J Korean Ophthalmol Soc.  2012 Oct;53(10):1378-1384.

Surgical Outcome of Levator Recession for Correction of Upper Eyelid Retraction

• Lee YE
• Paik JS
• Jung SK
• Sonn UH
• Yang SW

Abstract

PURPOSE
To assess the efficacy of levator recession under local anesthesia to treat upper eyelid retraction.
METHODS
Records of 12 patients (12 lids) were reviewed retrospectively. Postoperative cosmetic results were assessed as good, fair, or poor based on the upper lid height and symmetry. Preoperative and postoperative marginal reflex distance (MRD1, mm), upper eyelid asymmetry, lid lag, lagophthalmos, and ocular exposure symptoms were compared. The reoperation rate was also evaluated.
RESULTS
Causes accounting for upper lid retraction were Graves ophthalmopathy (9 lids, 75.0%), orbital pseudotumor (2 lids, 16.7%), and hypercorrection from previous ptosis operation (1 lid, 8.3%). At a mean +/- standard deviation of 27.7 +/- 24.0 months follow-up (range, 5-60 months), 11 patients (91.7%) showed significantly better cosmetic results. MRD1 decreased an average of 3.1 +/- 1.3 mm from 6.3 +/- 1.5 mm preoperatively to 3.2 +/- 0.9 mm postoperatively (p < 0.001). Upper lid asymmetry, lagophthalmos, and lid lag were also reduced significantly (p < 0.001). Overcorrection occurred in 3 lids (25%) and required levator advancement. Eleven patients (91.7%) experienced complete resolution of dry eye symptoms following levator recession.
CONCLUSIONS
Levator recession showed good cosmetic results up to 2 years after surgery for upper eyelid retraction.

Keyword

Asymmetry; Cosmetic results; Levator recession; Lid lag; Upper eyelid retraction

MeSH Terms

Accounting
Anesthesia, Local
Cosmetics
Eye
Eyelids
Follow-Up Studies
Graves Ophthalmopathy
Humans
Orbital Pseudotumor
Reflex
Reoperation
Retrospective Studies
Cosmetics

Figure

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  Figure 1 Preoperative and postoperative MRD1-time profiles. MRD1 levels were highest on the preoperative day, and decreased significantly after the levator recession.

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  Figure 2 (A) Preoperative photograph of case 3, showing right upper eyelid retraction due to thyroid-associated ophthalmopathy. (B) Large amount of lid lag before levator recession. (C) Postoperative photograph showing dramatic improvement in eyelid level 1month after the operation. (D) Incision along the lid crease.

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  Figure 3 (A) Preoperative upper eyelid retraction in the left eye (case No. 4). (B) 4 months after the operation with good cosmetic result.

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