The Efficacy of Orbital Septal Flap in the Treatment of Moderate and Severe Upper Eyelid Retraction

Abstract

To assess the long-term effectiveness of the orbital septal flap to lengthen the levator muscle in management of moderate and severe upper eyelid retraction.Methods: This study reports 46 eyes of 43 consecutive patients with moderate or severe upper eyelid retraction who were recommended for surgery. The period of the study was between October 2016 and October 2019. All cases were evaluated for eyelid position before and at 3, 6, and 12 months after the operation. Successful outcome was defined as "perfect," "acceptable," and "failure".Results: The average age was 33.3 years (range, 16-59 years). The average orbital septal flap height was 5.28 ± 0.77 mm. Before surgery, 78.3% had 1 of 3 central upper eyelid retraction (group 1), and 21.7% had 1 of 3 lateral upper eyelid retraction (group 2). During follow-up postoperatively, all eyelid parameters of upper marginal reflex distance, upper scleral show, and palpebral fissure height significantly decreased compared with preoperative values in both groups. The result was considered "perfect" or "acceptable" in 42 eyes (91.3%). However, at 12 months after surgery, of the 36 middle eyelid retraction cases (group 1), 35 (97.2%) showed a successful outcome (perfect or acceptable results), while the success rate in group 2 was 70% (7 of 10 cases), a significant difference (p = 0.008). No severe complications were seen during follow up.Conclusions: Orbital septal flap is a safe and reliable procedure for management of upper eyelid retraction of moderate and severe degree.

The Art of Upper Eyelid Retraction Repair

“…After an average of 13 months, the palpebral fissure height was reduced by 2.5 mm and was within 1 mm of the contralateral eyelid in 92% of the patients and they concluded that the turn-over orbital septal flap technique may be a viable option as an autogenous spacer for the treatment of ULR in TED. Recently, a prospective study was done in Vietnam assessing the use of the orbital septal flap technique for patients with moderate to severe UER 22 . They included 46 eyes of 43 consecutive patients with moderate to severe UER with a minimum follow-up period of 12 months (range from 12 to 37 mo).…”

“…Due to the few published papers describing this procedure, the long-term complications are not well described with few articles reporting few patients with recurrence of UER and nonresolve temporal flare in TED patients. Unfortunately, this surgical procedure is not suitable for patients with thin orbital septum, therefore, intraoperative assessment of such finding is important to prevent unwanted outcomes 20–22 …”

“…Recently, a prospective study was done in Vietnam assessing the use of the orbital septal flap technique for patients with moderate to severe UER. 22 They included 46 eyes of 43 consecutive patients with moderate to severe UER with a minimum follow-up period of 12 months (range from 12 to 37 mo). The etiology of UER was congenital (16.3%), secondary after TED (74.4%), and miscellaneous entities (9.3%).…”

“…Unfortunately, this surgical procedure is not suitable for patients with thin orbital septum, therefore, intraoperative assessment of such finding is important to prevent unwanted outcomes. [20][21][22]…”

“…Eyelid retraction secondary to TED can present with specific eyelid signs not seen in other causes of UER. Eyelid retraction more prominent laterally (temporal flare) is an important finding that should be looked for before choosing the appropriate surgical intervention 22 . Hence, mullerectomy alone will not address such finding, and the surgeon should combine it with the release of the levator lateral horn to resolve the temporal flare element seen in such patients (Fig.…”