Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Semin Ophthalmol. 2024 Jan;39(1):40-59. doi: 10.1080/08820538.2023.2273850. Epub 2023 Dec 27.
Cicatricial lower eyelid retraction is a challenging condition. It involves scarring of the lower eyelid, which causes it to retract and expose the sclera. This can lead to complications such as dry eye syndrome and corneal melting. It can be caused by trauma, burns, or previous eyelid surgery. Detailed assessment and understanding of eyelid anatomy and retraction are critical for successful surgical planning. Dynamic and static examinations of the eyelid including measurements of the lower eyelid margin reflex distance (MRD2) and scleral show are also essential to determine the appropriate treatment approach.
A systematic review was conducted using Medline, Scopus, and Cochrane databases with keywords related to cicatricial lower eyelid retraction. The publication language was limited to English after 2000. A total of 29 articles were included for data extraction and analysis.
The main surgical techniques include tarsoconjunctival grafts, spacers, midface lift, and lateral canthal tendon suspension, although no single procedure has been universally recognized as the gold standard. New innovations such as synthetic grafts and xenografts are being explored for their potential in eyelid reconstruction. Severe cases, defined as those with inferior scleral show greater than 2 mm, may require a combination of reconstruction methods.
Correcting cicatricial lower eyelid retraction is a major challenge in oculoplastic reconstruction. The surgical approach should be individualized, considering the pathologies and etiologies of lid retraction. In-depth knowledge and careful surgical planning are essential for best outcomes. There is no gold standard technique, and postoperative outcomes, complications, and management vary depending on the surgical approach used.
瘢痕性下眼睑退缩是一种具有挑战性的疾病。它涉及下眼睑的瘢痕形成，导致其回缩并暴露出巩膜。这可能导致干眼症综合征和角膜融解等并发症。它可能由创伤、烧伤或先前的眼睑手术引起。详细评估和了解眼睑解剖结构和退缩对于成功的手术规划至关重要。眼睑的动态和静态检查，包括下眼睑缘反射距离（MRD2）和巩膜暴露的测量，对于确定适当的治疗方法也至关重要。
使用 Medline、Scopus 和 Cochrane 数据库进行系统评价，使用与瘢痕性下眼睑退缩相关的关键词。在 2000 年后，出版物语言仅限于英语。共纳入 29 篇文章进行数据提取和分析。
主要的手术技术包括眼轮匝肌-结膜移植、间隔物、中面部提升和外眦肌腱悬吊术，尽管没有一种单一的手术方法被普遍认为是金标准。新型创新技术，如合成移植物和异种移植物，正在探索其在眼睑重建中的潜力。严重病例，定义为下巩膜暴露大于 2mm 的病例，可能需要结合多种重建方法。
纠正瘢痕性下眼睑退缩是眼整形重建的主要挑战。手术方法应个体化，考虑到眼睑退缩的病理学和病因。深入的知识和仔细的手术规划对于获得最佳结果至关重要。没有金标准技术，术后结果、并发症和管理因所使用的手术方法而异。
