Recession and Extirpation of the Lower Eyelid Retractors for Paralytic Lagophthalmos

Abstract

The authors' surgical technique is effective in addressing lower eyelid malposition and ocular surface disease in paralytic lagophthalmos.

Functional and aesthetic outcomes of eyelid skin grafting in facial nerve palsy

“…The principles of periorbital surgery in FNP are to restore natural eyelid position and closure to minimise lagophthalmos. This traditionally involves recession of retractors,1 eyelid loading,2 3 horizontal tightening,4 5 and static eyelid and canthal suspension or fixation 6 7. Forehead, brow and mid-face elevation and volume restoration are often also required 8 9 10.…”

A hybrid technique to address exposure keratopathy secondary to facial nerve paresis: A combination of a lateral tarsorrhaphy and lateral wedge resection

“…[4][5] All our patients underwent gold weight placement. Additionally, all our patients underwent lower eyelid retraction recession and extirpation as described by Compton et al [2] Most techniques described for lower eyelid tightening and treating lateral canthal tendon laxity involve anchoring the tarsus to the orbital rim. [6][7][8][9][10] The lateral tarsal strip was first described in 1979 by Richard L. Anderson, and has been used extensively to treat both eyelid laxity, malposition, and lateral canthal tendon laxity.…”

“…Patients were identified with CPT codes 67917 (ectropion repair), 67882 (permanent tarsorrhaphy) and ICD 10 code G51.0 (bell's palsy) and S04.50XA (injury of facial nerve). Medical records of the patients who met these criteria were reviewed to obtain data including age, gender, All patients also underwent lower eyelid recession and extirpation of the retractors as described by Compton et al [2] and upper eyelid gold weight placement.…”

“…Malposition of the lower eyelid due to facial nerve weakness may be exacerbated by multiple factors, including involutional changes such as horizontal eyelid laxity, lateral canthal tendon laxity, and midface descent. [1,2] Additional considerations include a negative vector configuration and unopposed lower eyelid retractors. [1] Each factor has its own unique challenges and can be addressed by various surgical techniques.…”

Outcomes of lower eyelid retractor recession and lateral horn lysis in lower eyelid elevation for facial nerve palsy

“…[5][6][7] Lower eyelid retractor recession (RR) has also been previously described as a procedure for correction of lower eyelid retraction. [8][9][10][11] The rationale for RR in FNP stems from the principles of upper eyelid levator recession, 12,13 either with or without upper eyelid loading [14][15][16] to improve lagophthalmos. Weakening of the pull by unopposed lower eyelid retractors by RR is analogous to weakening the levator to correct upper eyelid retraction and improve lagophthalmos.…”