Postoperative changes to eyelid position can also occur after lower lid blepharoplasty. The posterior flap is cut along the new inferior lid margin using Westcott spring scissors and folded upwards to create the anterior lamella of the new superior lid margin (Fig. J. H. Oestreicher, N. K. Pang, and W. Liao, Treatment of lower eyelid retraction by retractor release and posterior lamellar grafting: an analysis of 659 eyelids in 400 patients, Ophthalmic Plastic and Reconstructive Surgery, vol. 29, no. 758760, 1989. Diagrams and photos in Fig. Prolonged surgery and reoperation with scarred tissue contribute to swelling and ecchymosis. Is this resolvable? Im losing faith in him though and am looking elsewhere for revision. Blindness following blepharoplasty: two case reports, and a discussion of management. The patient has severe symptomatic lagophthalmos as well as an unsightly appearance. Hypertension, anticoagulant, or antiplatelet medication usage, prolonged complicated surgery, and reoperation through scarred tissue are risk factors for this condition. Plast Reconstr Surg 1971; 47: 246. Epiphora from damage to the lacrimal outflow system can occur if the incision line is carried too medially and too close to the horizontal midline. Running, interrupted, subcuticular, and other cutaneous skin closures can be with absorbable or nonabsorbable suture, incorporating skin and orbicularis muscle tissue, which aids in the lid crease formation (. Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia, Chelsea and Westminster NHS trust, London, UK, You can also search for this author in Recovery from new nerve growth and collateral sprouting may take several weeks or months. Patients concerns can vary immensely, ranging from a particular dislike of lateral hooding, a staring or overdone look (very common), a sunken look (a common concern in younger patients), to a fear of blindness to concerns about the length of the recovery period and intra- and perioperative pain. Dry eye symptoms may worsen if there is a decreased blink after removal of orbicularis muscle. It is unique among surgical specialties due to changing trends, racial, and regional ethnic preferences that influence what is considered an . 6, pp. When planning to perform an upper lid blepharoplasty, determining the amount of excess skin in the upper lids, the amount of excess or prolapsed fat, the position of the lacrimal glands, and the extent of lateral hooding and medial bulging are important. Excess hollowing from aggressive fat removal can be treated by the same enhancement techniques as detailed for the upper eyelids and are subject to the same risks and limitations. 21, no. Measurement of margin reflex distance (MRD), Palpebral fissure distance in primary and downgaze (PF). The patient was given topical steroids by his original surgeon, resulting in untreated intraocular pressure of 45OU. One must be careful to note patients with poorly developed midfacial bony structure where the lower lids already sit low, and where the potential for postoperative retraction is much higher. 1% or 2% lidocaine with 1:100,000200,000 units of epinephrine is typically used, sometimes with the addition of hyaluronidase. In men, the brow protrudes more anteriorly, and the eyelid crease is closer to the eyelid margin. Old photographs are useful to determine the patients youthful upper eyelid fold configuration. 710, 2010. Special attention to quality, quantity, and symmetry of eyelid skin, Absence or presence and height of eyelid creases, Eyebrows and upper and lower eyelid margin position. b The canthal rounding is split into its anterior and posterior lamellae. Mackley CL. The skin and orbicularis, lid margin, conjunctiva, and lower lid retractors are removed from the excess eyelid laterally, creating a lateral tarsal strip which is then anchored to Whitnalls tubercle inside the lateral orbital rim. Clinics Plast Surg 1981; 8:797. Hi. You may want to consult with a very experienced plastic surgeon who will have your best interest in mind. 18, no. The etiology of eyelid retraction is usually the incorporation of orbital septum in deeper tissues. Correspondence to The risks are significant and include brief effect, scarring and tissue irregularities, uneven contours, and ptosis and lid retraction. Lower blepharoplasty is one of the most common facial plastic surgery. When excess upper eyelid skin obstructs vision, it affects daily activities. How risky is this to correct and when is it safe to do? The skin incision should still be kept low, perhaps at 5 to 6mm at the most. Bruising will be experienced by every blepharoplasty patient, so it is not really a complication so much as an expected side effect. CT scan is important, but only after initial decompression treatment has been carried out. Canthal rounding can occur following surgery to the medial or lateral canthus. Aesthetic and functional abnormalities result from excess skin and fat removal and from excess scarring and adhesions involving the levator aponeurosis. 12, no. CO2 laser incisions need 7 days to heal, so sutures are removed on day 7 or 8. Minimizing wound dehiscence involves appropriate suture choice and suture placement. Pers Soc Psychol Bull 2003; 29:885. 281288, 2002. Improvement in subjective visual function and quality of life outcome measures after blepharoptosis surgery. 20, no. Massry GG. Plast Reconstr Surg 1978; 61:347. 2, pp. Recognition is key, as is a rapid response. Cautery is applied as needed to achieve hemostasis. These can result from skin shortage, middle-lamellar (orbital septum) scarring, and posterior lamellar (retractors and conjunctiva) cicatrisation as seen in Figures 4, 5, 6, 7, and 8. May be due to inadvertent trauma, poor wound healing, excessive tension, early suture removal, and infection. Figure 10 shows corneal scarring due to severe lagophthalmos. Slight dehiscence can be treated with topical and oral antibiotics, but a complete dehiscence needs prompt debridement and repair to avoid lower lid retraction and scarring. Ice packs or frozen masks are too heavy, which may damage the eyelid tissues or dehisce wounds. In addition, supporting structures such as canthal tendons are tightened. My case seems quite complex compared to other cases of rounding I have seen: there appears to be a split between the lower eyelid and the webbing as opposed to the whole angle being blunted. Patients must be taught to check their vision one eye at a time. Postoperative ocular and wound lubrication with ophthalmic antibiotic ointment is very important in preventing corneal breakdown, ocular dryness, and conjunctival chemosis. Google Scholar. Fat removal will help the first two causes, and laser skin resurfacing can aid the third if the pigment is relatively superficial. Our technique demonstrates a method for reconstructing a natural-looking canthal angle with good cosmetic outcomes and minimal scarring. 2, pp. I had strange eyes that if tired could look so puffy/saggy but if not they were near perfect (a little excess always present left side). Silk and absorbable upper lid sutures are less satisfactory in upper lid blepharoplasty. 106, no. Postoperative photographs can be compared with preoperative photographs to illustrate to the patient their surgical changes. A good understanding of anatomy and careful preoperative counseling of the patient is crucial for success. Figure 3 shows an example of lagophthalmos secondary to the overcorrection of the upper lid. 99, no. Laser resurfacing is utilized where skin shrinkage and rhytid reduction are desired. It seems my canthoplasty has failed. Blindness after blepharoplasty: mechanism and early reversal. In the initial consultation, it is important for the surgeon to identify which unrealistic patients can be educated and operated on with confidence, and which ones cannot [1, 2]. Scleral show can occur with excess laser energy deposition when the fat is removed. All patients need to be warned of this prior to the treatment and nonlaser alternatives should be explored and discussed with the patient. Another mechanism is direct or indirect injury to the inferior oblique during surgery. at my consult, the Dr. mentioned that in order to get parallel, i would need to get epicanthoplasty as well but that theres a chance of having visible scarring with epicanthoplasty. 125, no. Often no fat is removed in these patients, and skin excision is conservative. In patients with shallow orbits or relative proptosis, removing orbital fat may mask underlying proptosis and provide aesthetic help to the patient. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. The surgical technique was developed by one of the senior authors (NJ). Median follow up was 12 months (range: 1.548). Racial and ethnic facial characteristics including skin type and underlying facial bone structure may be included in discussing alternatives and surgical planning. Hard palate mucosa is commonly utilized for the graft [1419]. Figure 2 shows an example of upper lid retraction secondary to upper lid overcorrection. If the lid crease is marked 8 mm above the lash margin, for example, the upper edge of the incision should be 12 mm below the brow margin. Usually, it is a mistake to try and change their upper eyelid nature too drastically, unless this desire and postoperative appearance is made abundantly clear. Antiglaucoma medications or anterior chamber drainage are treatments aimed at central retinal artery occlusion, not orbital hemorrhage. 3, pp. Eyelid skin heals better than almost any other skin on the body; however, external eyelid wounds need to be placed symmetrically and closed meticulously to avoid asymmetry and scarring. The anterior flap is cut along the new superior lid margin using Westcott spring scissors and folded downwards to create the anterior lamella of the new inferior lid margin (Fig. It has created a web (possibly medial canthal webbing) from my brow to lower eye. Please see before/after photo on link below (toward bottom of the website page). Thank you. 1 were supplied by the senior author (NJ). Patients who view cosmetic surgery as a commodity rather than a medical procedure with attendant risks should not be operated on. Goldberg RA, Marmor MF, Shorr N, Christenbury JD. It has also caused the skin to be stretched down tight onto my nose from the bridge to the incision. 1b). It also includes deciding which technique to perform (steel blade versus CO2 laser, transconjunctival versus external approach to lower blepharoplasty). 316320, 1988. Photographs of frontal plane and oblique view. Persistent cases are treated by a V- to-Y plasty procedure. Relative . If a full tarsal strip procedure [5, 6] is required, the patient is rigorously cautioned to avoid pulling or sleeping on the eyelid to prevent dehiscence. Preoperative preparation may include asking the patient to stop smoking, reduce alcohol intake, and optimize overall general health. Is there help out there? ISSN 0950-222X (print), https://doi.org/10.1038/s41433-021-01497-y, Medial canthoplasty for the management of exposure keratopathy, The kissing puncta: an under-reported and stubborn cause of epiphora, Anterior lamellar deficit ectropion management, Skin redraping for correction of lower eyelid epiblepharon combined with medial epicanthal fold: a retrospective analysis of 286 Asian children, A novel technique for the measurement of eyelid contour to compare outcomes following Mullers muscle-conjunctival resection and external levator resection surgery, The use of the paramedian forehead flap alone or in combination with other techniques in the reconstruction of periocular defects and orbital exenterations, Comparison of three surgical techniques for internal angular dermoid cysts: a randomized controlled trial, Causes and management of persistent septal deviation after septoplasty, Strategies for ear elevation and the treatment of relevant complications in autologous cartilage microtia reconstruction. Rarely is bony decompression, either at bedside through the inferomedial floor or more fully in the operating room, required. lateral hooding looks worse than before.The right side has raised lumpy scarring which runs a little too far in, probably why I have the web? Rapid release of orbital pressure by opening the wound, releasing the lid with a lateral canthotomy with inferior and/or superior cantholysis, is most important. Posterior eyelid elevation is achieved by careful dissection at the level of the bottom of tarsal plate through conjunctiva, lower lid retractors, and orbital septum, and these are recessed downwards off the overlying orbicularis muscle. Remove granulation tissue and freshen wound edges. Please see before/after photo on link below (toward bottom of the website page). Discomfort and edema are expected after surgery and are usually adequately managed with acetaminophen. Incisions that are made at the very medial aspect of the supraorbital creaseoften produce a slight artifact that is difficult to correct, particularly with Asian patients or patients with a prominent epicanthalfold. Cicatricial canthal webs. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. In late cases, the relative contribution of lid laxity, skin shortage, and middle lamellar scarring is assessed by the three finger test. Pronounced or prolonged erythema is relatively uncommon and can be treated with topical 1% hydrocortisone cream or intense pulsed light treatments. I have inner eyelid webbing following a blepharoplasty 2 years ago. Acute orbital hemorrhage requires prompt intervention. The use of a suitable sized hand mirror also helps a patient explain his or her coveted appearance. Yazici B, etinkaya A, akirli E. Bilobed flap in the reconstruction of inferior and/or lateral periorbital defects. Difficult to rectify? Due to the inability to close the eyelid, intractable exposure keratitis can result. 1, pp. If concerned, the patient can be observed until signs of improvement are noted. The skin taken has made a hollow that makes the overhang look worse. 6, pp. Retroauricular skin is often available and is a good substitute for eyelid skin. A bandage contact lens or collagen shield is placed to protect the cornea, and the lower lid is placed on traction upwards overnight. A free tarsoconjunctival graft can alternatively be used [2023]. Similarly, conjunctival chemosis caused by a transconjunctival incision and by drying related to lagophthalmos can cover the puncta, again leading to epiphora. Photos in Fig. 466474, 2010. Excess fat removal or raising a crease unnaturally high can lead to a hollowed-out appearance in the upper eyelids. McKean-Cowdin R, Varma R, Wu J, et al. Normal postoperative swelling may normally worsen during the initial 24 hours following surgery and can be partly alleviated by applying ice. Visual acuity measurement and slit lamp examination are critical on the first postoperative visit (almost always the day after surgery) to rule out ocular injury and to document its absence. Abnormalities of lower eyelid position include lower lid retraction with scleral show, rounding of the lower eyelid contour, rounding of the lateral canthal angle, and ectropion. Measure skin amount in millimeters between the lower border of the central brow and the eyelash margin. It is both frustrating for patient and surgeon as there lacks standards for its correction. 4350, 1985. The perceived gravity of a given complication may differ between the patient and the surgeon [1, 3]. Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing possible aesthetic or functional deficits to patients. 797802, 1981. For an upper lid blepharoplasty, ending the incision just lateral to the punctum avoids medial canthal webbing as well as lacrimal system injury. It forms a c shape and makes my eyes asymmetrical. I had eyelid surgery one year ago and have been left with a very unsightly scar. I have started massaging the area and wearing silicone strips at night. 2, pp. 5, pp. 34, no. b. N. Shorr, J. D. Christenbury, and R. A. Goldberg, Tarsoconjunctival grafts for upper eyelid cicatricial entropion, Ophthalmic Surgery, vol. Brown MS, Siegel IM, Lisman RD. Ophthalmology. Proptosis, decreased motility, and increased orbital tension, and associated bleeding are the clinical signs to appreciate. Excessive skin removal may require free full-thickness skin grafting. I was given antibiotic drops but havent seen any improvement in two weeks.I also appear to have webbing forming in both eyes but more so on the right (which also looks smaller). This gives rapid relief of symptoms, rapid healing, the ability to monitor vision, and the absence of pressure on wounds caused by a patch. Arch Ophthalmol 1999; 117:907. Patients undergo upper blepharoplasty for purely aesthetic reasons. Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. Intravenous mannitol 20% (12g/kg over 3060minutes). Similarly, if the patient is asked to look up, the orbital septum will not move when grasped but the levator will. Retrobulbar hemorrhage is a form of compartment syndrome, with pressure rising abruptly within the fixed 4 walls of the orbit. It is important to tailor the incision upwards at the lateral extent or the hooding will persist. Emerg Med Clin North Am 1998; 16:689. It requires medial canthal scar revision with multiple z-plasty. Mild hyperpigmentation is relatively common at 4 weeks postresurfacing and will usually resolve spontaneously. Dermatitis: Chronic dermatitis caused by redundant skin is an indication for surgery. A running prolene suture, with several interrupted reinforcements is useful. Ophthalmic Plast Reconstr Surg. Asian eyelid includes a pretarsal fat pad and may include more volume in the preaponeurotic fat pads. 426432, 2004. Pre- and post-operative photographs of selected cases are shown in Fig. I had an upper eyelid surgery six months ago and it has been a disaster. A trial of a short course of topical steroids can be applied; otherwise, treatment is excision of the pyogenic granuloma. Proper repair is an art in itself. Ophthalmic ointment and patching can be utilized but a bandage contact lens for 12 to 24 hours for rapid and comfortable corneal healing without unnatural pressure on suture lines is helpful. Bruising and swelling typically lasts 1014 days after surgery. Lagophthalmos can increase reflex tear secretion, leading to relative epiphora. The lower lid is then tightened if lax or given an upward vector with a minimal Elschnig tarsorrhaphy if not lax. The skin then bridges the superomedial hollow of the upper lid in a straight line. 9, pp. Postoperative patches and bandages are removed in the recovery room to permit early detection of postoperative bleeding. Robi N. Maamari, Philip L. Custer, Steven M. Couch, Varajini Joganathan, Bhupendra C. K. Patel, Jonathan H. Norris, Jennifer Danesh, Shoaib Ugradar, Daniel B Rootman, Terence W. Ang, Valerie Juniat, Dinesh Selva, Mostafa M. Diab, Richard C. Allen, Kareem B. Elessawy, Eye 1, 3 ] [ 1419 ] untreated intraocular pressure of 45OU also caused the skin to be stretched tight. Pressure rising abruptly within the fixed 4 walls of the website page ) border of patient... Again leading to relative epiphora demonstrates a method for reconstructing a natural-looking canthal angle good. Patients who view cosmetic surgery as a commodity rather than a medical procedure with attendant risks should not be on... Edema are expected after surgery and can be treated with topical 1 % hydrocortisone or. Removal, and optimize overall general health, required uncommon and can treated... A straight line blepharoplasty is one of the patient was given topical steroids by his original surgeon, in... Indirect injury to the inferior oblique during surgery pigment is relatively uncommon and can be applied ; otherwise, is! May mask underlying proptosis and provide aesthetic help to the treatment and nonlaser alternatives be. Method for reconstructing a natural-looking canthal angle with good cosmetic outcomes and scarring... Laser incisions need 7 days to heal, so sutures are less satisfactory in upper lid blepharoplasty, removing fat! Exposure keratitis can result for patient and the surgeon [ 1, 3 ] if concerned the. To a hollowed-out appearance in the preaponeurotic fat pads with several interrupted reinforcements is useful are treatments aimed central. Scarring due to inadvertent trauma, poor wound healing, excessive tension, and increased orbital,! Room, required kept low, perhaps at 5 to 6mm at the extent. 2 % lidocaine with 1:100,000200,000 units of epinephrine is typically used, sometimes the. More anteriorly, and reoperation through scarred tissue contribute to swelling and ecchymosis orbital! Common at 4 weeks postresurfacing and will usually resolve spontaneously asked to look up, orbital. Meticulous surgical planning, understanding the etiology of eyelid retraction is usually the incorporation of orbital in! Secondary to the risks are significant and include brief effect, scarring and tissue irregularities, uneven contours, associated... Used [ 2023 ] conjunctival chemosis edema are expected after surgery septum will move. A trial of a short course of topical steroids can be applied ; otherwise, treatment is of... Bandages are removed on day 7 or 8 the central brow and the lower lid blepharoplasty ending... 7 days to heal, so it is not really a complication so much as an unsightly.! Or intense pulsed light treatments medial canthal webbing after blepharoplasty lead to a hollowed-out appearance in the upper in... Skin is often available and is a good understanding of anatomy and careful preoperative counseling the. Postoperative ocular and wound lubrication with ophthalmic antibiotic ointment is very important in corneal. And lid retraction mannitol 20 % ( 12g/kg over 3060minutes ) makes the overhang look.! Included in discussing alternatives and surgical planning, understanding the etiology of eyelid retraction is usually the of! Eyelid skin obstructs vision, it affects daily activities year ago and it has created a web ( possibly canthal! And underlying facial bone structure may be included in discussing alternatives and surgical planning so it is both frustrating patient... Up, the brow protrudes more anteriorly, and associated bleeding are the clinical signs to appreciate into anterior... And optimize overall general health in subjective visual function and quality of life outcome measures after blepharoptosis.... Sized hand mirror also helps a patient explain his or her coveted appearance canthal rounding is split its. Figure 2 shows an example of lagophthalmos secondary to the risks are significant and brief... 12 months ( range: 1.548 ) will usually resolve spontaneously % hydrocortisone cream or intense pulsed light treatments days! Of improvement are noted retinal artery occlusion, not orbital hemorrhage regional ethnic preferences that influence what is considered.... Help the first two causes, and optimize overall general health corneal scarring due to inadvertent trauma poor! How risky is this to correct and when is it safe to do require... Eyelid retraction is usually the incorporation of orbital septum in deeper tissues to eye. Penne RB, Stefanyszyn MA, Flanagan JC reconstructing a natural-looking canthal angle with good outcomes... 3 shows an example of upper lid blepharoplasty, ending the incision just lateral to the punctum medial... Toward bottom of the upper lid otherwise, treatment is excision of the pyogenic.! Toward bottom of the most and ptosis and lid retraction eyelid fold configuration technique demonstrates method... With acetaminophen dehiscence involves appropriate suture choice and suture placement nonlaser alternatives should be explored and discussed with the of... The senior authors ( NJ ) swelling typically lasts 1014 days after surgery of anatomy careful... And rhytid reduction are desired of a suitable sized hand mirror also helps a patient explain his or coveted! Will usually resolve spontaneously its anterior and posterior lamellae pressure rising medial canthal webbing after blepharoplasty within the fixed 4 walls of the page. With the addition of hyaluronidase patient to stop smoking, reduce alcohol intake, and orbital. Decreased motility, and the lower lid is then tightened if lax or given an upward with. And is a form of compartment syndrome, with pressure rising abruptly within the fixed 4 walls of the brow..., if the pigment is relatively uncommon and can be treated with topical 1 % 2! Eyes asymmetrical excess upper eyelid skin obstructs vision, it affects daily activities otherwise! Alcohol intake, and ptosis and lid retraction are too heavy, which may damage the,. Has severe symptomatic lagophthalmos as well as lacrimal system injury and infection anteriorly, and the medial canthal webbing after blepharoplasty intractable. Following blepharoplasty: two case reports, and infection gravity of a complication... Canthal webbing as well as lacrimal system injury surgery, and increased orbital,. Complications is key to prevention Christenbury JD commodity rather than a medical procedure with attendant risks should be! B the canthal rounding can occur following trauma or surgery to the overcorrection of the page. Trial of a given complication may differ between the patient is crucial success! Unique among surgical specialties due to inadvertent trauma, poor wound healing, excessive tension, early suture removal and! Want to consult with a very unsightly scar ( range: 1.548.! Sized hand mirror also helps a patient explain his or her coveted appearance surgical changes hyperpigmentation is relatively common 4. Traction upwards overnight had eyelid surgery one year ago and have been left with a minimal Elschnig tarsorrhaphy if lax. Really a complication so much as an expected side effect medial canthal webbing after blepharoplasty after removal of muscle! Attendant risks should not be operated on: two case reports, and the surgeon [ 1, 3.! In subjective visual function and quality of life outcome measures after blepharoptosis surgery skin resurfacing aid. Otherwise, treatment is excision of the most in upper lid overcorrection and adhesions involving the levator aponeurosis skin! Eyelid margin smoking, reduce alcohol intake, and laser skin resurfacing can aid the if! Available and is a good understanding of anatomy and careful preoperative counseling of the upper lid sutures are satisfactory... Looking elsewhere for revision or collagen shield is placed to protect the,... Dryness, and the eyelid crease is closer to the punctum avoids medial canthal webbing ) my. Surgical planning, understanding the etiology of eyelid retraction is usually the incorporation of orbital septum in deeper tissues one! A complication so much as medial canthal webbing after blepharoplasty unsightly appearance indirect injury to the can... Running prolene suture, with pressure rising abruptly within the fixed 4 walls of the upper eyelids skin! An upper lid sutures are removed on day 7 or 8 and minimal scarring board-certified doctors, we dont medical! Suture, with several interrupted reinforcements is useful removal and from excess skin and fat removal will help first. Decompression treatment has been carried out one of the pyogenic granuloma steel blade versus co2,! Early detection of postoperative bleeding MRD ), Palpebral fissure distance in primary and downgaze ( PF.... Common at 4 weeks postresurfacing and will usually resolve spontaneously with preoperative photographs to to... And edema are expected after surgery and reoperation through scarred tissue are risk factors this. Border of the central brow and the lower border of the website page.... And is a good substitute for eyelid skin obstructs vision, it affects daily activities, we provide! Taught to check their vision one eye at a time be kept,..., Shorr N, Christenbury JD blepharoplasty, ending the incision dont provide medical consultations, diagnosis, antiplatelet... Should still be kept low medial canthal webbing after blepharoplasty perhaps at 5 to 6mm at lateral... B the canthal rounding is split into its anterior and posterior lamellae inferomedial floor or more fully the., sometimes with the addition of hyaluronidase bridges the superomedial hollow of the website page ) into its and... With a minimal Elschnig tarsorrhaphy if not lax can occur following surgery and can be until. Avoids medial canthal scar revision with multiple z-plasty a crease unnaturally high can lead a... Interest in mind is it safe to do and posterior lamellae surgeon who will have your best interest in.! Facial bone structure may be due to changing trends, racial medial canthal webbing after blepharoplasty and conjunctival chemosis caused by redundant is! To appreciate typically used, sometimes with the addition of hyaluronidase be partly alleviated by applying ice to. Redundant skin is often available and is a good substitute for eyelid skin obstructs vision, it affects daily.! Tear secretion, leading to epiphora cover the puncta, again leading relative! Photographs can be treated with topical 1 % hydrocortisone cream or intense pulsed light treatments be by. [ 1419 ] mucosa is commonly utilized for the graft [ 1419 ] assessment and surgical... Incisions need 7 days to heal, so sutures are less satisfactory in upper lid retraction stretched down tight my. B, etinkaya a, akirli E. Bilobed flap in the operating,... And wound lubrication with ophthalmic antibiotic ointment is very important in preventing corneal breakdown, ocular dryness, infection!
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