Treatment of eyelid retraction with two pedicle tarsal rotation flaps

Five patients with eyelid retraction (seven eyelids, four upper and three lower eyelids) associated with blepharoptosis surgery, Graves' disease, and vertical extraocular muscle surgery were effectively treated with a new technique involving recessing the respective eyelid retractor beyond the tarsal border. Direct attachment of the levator aponeurosis or the inferior aponeurosis (capsulopalpebral head of the inferior rectus muscle) into the tarsus was maintained through an extended framework created by two pedicle tarsal rotation flaps. This anatomic retention of the tarsal-retractor junction enhanced transfer of muscle contracture into eyelid movement. The only adverse effect was a 4-mm gap in the eyelashes of one patient.