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Abstract ID: 24-161
Upper eyelid retraction in paralytic lagophthalmos: one-snip procedure
Jelena Juri Mandić
Purpose
To present a novel surgical technique of a gold weight insertion for the upper eyelid retraction in a paralytic lagophthalmos patients.
Methods
From 2021-2023 , 25 patients with facial paralysis and upper eyelid retraction underwent one-day, local anesthesia surgery. Weight providing eyelid closure and free visual axis was determined preoperatively. On the tarsus of the everted eyelid, vertical tarsal incision was placed. Stevens scissors were used to create the space by blunt, bloodless dissection carried out between tarsus and orbicularis muscle. Mosquito forceps was used to grab and place the weight into the created space. Weight position, upper eyelid dynamics and closure were checked at the end.
Results
In all 25 patients the surgery went uneventfully. On three follow ups, weight position, eyelid dynamics, closure, tearing and anterior eye segment findings were evaluated. First follow up showed good position, adequate eyelid dynamics and free visual axis. Slit lamp showed improvement of corneal parameters. All patients reported improvement of the anterior eye segment symptoms related to tearing and foreign body sensation. No gold weight displacement, protrusion, extrusion,swelling or discomfort was observed.Second follow up revealed gold weight displacement in 1patient by turning vertically within the created pocket. However, it did not compromise the function of the eyelid and the patient’s tolerability of the weight. Upon the third check up,3 had incomplete eyelid closure due to the worsening of the lower eyelid laxity. 17 patients remained stable with no reported complications.
Conclusion
Patients with paralytic lagophthalmos and upper eyelid retraction are referred to surgery due to exposure keratopathy and tearing, resulting in decreased quality of life. Described method of one snip posterior gold weight insertion approach is minimally invasive, quick, bloodless, sutureless, safe and effective in the majority of patients during the 1,5 year follow up. It might be a valuable alternative to standard surgeries.
Additional Authors
Maja Bakula – Medical School, University Hospital Center Zagreb, Croatia
Krešimir Mandić – Medical School, University Hospital Center Zagreb, Croatia
Jasenka Petrović Jurčević – Medical School , University of Zagreb, Croatia
Marko Jurčević – Faculty of Electrical Engineering and Computing, University of Zagreb, Croatia
Antonela Geber – Medical School, University Hospital Center Zagreb, Croatia