Anatomy of the Orbital Septum and Associated Eyelid Connective Tissues

Meyer, Dale R.; Linberg, John V.; Wobig, John L.; McCormick, Steven A.

doi:10.1097/00002341-199106000-00004

Cited by 136 publications

(46 citation statements)

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“…To successfully identify the OS, it helps to understand where the OS joins or fuses with the LA; this varies from a position B3-5 mm above the superior aspect of the tarsal plate to as far as 10-15 mm above the tarsal plate, 38 and is higher in Europeans than in Asians. 39 Therefore, after making the eyelid SC incision, one must dissect B5 mm superiorly in order to consistently identify the OS and LA before they join.…”

Section: Discussionmentioning

confidence: 99%

Turn-over orbital septal flap and levator recession for upper-eyelid retraction secondary to thyroid eye disease

Watanabe

Shams

Katori

et al. 2013

Eye

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Background A turn-over septal flap has been reported as a spacer for levator lengthening in a single case report. This study reports the preliminary outcomes of this technique in a series of patients with upper-lid retraction (ULR) associated with thyroid eye disease (TED) causing symptomatic exposure keratopathy (EK). Methods Retrospective, multicenter study of 12 eyelids of 10 patients with TED undergoing a transcutaneous levatorlengthening technique using the reflected orbital septum (OS) as a spacer. Change in palpebral aperture (PA) and contour, position of the skin crease (SC), symptoms of EK, and complications were recorded. Results The average age was 47.5 years. Two patients were excluded, as their septa were found to be very thin at surgery. At an average of 13 months postoperatively, the PA was reduced by 2.5 mm on average (Po0.001) and was within 1 mm of the contralateral eyelid in 11 cases (92%); the position of the SC was within 1 mm of the desired position in all cases. EK resolved in all cases. Complications included one case of overcorrection and one case of recurrent lateral flare. Conclusions The turn-over orbital septal flap technique may be a viable option as an autogenous spacer for the treatment of ULR in TED. This technique may be possible in cases where the OS has been opened by previous surgery but may not be feasible in patients in whom the septum is very thin.

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Section: Discussionmentioning

confidence: 99%

Turn-over orbital septal flap and levator recession for upper-eyelid retraction secondary to thyroid eye disease

Watanabe

Shams

Katori

et al. 2013

Eye

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“…1,3,4 A comparatively strong fibroadipose layer 3,4 is present on the anterior aspect of the orbital septum, and, furthermore, ligaments reinforce the orbital septum on the posterior aspect.…”

Section: Discussionmentioning

confidence: 99%

“…When the orbital septum becomes more hypotonic and droopy with advancing age, herniation of the orbital fat sometimes occurs, owing to reduced reinforcement by the ligaments and the effects of gravity. 2,3 Generally, herniation of the orbital fat in the lower eyelid occurs much more easily in the medial area than in the lateral area, 2 and this is thought to be affected by individual variations in the extent to which the orbital septum is reinforced by the ligaments.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] It originates at the arcus marginalis in the upper eyelid, at 1 to 2 mm outside the inferior orbital rim in the lower eyelid, 2 and at the posterior lacrimal crest in the medial canthus. 2 In Occidentals, it is attached to the levator aponeurosis at a site slightly above the upper tarsal edge of the upper eyelid 1-6 and to the capsulopalpebral fascia at a site slightly lower than the lower tarsal edge of the lower eyelid.…”

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Posterior Aspect of the Orbital Septum Is Reinforced by Ligaments

et al. 2005

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“…Blepharoplasty can be performed by many operative approaches and an almost uncountable number of different techniques have been published [1,9,13,14,18].…”

Section: Introductionmentioning

confidence: 99%