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Combination technique effectively corrected lower eyelid retraction

Closed canthal suspension combined with true lower eyelid retractor recession safely and effectively corrected lower eyelid retraction in patients with reduced orbicularis strength, according to recent study results.

To evaluate the technique, researchers retrospectively reviewed 29 patients who underwent minimally invasive, orbicularis-sparing (MIOS) lower eyelid recession from Jan. 1, 2010, to Oct. 1, 2012, at an ophthalmic plastic surgical practice. The patients (mean age, 52 years; 18 women) had reduced orbicularis strength and lower eyelid retraction attributed to eyelid paresis stemming from facial nerve disease (n=11), blepharoplasty trauma (n=13), involution change (n=4) or idiopathic causes (n=1).

The mean preoperative orbicularis strength of 2.7 on a 0-4 scale (4, normal function) remained unchanged after surgery for all patients. Mean follow-up was 11 months.

Eyelid retraction was unilateral in 12 patients and bilateral in the others. Six patients with facial nerve disease had a small adjunctive tarsorrhaphy. After surgery, mean eyelid elevation was 1.8 mm, including 1.95 mm mean correction in facial paralysis patients and 1.75 mm in the others.

No wound-healing issues, difficulty reading or inferior visual field limitations were reported, with patients “very satisfied” with their outcomes.

“No standard solution to eyelid retraction surgery exists,” the researchers reported. “Facial/eyelid surgeons continue … to improve results and minimize complications of standard surgical procedures. The combination of two such innovations, closed canthal suspension and true lower eyelid retractor recession, has led to the MIOS lower recession, which combines and adapts ideas from others. The technique shows promise as a safe and effective means of recessing retracted lower eyelids with orbicularis weakness in a consistent, reproducible and reliable manner.”

Disclosure: The researchers report no relevant financial disclosures.