Correction of lower eyelid retraction with hard palate graft in the anophthalmic socket

Objective

Lower eyelid retraction is a common and challenging complication of the anophthalmic socket. The underlying pathophysiology includes contraction of the posterior lamellae of the eyelid, shortening of the inferior fornix, and lateral canthal tendon laxity. This study aimed to evaluate the surgical efficacy of hard palate mucosa as a posterior spacer graft in the lower eyelid retraction repair in the anophthalmic socket.

Methods

The surgical technique involved hard palate grafting combined with recession of inferior retractors and lateral tarsal strip suspension to lengthen the posterior lamellar and strengthen the support of the lower eyelid. The records of anophthalmic patients with lower eyelid retraction who underwent this technique from January 2009 through August 2014 were reviewed. Postoperative outcomes were determined by lower eyelid elevation, presence of lagophthalmos, complications, prosthesis fitting, and patient satisfaction.

Results

A total of 12 patients (12 eyelids) were included. The mean age at surgery was 36 years (range, 29–52 years) and the mean follow-up period was 53 months (range, 20–71 months). The lower eyelids of the operated eyes significantly elevated by 2.9 ± 0.8 mm, and mild residual lagophthalmos was observed in 3 patients. All patients were satisfied with the surgical outcomes. Minor complications occurred in 3 cases, including mild recurrent retraction, granuloma, and mucous discharge. There were no complications detected at the donor site.

Conclusion

Hard palate grafting combined with recession of lower eyelid retractors achieves long-term stable outcomes in lower eyelid retraction repair in the anophthalmic socket.