Patel Munjal P, Shapiro Michael D, Spinelli Henry M
Division of Plastic and Reconstructive Surgery, The New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY, USA.
Plast Reconstr Surg. 2005 Jun;115(7):2105-14; discussion 2115-7. doi: 10.1097/01.prs.0000164677.25488.49.
Eyelid retraction is an unfortunate consequence of cosmetic surgery, trauma, and disease states. It is frequently symptomatic and may be associated with dry eye syndrome and corneal compromise. The pathophysiology of lower eyelid retraction usually involves some degree of lateral canthal tendon laxity, middle lamella scarring, and malar descent. The authors describe for the first time a series of patients whose lid retraction was treated with a tripartite procedure that addresses all three pathophysiologic components simultaneously and rehabilitates the patients cosmetically and functionally.
The authors retrospectively reviewed the records of 17 patients (24 eyelids) operated on between 1999 and 2003 by one senior surgeon. The age of the patients ranged from 26 to 77 years (mean, 50.3 years), and all presented with significant scleral show (average, 2.0 mm) and symptomatic corneal exposure from a variety of causes. Preoperatively, all patients were noted to have a combination of lower eyelid laxity, middle lamellar contracture, and malar descent. Preoperative and postoperative examinations included Shirmer's test, a measurement of scleral show, and a slit-lamp examination. Mean follow-up time was 13 months. All patients underwent a triad of hard palate spacer grafting, lateral canthal suspension, and midface elevation.
All 17 patients (representing 24 retracted eyelids) had complete resolution of scleral show (2.5-mm average correction) and were uniformly satisfied with their cosmetic and functional outcome at last follow-up. Preoperative dry eye symptoms resolved in all patients in the series. There were no major complications and only two minor complications (corneal irritation from graft sutures in one patient and an oronasal palatal fistula in another), both of which resolved in the early follow-up period.
The combination of hard palate spacer grafting, lateral canthoplasty, and midface suspension is an effective, aesthetic, and functional treatment for moderate to severe lower eyelid retraction resulting from multiple causes. This tripartite procedure is associated with predictable results, a low morbidity rate, and high patient satisfaction.
眼睑退缩是整形手术、外伤及疾病状态导致的不良后果。它常伴有症状，可能与干眼综合征及角膜损害相关。下睑退缩的病理生理通常涉及一定程度的外眦韧带松弛、中板瘢痕形成及颧骨下移。作者首次描述了一系列采用三联手术治疗眼睑退缩的患者，该手术同时解决了所有三个病理生理因素，并在外观和功能上使患者得到康复。
作者回顾性分析了1999年至2003年间由一位资深外科医生手术治疗的17例患者（24只眼）的病历。患者年龄26至77岁（平均50.3岁），均因各种原因出现明显的巩膜暴露（平均2.0mm）及有症状的角膜暴露。术前，所有患者均存在下睑松弛、中板挛缩及颧骨下移的综合表现。术前及术后检查包括泪液分泌试验、巩膜暴露测量及裂隙灯检查。平均随访时间为13个月。所有患者均接受了硬腭间隔移植、外眦悬吊及面中部提升三联手术。
所有17例患者（代表24只退缩眼睑）巩膜暴露均完全消失（平均矫正2.5mm），在最后一次随访时对其外观和功能结果均一致满意。该系列所有患者术前的干眼症状均得到缓解。无重大并发症，仅出现2例轻微并发症（1例患者移植缝线引起角膜刺激，另1例患者出现口鼻腭瘘），均在早期随访期内得到解决。
硬腭间隔移植、外眦成形术及面中部悬吊联合应用是治疗多种原因导致的中重度下睑退缩的一种有效、美观且功能性的治疗方法。这种三联手术具有可预测的结果、低发病率及高患者满意度。
