Correction of upper eyelid retraction using deep temporal fascia spacer grafts

Upper eyelid retraction may occur as a manifestation of infiltrative disease, previous surgery, or trauma. It is associated with dry eye syndrome and corneal compromise. The authors evaluate a lid-lengthening procedure performed through a lid crease incision that uses modified levator recession coupled with autologous deep temporal fascia upper lid spacer grafting.

Records of 15 patients (22 lids) treated by a single surgeon were reviewed retrospectively. Dry eye symptoms, scleral show, lagophthalmos, and keratopathy were evaluated. Each patient underwent slit lamp examination and a Schirmer's test.

Degrees of preoperative scleral show and lagophthalmos were 1.6 +/- 0.7 mm and 1.9 +/- 0.7 mm, respectively. Every patient experienced complete resolution of dry eye symptoms, scleral show (p < 0.001), and lagophthalmos (p < 0.001) following repair. Symmetry was achieved in 73 percent of patients. Overcorrection occurred in four lids (18 percent) and required lid-shortening operations in three. There were no instances of undercorrection or recurrence. No major complications were noted. Graft resorption, extrusion, and infection did not occur. Lid margin contour was consistently excellent. Mean follow-up was 30 months.

The authors' technique is efficacious, durable, and safe. Autogenous deep temporal fascia is easy to harvest and manipulate. Complications associated with other repairs including recurrence and contour irregularities are avoided. Asymmetry, in this series, resulted solely from overcorrection, and the authors' reoperation rate (13.6 percent) compares favorably with that of other methods of repair. Overall patient satisfaction remains excellent. Deep temporal fascia interposition is a powerful technique for the repair of upper lid retraction.