Abstract ID: 26-308
Dermal fat grafting reconstruction as a viable reconstructive strategy for refractory lagophthalmos in patients with multiple implant failures
Author: Saad Mahmud Khan Base Hospital / Institution: Norfolk and Norwich University Hospital
Presentation Type: ePoster Presentation
Purpose
To present a novel dermal fat grafting technique for managing complex paralytic lagophthalmos secondary to longstanding lower motor neuron facial nerve palsy with multiple prior eyelid implant exposures.
Methods
N/A
Results
A 57-year-old Caucasian female presented with left eye irritation and peri-orbital swelling, with a longstanding inability to fully close the left eyelid due to facial nerve palsy. Her history included hyperthyroidism treated with radioiodine and subsequent hypothyroidism for which she takes levothyroxine. Visual acuity was Snellen 6/6 bilaterally, with left lagophthalmos and associated corneal punctate epithelial erosions. A 1.4 gram platinum eyelid weight was inserted, followed by further procedures for persistent lagophthalmos. Her course was complicated by implant-related thinning of the anterior lamella, and eventual exposure of both platinum and later gold weights, requiring removal. She then developed granuloma formation and scarring, necessitating medical and surgical management including eyelid corticosteroid injections and scar revision.Due to ongoing symptoms and implant intolerance, a dermal fat graft was used to reconstruct the upper eyelid. A dermal fat graft was harvested from the lower abdomen, selected as a non-hair-bearing site with adequate subcutaneous tissue. The graft was appropriately sized to restore volume while preserving central vascularity and allowing for some degree of fat atrophy. This was positioned in the left upper eyelid at the level of the tarsal plate to reconstruct the medial defect found in the posterior lamella during dissection and add volume to the upper eyelid to help reduce the lagophthalmos. At seven months, the eye was comfortable with reduced lagophthalmos, reduced dependency on lubricants and a well lubricated ocular surface.
Conclusion
Dermal fat grafting may provide an effective alternative in patients with paralytic lagophthalmos who experience complications with synthetic eyelid implants, offering reduced risk of immune rejection and foreign body reactions along with good functional outcomes.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Chandrashekhara | Rai | Norfolk and Norwich University Hospital |
| Bijan | Beigi | Norfolk and Norwich University Hospital |