ePoster listing and sessions

Topic: ESOPRS 2021 ePoster sessions
Time: Sep 17, 2021 16:00 Amsterdam, Berlin, Rome, Stockholm, Vienna, 15:00 London

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Lower eyelid lengthening in facial nerve palsy: when is a periosteal flap required?

Author: Aaron Jamison
ePoster Number: 280


To present a case series of patients with facial nerve palsy (FNP) undergoing lower eyelid ectropion surgery where, after plication of the medial canthal tendon (MCT) to correct medial ectropion/retraction, inadequate horizontal tarsal length was encountered.


A two-centre retrospective, non-comparative case series of all patients with FNP who underwent lower eyelid periosteal flap procedures following, or at the time of, MCT plication. Theatre records allowed identification of all periosteal flap procedures performed in this context by, or under the direct supervision of, one of two surgeons (RM, BP) between November 2018 and November 2020. Outcome measures, including the CADS grading score, were measured pre- and post-operatively, as was the need for further intervention.


Of the 12 patients included in this series, four had previously undergone MCT plication and were subsequently listed for elective lower eyelid lengthening. In eight cases, the horizontal deficiency was encountered per-operatively, immediately following MCT plication, whereby the lateral tarsus was unable to be reattached to the lateral orbital rim periosteum. One patient had previously undergone four separate procedures that would have shortened the lower eyelid, such that the need for lower eyelid lengthening might have been expected, but two patients were surgery-naïve. All patients had improved lower eyelid position following surgery, and none have yet required re-operation.


Lower eyelid lengthening following MCT plication appears to be required most frequently in patients who have previously undergone lateral tarsal strip (LTS), and/or those within the contraction phase of FNP. The authors therefore highlight the importance of preventing any unnecessary loss of horizontal tarsal length (particularly during LTS procedures) in patients with FNP. Surgeons managing such patients should take care to identify inadvertent eyelid shortening early, and be prepared to perform a lateral periosteal flap when required.

Additional Authors

First nameLast nameBase Hospital / Institution
BhupendraPatelMoran Eye Center, University of Utah, Salt Lake City
RamanMalhotraQueen Victoria Hospital, East Grinstead

Abstract ID: 21-187