Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
J Craniofac Surg. 2023;34(2):498-502. doi: 10.1097/SCS.0000000000008935. Epub 2022 Aug 17.
Pseudoblepharoptosis, which is characterized by ptotic eyelid appearance with normal levator function, is a common abnormality observed in Eastern Asians. Misdiagnosis of pseudoblepharoptosis may lead to inappropriate treatments and unwanted complications. Using the data obtained from a modified levator function examination, this study sought to improve the diagnosis and explore the appropriate treatment of pseudoblepharoptosis based on the typical eyelid anatomy of Eastern Asians.
This retrospective study included patients with drooping and bulky eyelids who had been preoperatively diagnosed between January 2018 and December 2018 using a modified approach. Debulking of the retro-orbicularis oculus fat and orbital septum fat and release of the ligament-like structure were performed to correct pseudoblepharoptosis without manipulating the levator muscle. The functional and aesthetic outcomes were evaluated postoperatively.
The proposed modified approach was significantly more accurate than the traditional technique. Of the patients, 78 (84.8%) and 9 (9.8%) showed good and moderate cosmetic outcomes, respectively. The margin reflex distance 1 value significantly improved from 1.74±0.87 mm preoperatively to 4.56±0.71 mm postoperatively ( P <0.05). Moreover, 179 (97.3%) of the 184 eyelids examined achieved adequate correction.
The modified levator function examination approach used in this study may help improve the diagnosis of pseudoblepharoptosis. Surgical intervention focused on correcting the bulky and drooping upper eyelids and orbital septum may lead to satisfactory outcomes in Eastern Asians with pseudoblepharoptosis without manipulating the levator muscle.
假性上睑下垂是一种常见的东方人眼部异常，其特征为眼睑外观下垂，但提上睑肌功能正常。假性上睑下垂的误诊可能导致不当的治疗和不必要的并发症。本研究通过改良提上睑肌功能检查所获得的数据，旨在提高假性上睑下垂的诊断，并根据东方人的典型眼睑解剖结构，探讨假性上睑下垂的合适治疗方法。
本回顾性研究纳入了 2018 年 1 月至 2018 年 12 月期间，采用改良方法术前诊断为眼睑下垂和肥厚的患者。通过去除眶隔脂肪和眼轮匝肌眶部脂肪以及释放类似韧带的结构来矫正假性上睑下垂，而不操纵提上睑肌。术后评估功能和美学效果。
与传统技术相比，所提出的改良方法明显更准确。78 例（84.8%）和 9 例（9.8%）患者的美容效果分别为良好和中度，术后的睑裂高度差值明显改善，从术前的 1.74±0.87mm 增加到术后的 4.56±0.71mm（P<0.05）。此外，184 例受检眼睑中有 179 例（97.3%）获得了足够的矫正。
本研究中使用的改良提上睑肌功能检查方法可能有助于提高假性上睑下垂的诊断准确性。手术干预侧重于矫正肥厚和下垂的上眼睑和眶隔，可能会为东方人假性上睑下垂患者带来满意的效果，而无需操纵提上睑肌。
