K 390
Upper eyelid lengthening a modified technique
C. Hintschich, H. Herzum
Introduction: Upper eyelid lengthening in patients with Graves´ ophthalmopathy is often difficult, because the results are unpredictable. Not only the desired lid height, but also lid contour and skin crease can cause unfavourable results. We present a simplified alternative technique, which should avoid some of the above mentioned problems.
Method: The surgical technique will be shown on a short video. Under local anaesthesia via transcutaneous approach all lid layers including conjunctiva are transsected. Dissection into superior or inferior direction is avoided. Final adjustment is done with the patient sitting in upright position, overcorrection needs to be minimal. No traction sutures or spacers are used. The wound is closed with a running skin suture. Post-operatively lid contour and height can be modified by pulling and massaging. Thirty-three upper eyelids of 23 female with Graves´ disease were operated by one surgeon, one third under out-patient conditions. Palpebral aperture, retraction and skin crease height were measured pre- and post-operatively. Follow-up was 1 to 11 months.
Results: Pre-operative retraction was 1 to 6 mm. Post-operatively 30 of 33 eyelids (91%) ended up with a lid height within +/- 1 mm of the desired height. One lid was overcorrected (ptotis), two were undercorrected. The lid crease was unchanged in 29 lids. Cosmetic appearance and subjective complaints improved in 22 of 23 patients. The overall result was considered as very good in 4, as good in 14 and as moderate in 5 patients. One patient developed a wound dehiscence during the first post-operative week. None of the patients developed dry eyes.
Conclusions: This technique is simple and can be performed under out-patient conditions even in severe upper eyelid retraction. Lid height can be modified post-operatively, and the skin crease does not change. Therefore we find it an excellent alternative to other more sophisticated techniques, which gives reliable results.
Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstr. 8, 80336 Munich