Saturday, January 2, 2016

Doc, can you do something about my weird looking eye?

This patient underwent bilateral blepharoplasty and right ptosis surgery a few months ago. She complained the right eye appearing weird and had difficulty opening the left eyelid.

Examination showed that the right eye had poor contour with the highest point of the upper eyelid too far to the temporal side. In addition, there was slight droopy of the eyelid nasally.

The high point should be at the site of red arrow but in this patient, 
the highest point is at the white arrow

In Chinese eye, the highest point of the upper eyelid is usually just temporal to the pupil (in Western eye, the highest point corresponds to the centre of the pupil).  The patient's left eye also had undiagnosed ptosis which was not corrected. 
A Chinese eye (right) versus a Caucasian eye showing the highest point 
of the eyelid in Chinese is slightly temporal to the pupil. 

To correct the poor contour, the nasal side of the eyelid had to be lifted. This was achieved by by posterior approach conjunctivomullerectomy. The left ptosis was also corrected the same time using the same posterior approach. 

Before the operation, makings (in blue) were make for anchoring the sutures 
so that the highest point was just temporal to the pupil.

Steps showing the procedure for the right eye. a. The right eyelid was everted; 
b. a horizontal cut was made at the upper border of the tarsal plate, 
the cut corresponded to the distance between the two markings; 
c. Scissors were used to make vertical cuts to produce a strip of 10mm 
conjunctivomuller flap; d. the strip was cut and e. 2 nylon sutures were used to attached 
the cut ends to anterior surface of the tarsal plate; f. at the end of the procedure, 
the highest point has now been shifted nasally.

At the end of the operation, the left ptosis was also corrected.

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