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Lee, Paik, Jung, Sonn, and Yang: Surgical Outcome of Levator Recession for Correction of Upper Eyelid Retraction
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(10): 1378-1384.

Published online: 17 October 2012

DOI: https://doi.org/10.3341/jkos.2012.53.10.1378

Surgical Outcome of Levator Recession for Correction of Upper Eyelid Retraction

Yong Eun Lee, MD1, Ji Sun Paik, MD1, Su Kyung Jung, MD1, Uk Hyun Sonn, MD2, Suk Woo Yang, MD1

1Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

2Catholic St. Mary's Eye Clinic, Seoul, Korea

Address reprint requests to Suk Woo Yang, MD. Department of Ophthalmology, The Catholic University of Korea, Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: 82-2-2258-6200, Fax: 82-2-599-7405, yswoph@catholic.ac.kr

Received 16 March 2012       Accepted 25 August 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To assess the efficacy of levator recession under local anesthesia to treat upper eyelid retraction.

Methods

Records of 12 patients (12 lids) were reviewed retrospectively. Postoperative cosmetic results were assessed as good, fair, or poor based on the upper lid height and symmetry. Preoperative and postoperative marginal reflex distance (MRD1, mm), upper eyelid asymmetry, lid lag, lagophthalmos, and ocular exposure symptoms were compared. The reoperation rate was also evaluated.

Results

Causes accounting for upper lid retraction were Graves ophthalmopathy (9 lids, 75.0%), orbital pseudotumor (2 lids, 16.7%), and hypercorrection from previous ptosis operation (1 lid, 8.3%). At a mean ± standard deviation of 27.7 ± 24.0 months follow-up (range, 5-60 months), 11 patients (91.7%) showed significantly better cosmetic results. MRD1 decreased an average of 3.1 ± 1.3 mm from 6.3 ± 1.5 mm preoperatively to 3.2 ± 0.9 mm postoperatively (p < 0.001). Upper lid asymmetry, lagophthalmos, and lid lag were also reduced significantly (p < 0.001). Overcorrection occurred in 3 lids (25%) and required levator advancement. Eleven patients (91.7%) experienced complete resolution of dry eye symptoms following levator recession.

Conclusions

Levator recession showed good cosmetic results up to 2 years after surgery for upper eyelid retraction.

Keywords: Asymmetry, Cosmetic results, Levator recession, Lid lag, Upper eyelid retraction

Figures and Tables

Figure 1
Preoperative and postoperative MRD1-time profiles. MRD1 levels were highest on the preoperative day, and decreased significantly after the levator recession.
jkos-53-1378-g001
Figure 2
(A) Preoperative photograph of case 3, showing right upper eyelid retraction due to thyroid-associated ophthalmopathy. (B) Large amount of lid lag before levator recession. (C) Postoperative photograph showing dramatic improvement in eyelid level 1month after the operation. (D) Incision along the lid crease.
jkos-53-1378-g002
Figure 3
(A) Preoperative upper eyelid retraction in the left eye (case No. 4). (B) 4 months after the operation with good cosmetic result.
jkos-53-1378-g003
Table 1
Patient characteristics
jkos-53-1378-i001

*Bilateral upper lid blepharoplasty.

Table 2
Preoperative and postoperative data for patients undergoing levator recession for upper eyelid retraction
jkos-53-1378-i002

Values are presented as mean ± SD unless otherwise indicated.

*Calculation of p-values: paired samples t test and one-sample t test (after calculating delta values) were used for calculating preoperative and postoperative visual acuity, MRD1, and lagophthalmos differences; †Lid asymmetry was calculated as the absolute difference between both upper eyelids height (MRD1) preoperatively and postoperatively.

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