid eye disease and cicatricial paralytic lower eyelid retraction. Mean improvement in MRD2 was 1.5 mm for the AlloDerm group (4 patients, 7 eyelids) and 1.0 mm for the dermis-fat group (4 patients, 4 eyelids) after a minimum of 3 months' follow-up. The cosmetic result was satisfactory in all cases. "En-glove" lower eyelid retraction surgical technique offers a minimally invasive approach for the release of the lower eyelid retractors and allows for volume augmentation using either AlloDerm or dermis-fat spacer graft.

Treatment of Lower Eyelid Retraction by Retractor Release and Posterior Lamellar Grafting: An Analysis of 659 Eyelids in 400 Patients

To review one surgeon's experience with posterior lamellar grafting for lower eyelid elevation over a 15-year period, comparing the success of different posterior lamellar grafts used in 4 etiology groups. A retrospective chart review of 400 patients (659 eyelids) was conducted. Patients were grouped into thyroid ophthalmopathy, previous surgery, trauma, and idiopathic causes. Three graft types were used: hard palate mucosa, free tarsoconjunctival, and free scleral. Objective measurements of lagophthalmos, scleral show, and superficial punctate keratopathy, and subjective patient symptoms, preoperatively and postoperatively were compared between graft types and etiologic groups. Complications were tabulated and compared between groups, as was any need for further surgery. The mean follow-up interval was 16.5 months. The main outcome measures were objective measurements of lagophthalmos, scleral show, and superficial punctate keratopathy. A mean reduction in lagophthalmos ( approximately 0.5 mm), superficial punctate keratopathy (mean score reduction = 0.2, on a scale of 1-3), and scleral show ( approximately 1.3 mm) was demonstrated for all etiology groups and graft types. Furthermore, 90% of patients subjectively reported a reduction of 1 to 3 symptoms. Hard palate mucosa grafts were more likely to be used than tarsoconjunctival grafts in cases with one or more previous surgeries (p < 0.001). Complications were more common with tarsoconjunctival grafts (except for bleeding), but the difference was statistically significant only for wound dehiscence (p = 0.004). Lower eyelid retraction repair with posterior lamellar grafting and lateral eyelid tightening can be recommended with confidence for eyelid retraction patients because most improved subjectively and by objective examination.

Effectiveness of the Gold Weight Trial Procedure in Predicting the Ideal Weight for Lid Loading in Facial Palsy: A Prospective Study

To evaluate the effectiveness of the gold weight trial procedure in predicting postoperative eyelid closure after gold weight implantation surgery for facial palsy. Prospective, interventional case series. Patients with facial palsy undergoing gold weight implantation were enrolled prospectively to undergo the standard gold weight trial procedure. The criteria for ideal gold weight were defined before surgery as a minimum 50% reduction in lagophthalmos without induction of more than 2 mm ptosis during the trial procedure. The corrected weight (ideal gold weight + 0.2 g) was implanted in the pretarsal space. The main outcome measure was reduction in lagophthalmos according to predefined criteria at six weeks after surgery. Thirty eyes of 29 patients underwent gold weight implantation. The mean age at surgery was 41.6 years, and the median predicted ideal gold weight was 1.2 g. The mean preoperative lagophthalmos of 7 mm reduced to 2.3 mm at six weeks after surgery. As defined by the success criteria, undercorrection was noted in nine eyes (30%) at six weeks after surgery. A preoperative lagophthalmos of 8 mm or more was noted in seven (77.8%) of nine eyes in the undercorrection group, compared with six (28.6%) of 21 eyes in the success group. Six of the nine failures required implant exchange. The ideal gold weight as estimated by the trial procedure (with 0.2 g correction factor) led to undercorrection in 30% cases. Undercorrection was common (78%) in patients with preoperative lagophthalmos of more than 8 mm.

Implantation von Lidgewichten zur Therapie des Lagophthalmus

The aim of this study was to compare the clinical outcome and complication rate of rigid gold implants and flexible platinum chains in 96 patients treated for lagophthalmos. We treated 50 patients with peripheral facial palsy and lagophthalmos using rigid gold implants and 46 using a flexible platinum chain. Besides subjective assessment by the patients, reduction of lagophthalmos, improvement of visual acuity, and pre- and postoperative grade of keratopathy were evaluated. Both groups showed a statistically significant reduction of lagophthalmos and keratopathy and increase of visual acuity. Postoperative complications were observed in both groups. Two extrusions occurred in the group receiving gold implants. The incidence of corneal astigmatism and bulging of the implant was statistically significantly lower in the platinum chain group. The use of flexible platinum chains instead of rigid gold implants for therapy of lagophthalmos leads to a reduction of the complication rate, thus improving the clinical outcome.

Prospective evaluation of eyelid function with gold weight implant and lower eyelid shortening for facial paralysis.

To assess which signs and symptoms were relieved by gold weight implantation and which signs and symptoms persisted. Prospective observational cohort. Tertiary care neurotology and oncology center. Sixteen (4 males and 12 females) consecutive patients whose average age was 56 years (age range, 31-76 years). Inclusion criteria were gold weight implant, lagophthalmos of 2 mm or more, and a House-Brackmann score of 3 or less at the completion of follow-up. Mean follow-up was 13 months. Each patient received a gold weight implant. Six of these patients underwent a lower eyelid procedure. Surgical complications, static and dynamic lagophthalmos, static and dynamic corneal coverage, visual acuity, keratitis, topical treatment, and patient satisfaction. There were no extrusions. The preoperative mean lagophthalmos was 7.5 mm and the postoperative mean was 0.5 mm, (P<.001). Corneal coverage with eye closure before implantation was 73% and after implantation was 100%, (P<.001). Corneal coverage with normal (reflex) blink was less than 50% in 9 of 14 patients. When wearing correction, no patients had 20/20 visual acuity. The mean patient satisfaction score before the procedure was 3.5 and after was 7.1, (P<.001). Patient satisfaction was most closely related to visual acuity. The relationship was linear and statistically significant (P<.04). Gold weight implantation provides significant reduction in lagophthalmos and significant improvement in corneal coverage. But owing to delayed closure time and disrupted tear film, irritation may persist. As a result, some patients require ongoing topical treatment of the eye, which can compromise visual acuity.

Corneal astigmatism as a special complication after lid-loading in patients with lagophthalmos

Lid-loading with precious metals, described by Illig in 1958, has become increasingly important. because of its good functional and cosmetic results this method is superior to tarsorrhaphy. Furthermore, lid-loading can be combined with additional surgical techniques to achieve more dynamic lid-closure. In a prospective study we examined the results after lid-loading and discuss postoperative changes of the cornea. Between May 1994 and June 1998, 36 patients with peripheral facial paresis and lagophthalmos were treated with a pretarsally fixed upper-lid implant. We used 99.99% gold for the implants with a weight of 1.5 g on average. In all cases we obtained sufficient postoperative lid closure which resulted in a statistically significant reduction in lagophthalmos and improved keratopathy. Postoperative complications were: pseudoptosis, remaining lagophthalmos, bulge, extrusion, migration and corneal astigmatism. Depending on the implant pressure, an astigmatism of 1-2 D developed in the vertical meridian. In all cases the initial visual acuity was reached by an ordination of cylindrical glasses. So far, corneal astigmatism as a complication after lid-loading has not received much attention in the literature. In our opinion, the development of astigmatism is caused by implants that are too heavy, an incorrect implant radius and individual cofactors (consistency of lid and cornea). There has been no need for an explantation in any case.