Surgical correction of congenital blepharoptosis may be performed with autologous fascia lata, cadaveric allograft, or permanent suture material. The use of a frontalis muscle advancement flap is elegantly designed; however, its role in clinical practice remains to be defined. Advancement of the levator aponeurosis for senile blepharoptosis may be preformed via a minimally invasive small incision approach. Patients benefit with decreased operative time, edema, ecchymosis, and recovery times.

Patients undergoing tarsal strip for tearing caused by presumed lacrimal pump failure showed a significant rate of improvement in their tearing symptom after the procedure. The tarsal strip procedure appears to be effective in the surgical treatment of tearing secondary to laxity of the lower eyelid.

Although there were statistically significant differences in edema using autologous platelet gel in blepharoplasty surgery, trends toward improvement in postoperative edema and ecchymosis did not achieve clinical significance.

Erdheim-Chester disease, adult periocular xanthogranuloma, juvenile xanthogranuloma, and necrobiotic xanthogranuloma are presumed to be separate disease entities, but they are often confused clinically because of their similar presentations and histopathology. To further describe the xanthogranulomatous diseases and to identify possible pitfalls in their diagnoses, we retrospectively reviewed charts from 1998 to 2001 for all patients with biopsy-proven xanthogranulomatous process of the eyelid and/or orbit. We found 2 patients diagnosed with adult periocular xanthogranuloma and 1 with Erdheim-Chester disease, each case initially misdiagnosed. Careful review of the clinical manifestations, histopathological review of all previous biopsy specimens, and repeat biopsy aided in the correct diagnosis and management of disease in these 3 patients.

Our experience suggests that utilization of a small skin incision is safe, precise, and efficient and allows for more rapid recovery from surgery. The authors note a decreased incidence of reoperation and postoperative complaints compared with historical larger-incision cases.