Congenital anomalies, ptosis, and malpositions of the eyelids

Technique and results of operative treatment of primary congenital eyelid retraction are described by Collin et al. [1]. They report good results using an anterior or posterior approach for upper lid retraction and a posterior approach for lower lid retraction. A simple method using double-armed sutures placed supratarsally and in the conjunctival fornix is presented for the repair of total congenital eversion of the upper lids [2]. A new syndrome is suggested for midline facial detects, iris colobomata, and mental retardation if combined with abnormalities of the eyelids, which is important in view of delayed intellectual development [3,4,5]. The importance of the phenylephrine test for the Muller muscle resection even in Hornerʼs syndrome is reported by Clatt et al. [6,7“|. On the other hand there are many advantages of the levator aponeurosis approach used in cases of congenital ptosis with good levator function [8]. For minimal levator function, Anderson et al. [9] suggest the Whitnallʼs sling procedure. In cases of no levator function frontalis suspension is necessary [10]. The incidence of visual loss after blepharoplasty is fortunately rare (0.04%), but still the most devastating complication [11]. The good results of spray freezing cryoepilation in 1690 patients with trichiasis are reported by Matthaus et al. [12]. Disinsertion of the capsulopalpebral fascia might be the reason for entropion after cataract surgery [13]. New aspects in the treatment of medial lower eyelid ectropion are reported by Edelstein and Dryden [15] presenting a medial palpebral tendon reconstruction technique. This malposition also seems to be curable by a horizontal and vertical tightening [16]. Different methods are reported to be successful in the repair of severe lower eyelid retractionscleral graft and retroauricular skin graft [17], tightening and supraplacing of the temporal canthus [18], hard palate mucosa graft as a spacer graft [19], and combined techniques [20].