Korean J Ophthalmol.  2017 Aug;31(4):290-298. 10.3341/kjo.2016.0059.

Causes and Surgical Outcomes of Lower Eyelid Retraction

• Kim KH
• Baek JS
• Lee S
• Lee JH
• Choi HS
• Kim SJ
• Jang JW

• KMID: 2385577
• DOI: http://doi.org/10.3341/kjo.2016.0059

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 retraction surgery performed by a single surgeon at Kim's Eye Hospital between 2006 and 2013. We investigated the causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperative and 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%). Ten eyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affected by facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selective approach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was the most commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was used to horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) also received an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lower eyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactory in all cases.
CONCLUSIONS
To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severity of lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction is severe and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from below are required.

Keyword

Acellular dermal matrix allograft; Dermis fat graft; Lower eyelid retraction; Suborbicularis oculi fat lift

MeSH Terms

Dermis
Exophthalmos
Eyelids*
Facial Paralysis
Humans
Medical Records
Reflex
Retrospective Studies
Surgeons
Transplants

Figure

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  Fig. 1 Number of eyelids (percentage of all eyelids) treated using each type of surgical procedure. HT = horizontal tightening; LTS = lateral tarsal strip; SOOF = suborbicularis oculi fat lift.

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  Fig. 2 A 22-year-old woman with congenital lower eyelid retraction on both sides. (A) Preoperatively, the patient showed bilateral upper eyelid ptosis and bilateral lower eyelid retraction. (B) Photograph taken 9 months after surgery using an AlloDerm® graft for lower lid retraction and levator aponeurosis advancement surgery for bilateral ptosis. Informed consent was received from the patient.

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  Fig. 3 A 57-year-old man with thyroid-associated orbitopathy. (A) Preoperatively, the patient showed right lower eyelid retraction. He had a prior history of receiving a right inferior rectus recession. (B) Photograph taken 1 week after surgery using an AlloDerm® graft shows a slight overcorrection. Informed consent was received from the patient.

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  Fig. 4 A 22-year-old man with right lower eyelid retraction. (A) Preoperatively, the patient showed right lower eyelid retraction. He had a prior history of methicillin resistant staphylococcus aureus infection after endonasal dacryocystorhinostomy. (B) Orbital computed tomography before surgery revealed orbital fat hypertrophy in the right lower eyelid. (C) Photograph taken 1 week after surgery using an autogenous dermis fat graft shows a slight overcorrection. (D) Photograph taken 9 months after surgery demonstrates that the right lower eyelid retraction was corrected. Informed consent was received from the patient.

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