Correction of Lower Lid Retraction Using Autologous Ear Cartilage Graft

Changho Yoon; Namju Kim; Min Joung Lee; Hokyung Choung; Min Seop Pahn; Sang In Khwarg

doi:10.3341/jkos.2011.52.2.136

Journal List > J Korean Ophthalmol Soc > v.52(2) > 1008932

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Yoon, Kim, Lee, Choung, Pahn, and Khwarg: Correction of Lower Lid Retraction Using Autologous Ear Cartilage Graft

Original Article

J Korean Ophthalmol Soc 2011;52(2):136-140.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.2.136

Correction of Lower Lid Retraction Using Autologous Ear Cartilage Graft

Changho Yoon, MD^1,², Namju Kim, MD^1,³, Min Joung Lee, MD¹, Hokyung Choung, MD^1,⁴, Min Seop Pahn, MD^1,², Sang In Khwarg, MD^1,²

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

²Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea

³Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

⁴Department of Ophthalmology, SMG-SNU Boramae Medical Center, Seoul, Korea

Address reprint requests to Namju Kim, MD Department of Ophthalmology, Seoul National University Bundang Hospital #300 Gumi-dong, Bundang-gu, Seongnam 463-707, Korea Tel: 82-31-787-7376, Fax: 82-31-787-4057, E-mail: resourceful@hanmail.net

Received 19 November 20101 December 2010 Accepted 26 January 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the surgical results of lower eyelid retraction using autologous ear cartilage graft.

Methods

Fifty patients (54 eyes) who received surgical correction of lower eyelid retraction by lower eyelid retractors and conjunctiva recession from the tarsal plate with autologous ear cartilage grafts from March 2002 to July 2010 were evaluated. Medical records were reviewed and clinical characteristics, surgical outcomes, and postoperative complications were analyzed retrospectively.

Results

The use of prosthesis due to anophthalmos or microphthalmos (22 eyes) was the most common cause of lower eyelid retraction. The mean postoperative followup period was 16.6 months (1-98 months). Lower eyelid retraction was successfully corrected in 52 of 54 eyes. Postoperatively, 2 cases of corneal erosions, 1 case of conjunctival erosion, and 2 pyogenic granulomas developed. Corneal and conjunctival erosions resolved with conservative management and gran-ulation tissues were removed by excision.

Conclusions

Correction of lower eyelid retraction using autologous ear cartilage graft is an excellent surgical procedure with low complication rates for eyelid retraction of various etiologies.

Keywords: Ear cartilage, Lower eyelid retraction, Spacer

References

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Figure 1.

The degree of lower eyelid retraction (mm) and corresponding widths of autologous ear cartilage graft (mm) used for correction.

Figure 2.

A 49-year-old man underwent evisceration 20 years ago and has been wearing prosthesis in his right eye. (A) Preoperatively, the patient showed lower eyelid retraction of 4 mm and upper eyelid ptosis in his right eye. (B) A photograph 6 weeks after ear cartilage graft (5 mm width) in the right lower eyelid, lateral tarsal strip, and levator reattachment procedure in the upper eyelid showing corrected lower eyelid retraction and ptosis.

Figure 3.

A 46-year-old woman with thyroid associated ophthalmopathy. (A) Preoperatively, the patient showed right lower eyelid retraction of 5 mm and bilateral upper eyelid retraction. She had a prior history of receiving right inferior rectus recession. (B) A photograph 4 months after ear cartilage graft (5 mm width) in the right lower eyelid, and 1 month after levator recession in both upper eyelids showing corrected lower and upper eyelid retractions.

Table 1.

Causes of lower eyelid retractions in patients who underwent correctional surgery using ear cartilage graft

Cause	No. of eyelids (%)
Prosthesis used for anophthalmos or microphthalmos	22 (41)
Inferior rectus recession	8 (14)
Thyroid associated ophthalmopathy	6 (11)
Orbital floor fracture surgery through subciliary skin incision	4 (7)
Facial nerve palsy	4 (7)
Lower eyelid epiblepharon repair surgery	3 (6)
Congenital retraction	3 (6)
Burn	2 (4)
Maxillectomy	1 (2)
Eyelid laceration	1 (2)
Total	54 (100)

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