Correction of lower eyelid position in patients with paralytic lagophthalmos

OBJECTIVE

To analyze the effectiveness of surgical correction of lower eyelid position, including implantation of polymer implants, in patients with paralytic lagophthalmos.

MATERIAL AND METHODS

A retrospective study enrolled 61 patients with lagophthalmos following peripheral facial nerve palsy who underwent lower eyelid surgery. In the control group (n=10), patients underwent a modified Kuhnt-Szymanowski procedure, in the 1^st main group (n=46) — correction of lagophthalmos with reinforcement of tarsal plate using a polymer implant Reperen-6, in the 2^nd main group (n=15) — correction of lagophthalmos using an individually modeled perforated polymer endoprosthesis supported on inferior orbital rim. We assessed postoperative outcomes considering lagophthalmos measurement, Margin to Reflex Distance (MRD₂), Margin to Limbus Distance (MLD₂), palpebral fissure width and Hertel exophthalmometry.

RESULTS

After 3 and 6 months, all groups significantly differed in palpebral fissure width, MRD₂, and MLD₂. After 6 months, residual lagophthalmos significantly differed. In the 2^nd main group, exophthalmometry values significantly reduced on the affected side (after 3 months p=0.0004, after 6 months p=0.0003).

CONCLUSION

Vertical reinforcement of the lower eyelid using an implant supported on the orbital rim ensures stable eyelid position and restoration of its supportive function, as well as improves effectiveness of lagophthalmos correction in long-term postoperative period.