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Robert A. Goldberg - One of the best experts on this subject based on the ideXlab platform.
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hyaluronic acid gel injection for upper Eyelid Retraction in thyroid eye disease functional and dynamic high resolution ultrasound evaluation
Ophthalmic Plastic and Reconstructive Surgery, 2014Co-Authors: Jocelyne C Kohn, Daniel B Rootman, Wenjing Liu, Alice S Goh, Catherine J Hwang, Robert A. GoldbergAbstract:PURPOSE The goal of this study is to determine the functional and dynamic effects of hyaluronic acid (HA) gel injection into the levator plane for improving upper Eyelid Retraction in patients with thyroid eye disease (TED). METHODS This is a prospective, non-randomized study of consecutive patients with symptomatic unilateral upper Eyelid Retraction in the setting of active and inactive TED. Study participants underwent HA gel injection subconjunctivally into the levator plane and were examined before injection, 1 to 3 months after injection, and at the clinician's discretion thereafter. At each of the time points, high-resolution ultrasound imaging and clinical photographs were taken, and the marginal reflex distance 1 (MRD1) was measured. RESULTS Eight patients (4 in the active stage of TED, 4 in the inactive stage of TED) were injected on average with 0.45 ml of HA gel. The average baseline MRD1 was 5.6 mm prior to HA injection, 4.6 mm at the first follow up after injection, and 5 mm at the final follow up after injection. HA was localized ultrasonographically to multiple anatomical locations and changed in morphology over time but not in anatomical location. All patients demonstrated increased fluidity of Eyelid excursion on dynamic ultrasound after HA injection. There were no vision-threatening complications in this study. CONCLUSIONS Despite variability in the HA gel distribution and long-term conformational changes on ultrasound examination, HA injection may be an effective and minimally invasive method to improve upper Eyelid position for patients with mild Eyelid Retraction in both the active and inactive stages of TED.
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aesthetic considerations in upper Eyelid Retraction surgery
Ophthalmic Plastic and Reconstructive Surgery, 2012Co-Authors: Konstantinos I Papageorgiou, Michael Ang, Shu Hong Chang, Jocelyn Kohn, Saray Martinez, Robert A. GoldbergAbstract:PURPOSE Classically, the aesthetic outcomes of Eyelid Retraction surgery in patients with thyroid-associated orbitopathy have been described in reference to Eyelid margin position and marginal reflex distance. A critically important component of upper Eyelid contour is the tarsal platform show (TPS). With this study, the authors aimed to assess the hypothesis that modification of the tarsal platform in posterior Eyelid Retraction surgery has a significant effect on the final aesthetic outcome. METHODS In a retrospective, observational, case-cohort study, the authors reviewed the medical records of 36 patients with thyroid-associated orbitopathy who underwent primary Eyelid Retraction surgery by 1 surgeon. Patients who underwent Eyelid Retraction surgery at the time of orbital decompression were excluded. The surgical technique consisted of posterior approach conjunctival release of Mueller muscle and graded recession of the levator aponeurosis. To address lateral flare, dissection was carried toward the lateral orbital rim with spreading of the lateral horn of the levator aponeurosis. Outcome measures were millimeters of TPS, millimeters of brow fat span, and symmetry of the Eyelid margin position. Randomized preoperative and postoperative standardized photographs were evaluated in masked fashion by 4 surgeons to grade cosmetic outcomes. RESULTS Fifteen patients (24 Eyelids) met the inclusion criteria. Mean follow-up period was 6 months (range, 3-12). Mean TPS increased from 2.27 mm (standard deviation, 1.9 mm) to 4.77 mm (standard deviation, 1.7 mm; p 0.05). Evaluation of the aesthetic outcomes (Eyelid contour, Eyelid symmetry, and TPS) by 4 masked observers characterized the relevance of TPS in the postoperative aesthetics of Eyelid contour and symmetry. CONCLUSIONS In upper Eyelid Retraction surgery, the ability to control the TPS has a significant impact on the final aesthetic outcome. Posterior approach Eyelid Retraction surgery can control Eyelid contour and can represent an ideal surgical approach in carefully selected patients. However, it has limited ability to control upper orbital volume and eyebrow and orbital fat (brow fat span). This can result in relative overelongation of the TPS. Factors such as ethnic characteristics, bony asymmetry, brow fat span, and premorbid TPS influence cosmetic outcomes achieved by the anterior or posterior approach. For optimal aesthetic results in Eyelid Retraction surgery, the decision for anterior versus posterior approach should be individualized.
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en glove lysis of lower Eyelid retractors with alloderm and dermis fat grafts in lower Eyelid Retraction surgery
Ophthalmic Plastic and Reconstructive Surgery, 2011Co-Authors: Heather S Chang, Mehryar Taban, Raymond S Douglas, Robert A. GoldbergAbstract:Purpose: To describe a minimally invasive surgical technique using AlloDerm or dermis-fat grafts for lower Eyelid Retraction. Methods: A retrospective review of all patients undergoing lower Eyelid Retraction surgery via a minimal invasive, “en-glove” technique from 2005 through 2009. Charts were reviewed for the type of graft (AlloDerm or dermis-fat) used, the etiology of lower Eyelid Retraction, and the follow-up time. Outcome measures included lower Eyelid height (measured from the corneal light reflex to the lower Eyelid margin, or MRD2), reduction of lagophthalmos, cosmetic appearance, complications, and need for further surgery. Presurgery and postreconstruction photographs were reviewed and graded for functional and cosmetic outcome. Results: A total of 8 patients underwent successful lower Eyelid Retraction surgery using this minimally invasive technique. Etiologies included thyroid eye disease and cicatricial paralytic lower Eyelid Retraction. Mean improvement in MRD2 was 1.5 mm for the AlloDerm group (4 patients, 7 Eyelids) and 1.0 mm for the dermis-fat group (4 patients, 4 Eyelids) after a minimum of 3 months’ follow-up. The cosmetic result was satisfactory in all cases. Conclusions: “En-glove” lower Eyelid Retraction surgical technique offers a minimally invasive approach for the release of the lower Eyelid retractors and allows for volume augmentation using either AlloDerm or dermis-fat spacer graft.
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en glove lysis of lower Eyelid retractors with alloderm and dermis fat grafts in lower Eyelid Retraction surgery
Ophthalmic Plastic and Reconstructive Surgery, 2011Co-Authors: Heather S Chang, Mehryar Taban, Raymond S Douglas, Diana Lee, Robert A. GoldbergAbstract:Purpose: To describe a minimally invasive surgical technique using AlloDerm or dermis-fat grafts for lower Eyelid Retraction. Methods: A retrospective review of all patients undergoing lower Eyelid Retraction surgery via a minimal invasive, “en-glove” technique from 2005 through 2009. Charts were reviewed for the type of graft (AlloDerm or dermis-fat) used, the etiology of lower Eyelid Retraction, and the follow-up time. Outcome measures included lower Eyelid height (measured from the corneal light reflex to the lower Eyelid margin, or MRD2), reduction of lagophthalmos, cosmetic appearance, complications, and need for further surgery. Presurgery and postreconstruction photographs were reviewed and graded for functional and cosmetic outcome. Results: A total of 8 patients underwent successful lower Eyelid Retraction surgery using this minimally invasive technique. Etiologies included thyroid eye disease and cicatricial paralytic lower Eyelid Retraction. Mean improvement in MRD2 was 1.5 mm for the AlloDerm group (4 patients, 7 Eyelids) and 1.0 mm for the dermis-fat group (4 patients, 4 Eyelids) after a minimum of 3 months’ follow-up. The cosmetic result was satisfactory in all cases. Conclusions: “En-glove” lower Eyelid Retraction surgical technique offers a minimally invasive approach for the release of the lower Eyelid retractors and allows for volume augmentation using either AlloDerm or dermis-fat spacer graft.
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treatment of lower Eyelid Retraction by expansion of the lower Eyelid with hyaluronic acid gel
Ophthalmic Plastic and Reconstructive Surgery, 2007Co-Authors: Robert A. Goldberg, Raymond S Douglas, Seongmu Lee, Thiran Jayasundera, Angelo Tsirbas, John D MccannAbstract:PURPOSE To report our preliminary experience utilizing a nonsurgical alternative in the treatment of lower Eyelid Retraction: expansion and reinforcement of the lower Eyelid with hyaluronic acid gel. METHODS Retrospective review of patients with lower Eyelid Retraction treated with hyaluronic acid gel. Pretreatment, post-treatment, and follow-up photographs were digitized and overall outcomes assessed. Measurements of inferior scleral show were standardized and compared. RESULTS Sixty-five procedures (31 patients; 14 male; mean age 58 years, range, 33-78 years) with lower Eyelid Retraction of various etiologies were treated with hyaluronic acid gel. A mean change in scleral show of 1.04 mm was found when pre- and post-treatment measurements were compared. The overall mean follow-up period was 6.2 months (range, 1-12 months). During the interval from initial treatment to follow-up visit (mean 4.6 months, range, 1-12 months), the effect of the hyaluronic acid gel diminished, with a mean increase in inferior scleral show of 0.52 mm. Twelve patients underwent a second, and 6 patients underwent a third, maintenance treatment with an improvement in scleral show of 0.87 mm and 1.13 mm, respectively. Complications were minor and included swelling, redness, bruising, and tenderness at the sites of injection. CONCLUSIONS Based on our preliminary results, hyaluronic acid gel shows promise as a treatment modality for the management of lower Eyelid Retraction. Long-term follow-up will better clarify the required frequency of maintenance injections, the degree of hyaluronic acid gel retention, and the position of the lower Eyelid over time.
Victor M Elner - One of the best experts on this subject based on the ideXlab platform.
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graded full thickness anterior blepharotomy for correction of upper Eyelid Retraction not associated with thyroid eye disease
Ophthalmic Plastic and Reconstructive Surgery, 2007Co-Authors: Hakan Demirci, Bartley R Frueh, Adam S Hassan, Stephen D Reck, Victor M ElnerAbstract:PURPOSE To evaluate the efficacy of graded full-thickness anterior blepharotomy for upper Eyelid Retraction of various causes not associated with Graves eye disease. METHODS Twenty-one Eyelids of 18 patients with upper Eyelid Retraction not caused by Graves eye disease were treated with graded full-thickness anterior blepharotomy. Preoperative and postoperative symptoms, midpupil to upper Eyelid distance, lagophthalmos, and superficial punctuate keratopathy were evaluated. RESULTS Upper Eyelid Retraction was due to facial nerve palsy in 4 patients (22%), overcorrected ptosis in 5 patients (28%), and cicatrix after trauma in 6 patients (33%). One patient each (6% each) had Retraction from graft-versus-host disease, after blepharoplasty, and after orbicularis oculi myectomy for blepharospasm. At a mean of 10 months follow-up, presenting symptoms resolved or improved in 17 patients (94%) and remained unchanged in 1 patient (6%). Midpupil to upper Eyelid distance, lagophthalmos, and superficial punctuate keratopathy all improved significantly (all p < 0.001). No surgical complications occurred. CONCLUSIONS Graded full-thickness anterior blepharotomy is a safe, effective, and rapid technique for patients with symptomatic upper Eyelid Retraction due to etiologies other than Graves eye disease. This technique improves symptoms and signs of ocular exposure while addressing relative upper Eyelid height symmetry and contour.
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mullerectomy for upper Eyelid Retraction and lagophthalmos due to facial nerve palsy
Archives of Ophthalmology, 2005Co-Authors: Adam S Hassan, Bartley R Frueh, Victor M ElnerAbstract:Background Facial nerve palsy often results in symptoms of ocular irritation due to inadequate Eyelid closure. Weakened protractor function results in relative upper Eyelid Retraction and contributes to lagophthalmos. Objective To evaluate the role of mullerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy. Methods Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Muller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower Eyelid Retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper Eyelid position, lagophthalmos, and keratopathy were compared. Results Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper Eyelid position was lowered by an average of 1.35 mm ( P P = .002) and corneal exposure ( P Conclusion Mullerectomy is a rapid, safe, and reproducible surgical method for lowering the upper Eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.
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graded full thickness anterior blepharotomy for upper Eyelid Retraction
Archives of Ophthalmology, 2004Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:BACKGROUND: A chief morbidity of Graves eye disease is upper Eyelid Retraction that results in exposure keratopathy and cosmetic deformity. OBJECTIVE: To assess the efficacy of graded anterior blepharotomy to treat upper Eyelid Retraction. METHODS: Fifty Eyelids of 32 patients with Graves eye disease-associated upper Eyelid Retraction, causing symptomatic ocular exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper Eyelid position, lagophthalmos, and keratopathy were compared. RESULTS: At a mean +/- SD of 8.5 +/- 8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper Eyelid position (P<.001), lagophthalmos (P<.001), and keratopathy (P<.01) were significantly improved. Mild contour abnormalities (all Eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative Eyelid crease measurements. Complications of ptosis, wound dehiscence, and a full-thickness hole each occurred once. The mean +/- SD time taken to perform the procedure was 31.5 +/- 8.9 minutes per Eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper Eyelid Retraction is a safe and highly effective surgery for upper Eyelid Retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.
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graded full thickness anterior blepharotomy for upper Eyelid Retraction
Transactions of the American Ophthalmological Society, 2003Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:PURPOSE: A chief morbidity of Graves' eye disease (GED) is upper lid Retraction that results in exposure keratopathy and cosmetic deformity. This study was conducted to assess the efficacy of graded anterior blepharotomy to treat upper lid Retraction. METHODS: Fifty Eyelids of 32 patients with GED-associated upper lid Retraction causing symptomatic ocular exposure were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper lid position, lagophthalmos, and keratopathy were compared. RESULTS: At an average of 8.5 +/- 8.1 months (range, 2 to 35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper Eyelid position (P < .00001), lagophthalmos (P < .0001), and keratopathy (P < .01) were significantly improved. Mild contour abnormalities (all < or = 1 mm) occurred in 7 of 50 Eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative lid crease measurements. Complications of ptosis, wound dehiscence, and full-thickness hole each occurred once. The average time for performing the procedure was 31.5 +/- 8.9 minutes per Eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper lid Retraction is a safe and highly effective surgical treatment for symptomatic GED-associated upper Eyelid Retraction. This technique achieves excellent functional and cosmetic outcomes.
Bartley R Frueh - One of the best experts on this subject based on the ideXlab platform.
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graded full thickness anterior blepharotomy for correction of upper Eyelid Retraction not associated with thyroid eye disease
Ophthalmic Plastic and Reconstructive Surgery, 2007Co-Authors: Hakan Demirci, Bartley R Frueh, Adam S Hassan, Stephen D Reck, Victor M ElnerAbstract:PURPOSE To evaluate the efficacy of graded full-thickness anterior blepharotomy for upper Eyelid Retraction of various causes not associated with Graves eye disease. METHODS Twenty-one Eyelids of 18 patients with upper Eyelid Retraction not caused by Graves eye disease were treated with graded full-thickness anterior blepharotomy. Preoperative and postoperative symptoms, midpupil to upper Eyelid distance, lagophthalmos, and superficial punctuate keratopathy were evaluated. RESULTS Upper Eyelid Retraction was due to facial nerve palsy in 4 patients (22%), overcorrected ptosis in 5 patients (28%), and cicatrix after trauma in 6 patients (33%). One patient each (6% each) had Retraction from graft-versus-host disease, after blepharoplasty, and after orbicularis oculi myectomy for blepharospasm. At a mean of 10 months follow-up, presenting symptoms resolved or improved in 17 patients (94%) and remained unchanged in 1 patient (6%). Midpupil to upper Eyelid distance, lagophthalmos, and superficial punctuate keratopathy all improved significantly (all p < 0.001). No surgical complications occurred. CONCLUSIONS Graded full-thickness anterior blepharotomy is a safe, effective, and rapid technique for patients with symptomatic upper Eyelid Retraction due to etiologies other than Graves eye disease. This technique improves symptoms and signs of ocular exposure while addressing relative upper Eyelid height symmetry and contour.
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mullerectomy for upper Eyelid Retraction and lagophthalmos due to facial nerve palsy
Archives of Ophthalmology, 2005Co-Authors: Adam S Hassan, Bartley R Frueh, Victor M ElnerAbstract:Background Facial nerve palsy often results in symptoms of ocular irritation due to inadequate Eyelid closure. Weakened protractor function results in relative upper Eyelid Retraction and contributes to lagophthalmos. Objective To evaluate the role of mullerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy. Methods Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Muller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower Eyelid Retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper Eyelid position, lagophthalmos, and keratopathy were compared. Results Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper Eyelid position was lowered by an average of 1.35 mm ( P P = .002) and corneal exposure ( P Conclusion Mullerectomy is a rapid, safe, and reproducible surgical method for lowering the upper Eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.
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graded full thickness anterior blepharotomy for upper Eyelid Retraction
Archives of Ophthalmology, 2004Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:BACKGROUND: A chief morbidity of Graves eye disease is upper Eyelid Retraction that results in exposure keratopathy and cosmetic deformity. OBJECTIVE: To assess the efficacy of graded anterior blepharotomy to treat upper Eyelid Retraction. METHODS: Fifty Eyelids of 32 patients with Graves eye disease-associated upper Eyelid Retraction, causing symptomatic ocular exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper Eyelid position, lagophthalmos, and keratopathy were compared. RESULTS: At a mean +/- SD of 8.5 +/- 8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper Eyelid position (P<.001), lagophthalmos (P<.001), and keratopathy (P<.01) were significantly improved. Mild contour abnormalities (all Eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative Eyelid crease measurements. Complications of ptosis, wound dehiscence, and a full-thickness hole each occurred once. The mean +/- SD time taken to perform the procedure was 31.5 +/- 8.9 minutes per Eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper Eyelid Retraction is a safe and highly effective surgery for upper Eyelid Retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.
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graded full thickness anterior blepharotomy for upper Eyelid Retraction
Transactions of the American Ophthalmological Society, 2003Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:PURPOSE: A chief morbidity of Graves' eye disease (GED) is upper lid Retraction that results in exposure keratopathy and cosmetic deformity. This study was conducted to assess the efficacy of graded anterior blepharotomy to treat upper lid Retraction. METHODS: Fifty Eyelids of 32 patients with GED-associated upper lid Retraction causing symptomatic ocular exposure were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper lid position, lagophthalmos, and keratopathy were compared. RESULTS: At an average of 8.5 +/- 8.1 months (range, 2 to 35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper Eyelid position (P < .00001), lagophthalmos (P < .0001), and keratopathy (P < .01) were significantly improved. Mild contour abnormalities (all < or = 1 mm) occurred in 7 of 50 Eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative lid crease measurements. Complications of ptosis, wound dehiscence, and full-thickness hole each occurred once. The average time for performing the procedure was 31.5 +/- 8.9 minutes per Eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper lid Retraction is a safe and highly effective surgical treatment for symptomatic GED-associated upper Eyelid Retraction. This technique achieves excellent functional and cosmetic outcomes.
Adam S Hassan - One of the best experts on this subject based on the ideXlab platform.
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Surgery of the Eyelid, Lacrimal System, and Orbit - Management of Eyelid Retraction
Surgery of the Eyelid Lacrimal System and Orbit, 2011Co-Authors: Alexander Taich, Adam S HassanAbstract:Eyelid Retraction has numerous causes. Most notably Eyelid Retraction is caused by thyroid eye disease (TED), trauma, and postsurgical changes. The upper Eyelid margin is typically measured at 3.5 to 4.5 mm above the center of the cornea. The lower Eyelid margin is typically situated at the inferior border of the limbus. Eyelid Retraction is a condition in which the upper Eyelid margin is displaced superiorly or the lower Eyelid margin is displaced inferiorly. Eyelid Retraction may result in exposure keratopathy and disturbing ocular symptoms, including blurred vision, photophobia, foreign body sensation, burning, and reactive tearing. Eyelid Retraction in TED is thought to be due to a combination of inflammation, fibrosis, and adrenergic stimulation of the Eyelid retractors. Proptosis can also contribute to Eyelid Retraction. In the upper Eyelid, factors responsible for Eyelid Retraction include (1) inflammation and fibrosis of the levator and Müller’s muscles, (2) adrenergic stimulation of Müller’s muscle, and (3) inflammation and fibrosis of the inferior rectus muscle, causing hypodeviation of the globe and compensatory overaction of the superior rectus–levator complex. In the lower Eyelid, factors responsible for Eyelid Retraction include (1) inflammation and fibrosis of the inferior rectus muscle with consequent traction on its anterior extension, the capsulopalpebral fascia, which is the main lower lid retractor, and (2) adrenergic stimulation of the smooth muscle fibers within the lower lid retractor complex. A combination of Eyelid Retraction and proptosis in TED may result in ocular exposure with symptoms of ocular irritation, an undesirable cosmetic appearance, corneal erosion and infection, or (rarely) globe luxation. Mild exposure problems can be managed with topical lubricants. Guanethidine, a topical sympatholytic agent, is of limited usefulness in the management of Eyelid Retraction due to its variable efficacy and frequent ocular side effects, including irritation, hyperemia, photophobia, pain, edema, burning sensation, and punctate keratitis. It may be more tolerable if used in lower concentrations. Exposure problems in the inflammatory phase of the condition present a special challenge as surgical correction of Eyelid Retraction is best performed in the pos-tinflammatory, stable phase. Several reports have described using Botulinum toxin injections, 2.5 to 15 U, either subconjunctivally or percutaneously, just above the superior border of the tarsus.
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graded full thickness anterior blepharotomy for correction of upper Eyelid Retraction not associated with thyroid eye disease
Ophthalmic Plastic and Reconstructive Surgery, 2007Co-Authors: Hakan Demirci, Bartley R Frueh, Adam S Hassan, Stephen D Reck, Victor M ElnerAbstract:PURPOSE To evaluate the efficacy of graded full-thickness anterior blepharotomy for upper Eyelid Retraction of various causes not associated with Graves eye disease. METHODS Twenty-one Eyelids of 18 patients with upper Eyelid Retraction not caused by Graves eye disease were treated with graded full-thickness anterior blepharotomy. Preoperative and postoperative symptoms, midpupil to upper Eyelid distance, lagophthalmos, and superficial punctuate keratopathy were evaluated. RESULTS Upper Eyelid Retraction was due to facial nerve palsy in 4 patients (22%), overcorrected ptosis in 5 patients (28%), and cicatrix after trauma in 6 patients (33%). One patient each (6% each) had Retraction from graft-versus-host disease, after blepharoplasty, and after orbicularis oculi myectomy for blepharospasm. At a mean of 10 months follow-up, presenting symptoms resolved or improved in 17 patients (94%) and remained unchanged in 1 patient (6%). Midpupil to upper Eyelid distance, lagophthalmos, and superficial punctuate keratopathy all improved significantly (all p < 0.001). No surgical complications occurred. CONCLUSIONS Graded full-thickness anterior blepharotomy is a safe, effective, and rapid technique for patients with symptomatic upper Eyelid Retraction due to etiologies other than Graves eye disease. This technique improves symptoms and signs of ocular exposure while addressing relative upper Eyelid height symmetry and contour.
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mullerectomy for upper Eyelid Retraction and lagophthalmos due to facial nerve palsy
Archives of Ophthalmology, 2005Co-Authors: Adam S Hassan, Bartley R Frueh, Victor M ElnerAbstract:Background Facial nerve palsy often results in symptoms of ocular irritation due to inadequate Eyelid closure. Weakened protractor function results in relative upper Eyelid Retraction and contributes to lagophthalmos. Objective To evaluate the role of mullerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy. Methods Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Muller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower Eyelid Retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper Eyelid position, lagophthalmos, and keratopathy were compared. Results Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper Eyelid position was lowered by an average of 1.35 mm ( P P = .002) and corneal exposure ( P Conclusion Mullerectomy is a rapid, safe, and reproducible surgical method for lowering the upper Eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.
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graded full thickness anterior blepharotomy for upper Eyelid Retraction
Archives of Ophthalmology, 2004Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:BACKGROUND: A chief morbidity of Graves eye disease is upper Eyelid Retraction that results in exposure keratopathy and cosmetic deformity. OBJECTIVE: To assess the efficacy of graded anterior blepharotomy to treat upper Eyelid Retraction. METHODS: Fifty Eyelids of 32 patients with Graves eye disease-associated upper Eyelid Retraction, causing symptomatic ocular exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper Eyelid position, lagophthalmos, and keratopathy were compared. RESULTS: At a mean +/- SD of 8.5 +/- 8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper Eyelid position (P<.001), lagophthalmos (P<.001), and keratopathy (P<.01) were significantly improved. Mild contour abnormalities (all Eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative Eyelid crease measurements. Complications of ptosis, wound dehiscence, and a full-thickness hole each occurred once. The mean +/- SD time taken to perform the procedure was 31.5 +/- 8.9 minutes per Eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper Eyelid Retraction is a safe and highly effective surgery for upper Eyelid Retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.
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graded full thickness anterior blepharotomy for upper Eyelid Retraction
Transactions of the American Ophthalmological Society, 2003Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:PURPOSE: A chief morbidity of Graves' eye disease (GED) is upper lid Retraction that results in exposure keratopathy and cosmetic deformity. This study was conducted to assess the efficacy of graded anterior blepharotomy to treat upper lid Retraction. METHODS: Fifty Eyelids of 32 patients with GED-associated upper lid Retraction causing symptomatic ocular exposure were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper lid position, lagophthalmos, and keratopathy were compared. RESULTS: At an average of 8.5 +/- 8.1 months (range, 2 to 35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper Eyelid position (P < .00001), lagophthalmos (P < .0001), and keratopathy (P < .01) were significantly improved. Mild contour abnormalities (all < or = 1 mm) occurred in 7 of 50 Eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative lid crease measurements. Complications of ptosis, wound dehiscence, and full-thickness hole each occurred once. The average time for performing the procedure was 31.5 +/- 8.9 minutes per Eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper lid Retraction is a safe and highly effective surgical treatment for symptomatic GED-associated upper Eyelid Retraction. This technique achieves excellent functional and cosmetic outcomes.
Dale R Meyer - One of the best experts on this subject based on the ideXlab platform.
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Eyelid Retraction lid lag lagophthalmos and von graefe s sign quantifying the Eyelid features of graves ophthalmopathy
Ophthalmology, 2008Co-Authors: Ramakrishna V Gaddipati, Dale R MeyerAbstract:Purpose To report the frequency and relationship of Eyelid Retraction, lid lag, lagophthalmos, and von Graefe's sign in a group of patients with Graves' ophthalmopathy and compare these findings to those in a group of normal individuals. Design Retrospective comparative cohort study. Participants Fifty consecutive Graves' ophthalmopathy patients were compared to a control group of 50 normal individuals. Methods Measurements were made of Eyelid position in primary gaze and downgaze to assess Eyelid Retraction and lid lag, and the presence of lagophthalmos and von Graefe's sign was noted when present. Main Outcome Measures Eyelid position in primary gaze and downgaze and presence of lagophthalmos and von Graefe's sign. Results In the Graves' group, Eyelid Retraction (38%), von Graefe's sign (36%) and lagophthalmos (16%) were observed at a significantly greater frequency ( P P = 0.67). Conclusions The terms lid lag and von Graefe's sign have been used interchangeably in the past; however, they are distinct signs of downgaze-related upper Eyelid static position and dynamic movement, respectively. Although von Graefe's sign was commonly exibited in Graves' patients, the relatively low frequency of lid lag suggests that factors other than restriction/fibrosis are likely responsible for the etiology of Eyelid Retraction in many cases.
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primary infratarsal lower Eyelid retractor lysis to prevent Eyelid Retraction after inferior rectus muscle recession
American Journal of Ophthalmology, 1996Co-Authors: Dale R Meyer, John W Simon, Mary KansoraAbstract:Purpose To evaluate a procedure to prevent lower Eyelid Retraction, which may occur after inferior rectus muscle recession surgery as a direct consequence of the intimate anatomic connections between the inferior rectus muscle and lower Eyelid retractors. Methods We evaluated the technique of primary infratarsal lower Eyelid retractor lysis on 12 Eyelids of ten patients undergoing inferior rectus muscle recession of 3 mm or more. Indications for surgery included restrictive strabismus related to Graves' ophthalmopathy, orbital blowout fracture, and orbital fibrosis syndrome. Results For the 12 eyes, inferior rectus muscle recession ranged from 3 to 10 mm (mean, 5.3 mm). Postoperatively there was no significant change in mean lower Eyelid position (P > .82), and no patient developed inferior scierai show. Conclusion Primary infratarsal Eyelid retractor lysis is an effective technique for preventing lower Eyelid Retraction after inferior rectus muscle recession strabismus surgery.
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detection of contralateral Eyelid Retraction associated with blepharoptosis
Ophthalmology, 1992Co-Authors: Dale R Meyer, John L WobigAbstract:The association between induced contralateral upper Eyelid Retraction and blepharoptosis, although well known, has not been well analyzed. The authors prospectively studied 50 consecutive patients with blepharoptosis. Interpalpebral fissure measurements of the contralateral "normal" or relatively less blepharoptotic Eyelids were made in the resting position, with the blepharoptotic eye occluded, manually elevated, and after instillation of phenylephrine 2.5%. Ocular dominance also was tested. Contralateral interpalpebral fissure height decreased >_1 mm in 10 of 50 patients (20%) after manual elevation. Blepharoptosis was present or greater in the dominant eye in 7 of 10 (70%) patients in this group, but in only 7 of 40 (18%) patients in the group not showing such a response (P
