J Korean Ophthalmol Soc.  1978 Jun;19(2):175-183.

Comparison between Static Procedure and Gillies Technique for Correction of Lagophthalmos in Leprosy

• Kim SH
• Bae JK

Abstract

The authors presented a clinical review on 67 cases of lagophthalmos in leprosy, who were treated in Leprosy Mission Hospital from 1970 to 1978. The static procedure was performed on 59 eyes of 45 patients. The tarsorraphy was simple and quick method, and has hitherto been the main stay of surgical procedure employed for correction of lagophthalmos. Although technically a simple procedure, its disadvantages are permanent narrowing of palpebral fissure, epiphora and chronic conjunctivitis due to exposure of the bulbar conjunctiva on effort or during sleep. The sling technique with silk was temporary in its effectiveness. The sling technique with fascia lata also tender to stretch in time resulting in recurrence of the ectropion. For these reason static procedure is considered unsatisfactory as a definite surgical procedure for the correction of lagophthalmos in leprosy. The lagophthalmos in leprosy was not found in association with temporal nerve paralysis. So authors performed temporal muscle transfer on 18 eyes of 12 patients, the same as originally devised by Gillies. 12 out of 18 eyes had no residual lagophthalmos. 3 eyes had fair results due to low tension of the transfer. One patient (2 eyes), who was operated during acute phase of lepra reaction, had poor results due to low tension of the transfer. One eye was a failure due to adhesion and infection of the transfer. Ectropion of the lower lid in one eye was produced as a result of placing the fascial strip too far away from the lid margin. The Gillies technique requires wide surgical field and takes a long time to operate. Nevertheless, this technique to activate a circumocular sling of its own attached fascia restores natural contour of the eye and enables the patient to close his eye completely on effort or during sleep. This surgical procedure was permanent in result and considered the method of choice for the correction of lagophthalmos in leprosy. Even when it fails, Gillies technique for lagophthalmos is much better than static procedure.

MeSH Terms

Conjunctiva
Conjunctivitis
Ectropion
Fascia
Fascia Lata
Humans
Lacrimal Apparatus Diseases
Leprosy*
Missions and Missionaries
Paralysis
Recurrence
Silk
Temporal Muscle
Silk