The authors report a case with upper eyelid retraction caused by topical bimatoprost therapy. Topical bimatoprost 0.03% was administered to a 69-year-old woman with bilateral normal-tension glaucoma. It was first administered to the left eye, and 3 weeks later, therapy on the right side of the eye was initiated. One week after the initiation of therapy on the right side, right upper eyelid retraction occurred, and 63 days after starting treatment on the left side (42 days after initiation on the right side), conspicuous bilateral upper eyelid retraction was observed. Bimatoprost instillation was then stopped and the medication was switched to latanoprost 0.005%. Upper eyelid retraction was reversed to normal levels approximately 1 week after cessation of bimatoprost therapy. In conclusion, a rare case of upper eyelid retraction caused by topical bimatoprost therapy, which was reversed after discontinuation of the medication, is reported.

Transcutaneous blepharoptosis surgery with simultaneous advancement of the levator aponeurosis and Müller’s muscle (levator resection) is a popular surgery which is considered effective for all types of blepharoptosis except for the myogenic type. Repair of ptosis cases with good levator function yields excellent results. A good outcome can be also obtained in cases with poor levator function, however, in such cases; a large degree of levator advancement may be required, which may result in postoperative dry eyes, unnatural eyelid curvature and astigmatism. These cases are therefore better treated with sling surgery. With the right patient selection, the levator resection technique is an effective method for ptosis repair.

Background: There are several known ocular complications of suture blepharoplasty which includes suture exposure, cyst formation, and surgical site infection. Objective: To present late complications of nylon suture blepharoplasty that causes damage to the ocular surface. Methods: Medical records of patients who developed ocular surface injury at least 1 year after nylon suture blepharoplasty were reviewed. Results: A total of 9 eyes (3 right and 6 left) of 9 patients (all females) were included in this study. All patients underwent trans-tarsal nylon suture blepharoplasty. The average age of the patients was 36.2 years (range: 22-64 years). The average interval between suture blepharoplasty and revision surgery was 9.6 years (range: 5-15 years). The mean follow-up period after revision surgery was 17 months (range: 7-48 months). Before revision surgery, all patients had reported ocular discomfort. Slit lamp examination revealed ocular surface injury caused by the presence of granulation tissue in the palpebral conjunctiva and deformity of the tarsal plate. Intraoperatively, suture exposure was absent in all but one eyelid. All of the symptoms completely disappeared postoperatively. Conclusion: Late complications of nylon suture blepharoplasty such as granulation tissue formation and tarsal plate deformity cause damage to the ocular surface. The trans-tarsal technique and hydrolytic denaturation of nylon sutures were considered as the main contributory factors leading to the mechanisms of ocular surface injury.

A 37-year-old woman presented with right upper eyelid blepharochalasis with ptosis. Right upper eyelid edema had occurred 2 to 3 times per year by 30 years old, although the frequency decreased with age. The edema occurred spontaneously and resolved within 1 to 2 days. She underwent a right levator tucking surgery at 22 years old, and the ptosis recurred 2 years postoperatively. She again underwent ptosis surgery with skin excision at 37 years old. The intraoperative findings showed a thin levator aponeurosis. The white line was therefore advanced to the upper tarsal edge, resulting in an appropriate height and curvature. Three months later, the patient's eyelid height was 1.5 mm higher with a little temporal peaking. The levator aponeurosis was histopathologically shown to contain many capillaries. The increased vascularity of the levator aponeurosis may contribute to recurrent bouts of edema resulting in stretching and disinsertion of the aponeurosis.

A 79-year-old patient showed left conjunctival injection and bilateral epiphora for years. He was diagnosed with left lower eyelid medial ectropion and bilateral lacrimal obstructions. Lacrimal syringing and a dacryoendoscopic examination showed left upper and lower canalicular obstructions and a right common canalicular obstruction. Canaliculoplasty was performed to the obstruction sites directly by the dacryoendoscope. Bilateral bicanalicular intubation was performed with a three-piece segmented tube. Just after the procedure, the left lower eyelid medial ectropion was also improved. The tubes were left in place for 2 months. The tear meniscus had been well reconstructed and the ectropion continued to improve during this period. Six months postoperatively, the medial ectropion was further improved with an appropriate tear meniscus height.