Management of the upper eyelid retraction by severing of the Levator & Muller Muscle in upper eyelid

Ahn, Sung Yul; Pak, Hyang Jun; Kim, Jong pill

Abstract

The surgical treatment of long duration lagaphthalmos was traditionally conducted using the Gillies (1934) method of temporal muscle transfer. This method has been effective in cases of simultaneous lagaphthalmos in the upper eyelid and ectropion in the lower eyelid. In the past, we treated 18 leprosy patients who suffered complications of ptosis in the upper eyelid and ectropion in the lower eyelid after the application of the Gillies method. To treat these complications, we removed the fascia strips emplaced during temporal muscle transfer from the upper and lower eyelid. Thereafter, we implanted a 1.0 gram gold plate in the upper eyelid and either a conchal cartilage graft. In the treatment of Lagaphthalmos over the past seven years, we have applied gold plate lid loading in 120 cases. However, in five of these cases, patients suffered from exposure of the gold plate due to paralytic orbicularis oculi muscle tearing. Recently, to correct this, we covered the gold plate with AlloDerm tissue to protect and support the muscle. In the treatment of ectropion over the last six years, we have had over 30 cases of cartilage grafts (over 35mm in length and 5mm in breadth) in the lower eyelid. However, the end of the cartilage graft would warp and create new partial ectropion several months later. Because of this, we shifted from cartilage to AlloDerm. We applied 40mm (length) and 7mm (breadth) to the lower border of the tarsus and fixed at each end with medial and canthal ligament. From 1997 to 2002, in the Institute of Leprosy Research, we operated on 25 patients suffering from Lagaphthalmos and Ectropion using a newer treatment to correct ectropion more effectively. The levator muscle of the upper eyelid loses the funtion of its antagonistic muscle, namely the orbicularis oculi due to facial nerve palsy, and results in retraction of the upper eyelid. To correct upper eyelid retraction, we severed the levator and muller muscle from the superior tarsal border and discontinued the use of gold lid loading which is visually evident. This method does not result in ptosis and the eye is more normal in appearance.