Stepwise management of upper eyelid retraction after Hughes flap
Author: Alberto Chierigo
Base Hospital / Institution: Ophthalmology Department – San Martino Hospital, University of Genova
ePoster presentation
Abstract ID: 24-298
Purpose
Upper eyelid retraction is a known complication of the Hughes flap (HF) and can be managed with several surgical techniques. We describe a case in which upper eyelid retraction was managed in a stepwise fashion, starting with a conservative approach, and progressively transitioning to more powerful and invasive procedures.
Methods
A 68-year-old woman underwent an uneventful HF procedure to reconstruct her lower eyelid after excision of a squamous cell carcinoma.
Results
Upper eyelid position and contour were normal after eyelid separation. Upper eyelid retraction (MRD1 8 mm) was noted 1 week thereafter and was associated with an inflamed eyelid, lagophthalmos and upper lid lag. Clinical examination revealed excessive scarring in the inner lamella, which was managed with four weekly triamcinolone injections and vigorous downward massage. Lubricants were prescribed to relieve symptoms. This treatment improved symptoms but had a minimal effect on upper eyelid position (MRD1 7 mm).
Six months later, internal recession of the Muller muscle was performed to provide additional lowering of the upper eyelid. The result was acceptable, but the patient sought further improvement in her eyelid position, therefore an upper blepharotomy will be performed.
1.25 IU of botulinum toxin type A was injected in the levator muscle to decrease upper eyelid retraction until blepharotomy.
Conclusion
Upper eyelid retraction can be managed in a stepwise fashion. This approach is safe and effective and allows the surgeon to deliver the least invasive procedure that addresses patients’ complaints.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Chiara | Del Noce | Ophthalmology Department – San Martino Hospital, University of Genova |
| Michele | Iester | Ophthalmology Department – San Martino Hospital, University of Genova |
| Carlo Enrico | Traverso | Ophthalmology Department – San Martino Hospital, University of Genova |
| Alessandra | Zambelli | Ophthalmology Department – San Martino Hospital, University of Genova |
