Surgical Correction of Cicatricial Lower Eyelid Retraction: A Systematic Review

Authors

Seyed Mohsen Rafizadeh, Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Masoud Mirghorbani, Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mehdi Tavakoli, Department of Ophthalmology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Ali A. Haydar, Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Document Type

Journal Article

Publication Date

10-30-2023

Journal

Seminars in ophthalmology

DOI

10.1080/08820538.2023.2273850

Keywords

Cicatricial; Lower eyelid retraction; MRD2; Surgical techniques

Abstract

BACKGROUND: Cicatricial lower eyelid retraction is a challenging condition. It involves scarring of the lower eyelid, which causes it to retract and expose the sclera. This can lead to complications such as dry eye syndrome and corneal melting. It can be caused by trauma, burns, or previous eyelid surgery. Detailed assessment and understanding of eyelid anatomy and retraction are critical for successful surgical planning. Dynamic and static examinations of the eyelid including measurements of the lower eyelid margin reflex distance (MRD2) and scleral show are also essential to determine the appropriate treatment approach. METHODS: A systematic review was conducted using Medline, Scopus, and Cochrane databases with keywords related to cicatricial lower eyelid retraction. The publication language was limited to English after 2000. A total of 29 articles were included for data extraction and analysis. RESULTS: The main surgical techniques include tarsoconjunctival grafts, spacers, midface lift, and lateral canthal tendon suspension, although no single procedure has been universally recognized as the gold standard. New innovations such as synthetic grafts and xenografts are being explored for their potential in eyelid reconstruction. Severe cases, defined as those with inferior scleral show greater than 2 mm, may require a combination of reconstruction methods. CONCLUSIONS: Correcting cicatricial lower eyelid retraction is a major challenge in oculoplastic reconstruction. The surgical approach should be individualized, considering the pathologies and etiologies of lid retraction. In-depth knowledge and careful surgical planning are essential for best outcomes. There is no gold standard technique, and postoperative outcomes, complications, and management vary depending on the surgical approach used.

APA Citation

Rafizadeh, Seyed Mohsen; Mirghorbani, Masoud; Tavakoli, Mehdi; and Haydar, Ali A., "Surgical Correction of Cicatricial Lower Eyelid Retraction: A Systematic Review" (2023). GW Authored Works. Paper 3535.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3535

Department

Ophthalmology