Modified Retrograde Approach to Upper Eyelid Static Loading

Objectives/Hypothesis: Upper eyelid static weight loading is a technique commonly used to treat paralytic lagophthalmos. The traditional approach using the pretarsal crease incision leads to interruption of the anterior levator muscle fibers that attach to the face of the tarsus at its upper two thirds. This disruption can lead to permanent upper eyelid blepharoptosis. The retrograde approach avoids this problem but results in an incision at the lid margin, the dependent aspect of the weight. This increases the risk of implant extrusion. We hypothesize that a newly described modified retrograde approach is a safe and effective approach that avoids the pitfalls of previously described techniques. Study Design: Retrospective review. Methods: Eight patients were evaluated with preoperative and 3 to 6 month postoperative photographs with the eyes in the open and closed positions for the degree of lagophthalmos and blepharoptosis present. Patients were also evaluated for development of complications such as implant extrusion, pain, or infection. The surgical technique uses a supratarsal skin crease incision, supramuscular dissection to the lid margin, entry into the tarsal plane at its inferior‐most aspect, creation of a pocket for implant insertion, and layered closure. Results: All patients had complete correction of lagophthalmos. No patients experienced infection, extrusion, or eye pain after surgery. All patients had less than 2‐mm ptosis after surgery, with no patients experiencing any visual field disruption. Conclusions: The modified retrograde approach to upper eyelid static loading for paralytic lagophthalmos provides advantages over other techniques described. It is a safe, efficacious procedure, well tolerated by patients.