A variant of surgical reconstruction of ptosis of the upper eyelids

Despite the apparent simplicity of the surgical correction of ptosis of the upper eyelids, in some cases this condition is not amenable to conventional methods of surgical treatment. Repeated attempts at reconstructive interventions lead to the development of fibrosis in the area of ​​manipulation and do not bring the desired result. Sometimes the cause of ptosis recurrence is various variants of neurological disorders of a congenital or acquired nature, which cause a change in the quality and turgor of tissues in the area of ​​innervation.

As you know, the ability to close the eyes and blink is provided mainly by the upper eyelid, which normally closes the eye by 85%, and the lower eyelid covers only 15% with a palpebral fissure of 8-10 mm. Ptosis of the upper eyelids causes not only functional disorders of the visual analyzer (narrowing of the visual fields), but entails a constant, forced mimic load of an adaptive nature, which also causes psychological problems.

We present one of the possible options for the surgical correction of ptosis of the upper eyelid.

Patient E., 18 years old, came to the clinic with complaints of ptosis of the right eyelid, limitation of the upper field of vision, asymmetry of the palpebral fissure, psychological discomfort due to the forced constant position of the head.

From the anamnesis it is known that 4 attempts of surgical correction were made for this congenital disorder (during the last 10 years), but the desired result was not fully achieved.

Operation. In search of a rational way to correct ptosis, it was decided not to include the area of ​​manipulation of the anatomical complex of tissues that is involved in the process of lifting the eyelid, since after previous operations there are significant cicatricial changes.

The operation was performed under local anesthesia (lidocaine solution 1%), an incision was made along the upper palpebral fold with a continuation beyond the boundaries of the orbit, all tissues were dissected up to m. levator palpaebrae superior and Müllerian muscle. The tissues of the lateral angle were mobilized with the release of the canthal ligament, the tarsal plate was isolated along the entire anterior surface from top to bottom, along the entire length of the lower edge, with the transition to the back, the inner surface from which mobilization was performed at a distance of 3 mm from the lower edge upwards along the entire length, and the conjunctiva remained intact. The resection of the mobilized lower edge of the tarsal plate was performed 4 mm away from the inner corner of the eye. The outer canthus is cut off, the canthal ligament is fixed in the contour determined earlier by marking. The normal anatomy of the manipulation area was restored.

Treatment results. As a result of the intervention, the soft tissues of the upper eyelid, left without cartilaginous support, move up to a simulated distance, and the movement of the outer canthus (to the previously specified position according to the marking) makes it possible to obtain the planned result. The palpebral fissure closes completely when the eyes are closed. The patient notes that she can look freely with her right eye (the eyelid does not interfere), a good aesthetic result has been obtained.

Talk

The presented variant of surgical correction is technically relatively simple, gentle and reliable. The use of such a tactical approach is dictated by the initial state and seems justified.

Thus, the application of the proposed methodology allowed us to solve the problem. The effective method is quite simple in execution, gives a good aesthetic result.

Adapted from ssprasc.com