Correcting upper eyelid retraction by means of pretarsal levator lengthening for complications following ptosis surgery.

BACKGROUND: Eyelid retraction is a condition in which the upper eyelid ascends past its ideal position, 1 to 2 mm below the upper limbus of the cornea. This condition can be a result of overcorrecting ptosis, hyperthyroidism, and other causes. The authors present studies conducted on eyelid retraction caused by ptosis overcorrection. An innovative approach for levator lengthening using the pretarsal tissue as a spacer flap is introduced as a method to correct the retraction.

METHODS: A series of 60 patients over a 6-year period underwent 71 eyelid procedures to correct upper lid retraction following upper blepharoplasty and ptosis repair. All eyelid retractions ranged from 1 to 3 mm above its ideal position. All eyelids were corrected with the authors' technique of lengthening the levator with pretarsal tissue. Twelve cases that required further lengthening were completed by creating a superiorly based rotation flap.

RESULTS: Of the 71 cases, 61 (86 percent) observed favorable results, six (8 percent) attained mild ptosis after surgery, and four (6 percent) regained upper eyelid retraction. All of the unsuccessful cases were corrected through early revision surgery, more advancement for the ptosis, and further recess or rotation flap for the retraction. No other complications were observed, except formation of supratarsal fold asymmetry, which was corrected through minor revision surgery.

CONCLUSIONS: It is very difficult to correct eyelid retraction caused by tissue fibrosis and muscle degeneration. Correction of the retraction by levator lengthening using the pretarsal tissue is simpler to execute, measurable during surgery, and easy to adjust, and offers high predictability in its result.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.