Surgery for upper eyelid retraction, three techniques

This paper is based on the author's experience with 145 operations on 181 upper eyelids in 100 patients using three techniques for recession of the upper eyelid. The results include 15 years' experience with adjustable sutures in upper eyelid recession surgery.

Each chart was reviewed by the author. Patient data was entered into a database and analyzed. The operations used were (1) The prewhitnall levator recession (Trans Am Ophthalmol Soc. 1988: 86: 725-793). This operation is unique in that it is performed on the levator muscle proximal to Whitnall's ligament. (2) Recession of the levator aponeurosis and (3) the Henderson operation (Arch Ophthalmol 1965; 74: 205-216). Adjustable sutures were used in all prewhitnall recessions, about half of the levator aponeurosis recessions and none of the Henderson operations.

Complications were divided between over and undercorrection. There were 24% reoperations in 73 patients with thyroid eye disease and 14% reoperations in 17 patients with overcorrected ptosis. The overall reoperation rate was 23%. Adjustable sutures were effective in prewhitnall recessions but less so in levator aponeurosis recessions. There were fewer Henderson operations but the results were good.

The prewhitnall operation is good for marked bilateral eyelid retraction in thyroid eye disease. It is technically challenging but has advantages. Recession of the levator aponeurosis can be used for thyroid eye disease and overcorrected ptosis. The Henderson operation is useful in lesser degrees of eyelid retraction. The need for reoperation is an acceptable occurrence and can be expected in up to one fourth of patients.