Causes and Surgical Outcomes of Lower Eyelid Retraction
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Purpose: To investigate the causes of lower eyelid retraction and evaluate the outcomes of various surgical procedures. Methods: We conducted a retrospective medical record review of patients who underwent lower eyelid retractionsurgery performed by a single surgeon at Kim’s Eye Hospital between 2006 and 2013. We investigatedthe causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperativeand postoperative margin reflex distance 2 and inferior scleral show were measured for each eyelid. Success was defined as a positive eyelid elevation and a decrease in inferior scleral show. Results: A total of 19 lower eyelids were treated in 14 patients with lower eyelid retraction. For cosmetic reasons,surgical correction for congenital lower eyelid retraction was performed on seven eyelids (36.8%). Teneyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affectedby facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selectiveapproach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was themost commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was usedto horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) alsoreceived an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lowereyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactoryin all cases. Conclusions: To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severityof lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction issevere and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from beloware required.
Abstract
Purpose: To investigate the causes of lower eyelid retraction and evaluate the outcomes of various surgical procedures. Methods: We conducted a retrospective medical record review of patients who underwent lower eyelid retractionsurgery performed by a single surgeon at Kim’s Eye Hospital between 2006 and 2013. We investigatedthe causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperativeand postoperative margin reflex distance 2 and inferior scleral show were measured for each eyelid. Success was defined as a positive eyelid elevation and a decrease in inferior scleral show. Results: A total of 19 lower eyelids were treated in 14 patients with lower eyelid retraction. For cosmetic reasons,surgical correction for congenital lower eyelid retraction was performed on seven eyelids (36.8%). Teneyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affectedby facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selectiveapproach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was themost commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was usedto horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) alsoreceived an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lowereyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactoryin all cases. Conclusions: To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severityof lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction issevere and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from beloware required.
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