Myriam Loyo1, Danielle Jones1, Linda N Lee1, Ryan M Collar2, Josher Molendijk1, Kofi D Boahene1, Lisa E Ishii1, Patrick J Byrne3. 1. Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, West Chest, OH, USA. 3. Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA pbyrne2@jhmi.edu.
Abstract
OBJECTIVES: Paralytic lagophthalmos can lead to devastating exposure keratitis. The main surgical intervention consists of upper eyelid loading. However, adjunctive lower eyelid and brow procedures are also available as necessary. We sought to analyze the use of periocular procedures in paralytic lagophthalmos at Johns Hopkins. METHODS: The method was a retrospective review of patients treated at a single tertiary care center from 2006 to 2012. RESULTS: One hundred one patients met inclusion criteria, and 20 patients were excluded for not meeting the minimum follow-up. Upper eyelid loading was required on 95/101 patients (95%). Adjunctive procedures were necessary in 73% (73/101) of patients. Lower eyelid procedures were used in 47% (47/101) and brow lifts in 47% (47/101). Older patients (>50 years) were more likely to require lower eyelid procedures (P=.04) and more likely to require revision (P=.003). Medial canthopexy and direct brow lift were associated with the need for revision (P=.006, P=.03). CONCLUSION: Paralytic lagophthalmos management is not one-size-fits-all. Upper eyelid loading is the mainstay of treatment; however, adjunctive procedures to the lower eyelid and brow are indicated in the majority of patients. Our retrospective review has allowed us to continue to refine our strategy for managing these patients.
OBJECTIVES:Paralytic lagophthalmos can lead to devastating exposure keratitis. The main surgical intervention consists of upper eyelid loading. However, adjunctive lower eyelid and brow procedures are also available as necessary. We sought to analyze the use of periocular procedures in paralytic lagophthalmos at Johns Hopkins. METHODS: The method was a retrospective review of patients treated at a single tertiary care center from 2006 to 2012. RESULTS: One hundred one patients met inclusion criteria, and 20 patients were excluded for not meeting the minimum follow-up. Upper eyelid loading was required on 95/101 patients (95%). Adjunctive procedures were necessary in 73% (73/101) of patients. Lower eyelid procedures were used in 47% (47/101) and brow lifts in 47% (47/101). Older patients (>50 years) were more likely to require lower eyelid procedures (P=.04) and more likely to require revision (P=.003). Medial canthopexy and direct brow lift were associated with the need for revision (P=.006, P=.03). CONCLUSION:Paralytic lagophthalmos management is not one-size-fits-all. Upper eyelid loading is the mainstay of treatment; however, adjunctive procedures to the lower eyelid and brow are indicated in the majority of patients. Our retrospective review has allowed us to continue to refine our strategy for managing these patients.
Authors: Gitanjali M Fleischman; Brian D Thorp; William W Shockley; J Madison Clark Journal: JAMA Facial Plast Surg Date: 2019-03-01 Impact factor: 4.611
Authors: Orlando Guntinas-Lichius; Carl E Silver; Jovanna Thielker; Manuel Bernal-Sprekelsen; Carol R Bradford; Remco De Bree; Luis P Kowalski; Kerry D Olsen; Miquel Quer; Alessandra Rinaldo; Juan R Rodrigo; Alvaro Sanabria; Ashok R Shaha; Robert P Takes; Vincent Vander Poorten; Peter Zbären; Alfio Ferlito Journal: Eur Arch Otorhinolaryngol Date: 2018-09-28 Impact factor: 2.503