26 Management of the Prominent Eye |
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Fig. 26.11 (a) Negative vector eyelid as described in Fig. 26.1. (b) Surgical placement of malar implant to project cheek anteriorly and correct the negative vector
Fig. 26.12 (Left) Bowstringing of a prominent eye with lid tightening as is shown in
Fig. 26.2. (Right) Modification of canthoplasty by hang-back and supra-placement of eyelid fixation suture. This prevents “the bowstinging” effect. Note elevation of lower lid and reduction of scleral show
The take-home message is to avoid skin excision and lid tightening if at all possible. In most cases, this can be accomplished.
the readers of this chapter embark on eyelid surgery on the patient with a prominent eye with a new respect for the problem and its potential to produce suboptimal results.
26.7 Conclusion |
References |
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The prominent eye may have important medical associations including congenital syndromes, myopia, and thyroid eye disease. A prominent globe is a common and significant complicating factor in performing cosmetic periocular surgery. Recognition of the cause of globe prominence and appropriately accounting for it are essential to avoid surgical complications when performing blepharoplasty and other eyelid surgery in such patients.
An armentarium of surgical corrective techniques combined with cosmetic approaches that prevent worsening of the underlying problem allow safe and cosmetically appropriate surgery in this challenging patient population. The treatment of complications of surgery is more challenging, and requires more complex reconstructive techniques than in similar patients without prominent eyes. It is hoped that
1.Goldberg RA, Weinberg DA, Shorr N. Management of the patient with a relatively prominent eye. Facial Plast Surg Clin North Am. 1998;6:11–9.
2.Hirmand H, Codner MA, McCord CD, Hester Jr TR, Nahai F. Prominent eye: operative management in lower lid and midfacial rejuvenation and the morphologic classification system. Plast Reconstr Surg. 2002;110(2):620–8; discussion 629–34.
3.Massry GG. Comprehensive lower eyelid rejuvenation. Facial Plast Surg. 2010;26:209–21.
4.Olivari N. Transpalpebral decompression of endocrine ophthalmopathy (Graves’ disease) by removal of intraorbital fat: experience with 147 operations over 5 years. Plast Reconstr Surg. 1991;87: 627–41; discussion 642–3.
5.Richter DF, Stoff A, Olivari N. Transpalpebral decompression
of endocrine ophthalmopathy by intraorbital fat removal (Olivari technique): experience and progression after more than 3000 operations over 20 years. Plast Reconstr Surg. 2007;120: 109–23.
306 |
J.B. Holds |
|
|
6.Leone Jr CR, Piest KL, Newman RJ. Medial and lateral wall decompression for thyroid ophthalmopathy. Am J Ophthalmol. 1989;108(2):160–6.
7.Graham SM, Brown CL, Carter KD, Song A, Nerad JA. Medial and lateral orbital wall surgery for balanced decompression in thyroid eye disease. Laryngoscope. 2003;113(7):1206–9.
8.Schaefer SD, Soliemanzadeh P, Della Rocca DA, Yoo GP, Maher EA, Milite JP, et al. Endoscopic and transconjunctival orbital decompression for thyroid-related orbital apex compression. Laryngoscope. 2003;113:508–13.
9.Trokel S, Kazim M, Moore S. Orbital fat removal. Decompression for Graves orbitopathy. Ophthalmology. 1993;100:674–82.
10. Carter RD, Freuh BR, Hessberg TP, et al. Long term efficacy of orbital decompression for compressive optic neuropathy of Graves disease. Ophthalmology. 1991;98:1435–42.
11. Warren JD, Spector JG, Burde R. Long term follow-up and recent observation of 305 cases of orbital decompression for dysthyroid orbitopathy. Laryngoscope. 1989;99:35.
12. Gilliland GD, Clayton E. Beveled osteotomy with lateral wall advancement and interpositional bone grafting for severe thyroid orbitopathy. Ophthal Plast Reconstr Surg. 2007;23:192–6.
13.Weinberg DA, Goldberg RA, Hoenig J, Shorr N, Baylis HI. Management of relative proptosis with a porous polyethylene orbital rim onlay implant. Ophthal Plast Reconstr Surg. 1999;15:67–73.
14. Yaremchuk MJ. Infraorbital rim augmentation. Plast Reconstr Surg. 2001;107:1585–92; discussion 1593–5.
15. Yaremchuk MJ, Kahn DM. Periorbital skeletal augmentation to improve blepharoplasty and midfacial results. Plast Reconstr Surg. 2009;124:2151–60.
16. Harvey JT, Corin S, Nixon D, Veloudios A. Modified levator aponeurosis recession for upper eyelid retraction in Graves’ disease. Ophthalmic Surg. 1991;22:313–7.
17.Putterman AM, Fett DR. Muller’s muscle in the treatment of upper eyelid retraction: a 12 year study. Ophthalmic Surg. 1986;17:361–7.
18. Shorr N, Perry JD, Goldberg RA, et al. The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery. Ophthal Plast Reconstr Surg. 2000;16:223.
19. Rubin PA, Fay AM, Remulla HD, Maus M. Ophthalmic plastic applications of acellular dermal allografts. Ophthalmology. 1999; 106:2091.
20. Fay AM, Pieroth L, Rubin PAD. An animal model of lower eyelid spacer grafting with acellular dermis. Ophthal Plast Reconstr Surg. 2001;17:270.
21. Siegel RJ. Palatal grafts for eyelid reconstruction. Plast Reconstr Surg. 1985;76:411.
22. Cohen MS, Shorr N. Eyelid reconstruction with hard palate mucosa graft. Ophthal Plast Reconstr Surg. 1992;8:183–95.
23. Kersten RC, Kulwin DR, Levartovsky S, et al. Management of lower-lid retraction with hard-palate mucosa grafting. Arch Ophthalmol. 1990;108:1339.
24. Espinoza GM, Holds JB. Evaluation and treatment of the tear trough deformity in lower blepharoplasty. Semin Plast Surg. 2007;21:57–64.
25. Nassif PS. Lower blepharoplasty: transconjunctival fat repositioning. Facial Plast Surg Clin North Am. 2005;13:553–9.
26. Mohadjer Y, Holds JB. Cosmetic lower eyelid blepharoplasty with fat repositioning via intra-SOOF dissection: surgical technique and initial outcomes. Ophthal Plast Reconstr Surg. 2006;22: 409–13.
27. Morely AM, Malhotra R. Use of hyaluronic acid filler for teartrough rejuvenation as an alternative to lower eyelid surgery. Ophthal Plast Reconstr Surg. 2010;27(2):69–73.
28. Goldberg RA, Fiaschetti D. Filling the periorbital hollows with hyaluronic acid gel: initial experience with 224 injections. Ophthal Plast Reconstr Surg. 2006;5:335–41;discussion 341–343.
29. Shorr N. Madame Butterfly procedure with hard palate graft: management of post-blepharoplasty round eye and scleral show. Facial Plast Surg. 1994;10:90.
30. Edelstein C, Balch K, Shorr N, Goldberg RA. The transeyelid subperiosteal midface-lift in the unhappy postblepharoplasty patient. Semin Ophthalmol. 1998;13(3):107–14. Review.
31. Anderson RDA, Lo MW. Endoscopic malar/midface suspension procedure. Plast Reconstr Surg. 1998;102:2196.
32. Smith B, Petrelli R. Surgical repair of prolapsed lacrimal glands. Arch Ophthalmol. 1978;96:1132.
33. Beer GM, Kompatscher P. A new technique for the treatment of lacrimal gland prolapsed in blepharoplasty. Aesthet Plast Surg. 1994;18(1):65–9.
34. Smith B, Lisman RD. Dacryoadenopexy as a recognized factor in upper lid blepharoplasty. Plast Reconstr Surg. 1983;71(5):629–32.