Multistage correction of blepharophimosis: our rationale for 18 cases

Due to the complexity of staging order and the number of surgical procedures required to correct blepharophimosis-ptosis-epicanthus inversus (BPES), this study aimed to analyze multistage correction of BPES syndrome objectively.

This retrospective study was undertaken with 18 BPES patients who underwent multistage correction from April 2004 to September 2007. Data regarding levator function, horizontal palpebral fissure length (HPFL), vertical interpalpebral fissure height (IPFH), inner intercanthal distance (IICD), and the ratio of IICD to HPFL were recorded and analyzed. Facial photographs were taken both pre- and postoperatively. Any complications were documented.

The Mustardé method was used for 13 patients, and the Y-to-V technique was selected for 5 patients. In addition, seven patients also received lateral canthoplasty. All the patients underwent frontalis aponeurosis suspension. Changes in both IICD and HPFL were statistically significant (P < 0.001). The IPFH also showed statistically significant improvement after surgery. The range in the preoperative ratio of IICD to HPFL was 1.48-2.35 (mean, 2.04 +/- 0.28). Postoperatively, the ratios for all the patients were less than 1.8 (range, 1.1-1.5; mean, 1.28 +/- 0.13). Changes in the ratio of IICD to HPFL were statistically significant (P < 0.001). Mild undercorrection was observed in two patients postoperatively. Although neither keratitis nor overcorrection occurred, conjunctiva prolapse was experienced by one patient 10 days after frontalis aponeurosis suspension.

Staged surgery for correction of BPES syndrome is beneficial in terms of improved function and cosmesis.