• The Korean Journal of Pain
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• v.11 no.1
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• pp.116-118
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• 1998

Stellate ganglion block(SGB) is frequently performed in pain clinics. Facial palsy produces asymmetry of the face, lagophthalmos and incomplete eyelid closure. Exposure keratitis and eyeball pain can be induced by prolonged lagophthalmos. SGB was performed on a 51-year-old female patient who had exposure of keratitis and eyeball pain due to facial nerve palsy after an operation for chronic otitis media. After 31 stellate ganglion blocks, eyeball pain and keratitis nearly subsided. SGB is an effective method to treat lagophthalmos caused by facial nerve palsy.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.49-52
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• 2020

The specialized structure of the upper eyelid ensures complete closure of the eye and eyeball sealing. An upper eyelid injury can cause various symptoms associated with eyeball trauma, not just scar formation or eyelid deformity. In this report, we describe a case of lagophthalmos observed after wound repair in a patient with a crushing injury caused by a grinder. Several surgical techniques are used to treat lagophthalmos or scar contracture. In most cases, a releasing procedure is performed after 6 months of initial repair. However, if the patient has severe symptoms that are not relieved by conservative care, early revision is inevitable. We describe a case of early lagophthalmos successfully resolved with pentagonal wedge resection, fat redistribution, and full-thickness skin grafting. After the revisional surgery, we observed that the patient regained the ability to completely close the injured eyelid, with restoration of function and favorable cosmetic outcomes. Pentagonal wedge resection to release a retracted structure, fat redistribution to prevent readhesion, and full-thickness skin grafting for enough amount of skin to regain upper eyelid function is useful for scar release and lagophthalmos following crushing injuries of the upper eyelid.

• Archives of Plastic Surgery
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• v.51 no.2
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• pp.163-168
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• 2024

Background The study determined to compare the clinical outcomes of traditional gold weight implantation for the correction of paralytic lagophthalmos with those of a newly designed model. Methods In this retrospective cohort study, we enrolled 30 patients (76% females; average age 60.8 ± 12 years) with facial palsy who underwent implantation of either the traditional pretarsal gold weight (PT group; n = 15) or a new supratarsal model (ST group; n = 15) from May 2014 to April 2019. The main outcome measures were the 12-month postoperative weight prominence, weight migration, improvement of lagophthalmos, upper eyelid contour, and upper eyelid ptosis. The secondary outcome was long-term (24 months) reoperative rate. Results The new model group had significantly better eyelid contour (risk ratio [RR] 3.16, 95% confidence interval [CI] 1.62-6.15, p = 0.001), less weight prominence (RR 1.74, 95% CI 1.13-2.70, p = 0.013), less weight migration (RR 1.31, 95% CI 1.12-1.54, p = 0.001), and less eyelid ptosis (RR 2.36, 95% CI 1.21-4.59, p = 0.011) than the traditional model group. Improvement of lagophthalmos was not statistically significant between the two groups (RR 1.44, 95% CI 0.72-2.91, p = 0.303). The 24-month reoperative rate was 53.3% in the PT group versus 13.3% in the ST group (RR 2.00, 95% CI 1.15-3.49, p = 0.015). Conclusion The newly designed supratarsal gold weight showed superior postoperative outcomes than the standard traditional model.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.576-583
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• 2014

Background Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. Methods A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. Results There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected. Conclusions Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.222-228
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• 2018

Background The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications. Methods A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0-1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum. Results Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients. Conclusions Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.2
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• pp.55-61
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• 1990

Patients with facial paralysis, in whom nerve damage is irreparable or in whom the innervation of the paralyzed musculature cannot be restored by nerve suture, grafting, or cross-face nerve transplantation, should be offered some form of reconstructive static and dynamic aid. Temporalis muscle-fascia unit used as a circumorbital sling and motor unit is a dynamic controlled reconstructive procedure, but it has several disadvantages such as wide surgical exposure, bulky-looking at lateral canthal area, insufficient voluntary control. This is a case report of facial palsy of posttraumatic lagophthalmos of 41-year-old male, which was corrected by temporalis muscle-tendon transfer with plantaris tendon transplantation.

• Archives of Plastic Surgery
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• v.45 no.6
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• pp.598.1-598.1
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• 2018

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.290-296
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• 2020

In many aging individuals, dermatochalasis and involutional ptosis appear together. Therefore, for functional and aesthetic purposes, ptosis correction and upper blepharoplasty are performed together. The aim of this article is to investigate factors that should be considered in order to achieve good results when simultaneously performing involutional ptosis correction and upper blepharoplasty in aging patients. Involutional ptosis is usually corrected through aponeurosis advancement in mild cases. In moderate or severe ptosis, the Muller muscle and aponeurosis are used together to correct ptosis. Using the two muscles together has the advantages of reducing lagophthalmos and increasing the predictability of outcomes after surgery. Broadly speaking, the surgical method used for involutional ptosis varies depending on the specific case, but unlike congenital ptosis, it is often not necessary to perform overcorrection. In particular, if there are problems such as severe dry-eye symptoms or risk of lagophthalmos, undercorrection should be considered. When performing ptosis correction, the surgeon should be careful not to overdo skin excision; instead, limited excision should be performed. After ptosis surgery, the brow may descend and the double fold may look too small. However, in order to make the double eyelids look larger, the surgeon should consider making the double eyelid design high rather than excising an excessive amount of skin. In some cases, to obtain more natural double eyelids and favorable results, it may be necessary to perform a sub-brow lift or forehead lift before or after involutional ptosis surgery.

• Journal of Veterinary Clinics
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• v.40 no.4
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• pp.283-287
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• 2023

A 10-year-old spayed female beagle dog presented with a 2-month history of third-eyelid elevation in the left eye (OS). Ophthalmic examination revealed slightly diminished corneal and palpebral reflexes along with exophthalmos in the OS. Schirmer's tear test and intraocular pressure values were within the normal range for the OS. Slit-lamp biomicroscopy revealed protrusion of the third eyelid and corneal opacity in the OS. Fundoscopy revealed a prominent black mass in the OS covering the optic nerve. Tapetal hyper-reflectivity was also observed around the mass. Ocular ultrasonography showed a 0.74 × 0.67 cm echogenic posterior segment mass around the optic nerve protruding into the retrobulbar space. Computed tomography revealed a contrast-enhanced soft tissue lesion in the posteromedial aspect of the left eyeball protruding into the retrobulbar region, and the optic nerve was suspected to be involved. No evidence of osteolytic changes in the adjacent bone or distant metastasis was observed. Enucleation was performed to prevent potential metastasis or local invasion of the mass and to relieve discomfort due to exposure to keratopathy resulting from lagophthalmos. Histopathological examination revealed a central choroidal melanocytoma extending into the optic nerve. No local recurrence was detected until 16 months postoperatively.

• Archives of Plastic Surgery
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• v.45 no.6
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• pp.598.2-598.2
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• 2018