Single Stage Management of Recalcitrant Eyelid Festoons
Author: Zvi Gur
Base Hospital / Institution: 1Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Rapid fire oral presentation
Abstract ID: 24-321
Purpose
Lower eyelid festoons are a challenging aesthetic concern with multiple etiologies, characterized by redundant and edematous folds of lower eyelid skin and minimal orbital fat prolapse. Achieving satisfactory and durable outcomes remains difficult for surgeons. We present our surgical approach to managing lower eyelid festoons.
Methods
We conducted a retrospective chart review of patients who underwent surgical repair of lower eyelid festoons at two different academic centers. Data collected included margin reflex distance (MRD1/2), eyelid malposition, slit lamp examination, postoperative scar appearance, recurrence rate, and patient and physician satisfaction. All procedures were performed under local anesthesia, starting with lower eyelid tightening. An infraorbital curvilinear incision was made along the base of the lowest festoon, followed by subcutaneous dissection superior to the festoon’s peak. The skin was redraped inferiorly, and redundant tissue was excised. Closure was performed with a running 7-0 Prolene suture for the skin. The orbital septum was kept intact with no orbital fat manipulation.
Results
Fifty-four eyes of 27 patients (15 men, 12 women; mean age 69±10 years) were studied, with a mean follow-up of 11 months. The average vertical extent of excised skin was 15 mm. All patients underwent simultaneous lower lid tightening. No patients developed lagophthalmos, corneal staining, or eyelid retraction. One patient developed a hyperemic incision line, and one patient developed an infection at the surgical bed that was resolved with systemic and topical antibiotics. The recurrence rate was 3.7%, with one patient requiring additional skin excision. Patient and physician satisfaction were high.
Conclusion
Direct infraorbital excision of festoons with concomitant preservation of the inferior tarsal orbicularis oculi muscle, lower eyelid tightening and septal preservation is a simple and effective treatment option for managing this condition. Over 10 mm of skin can be safely excised without causing lower eyelid retraction. Outcomes are durable at a mean follow-up of nearly one year.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Cat | Burkat | 1Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel |
| Catherine | Liu | 1Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel |
| Don | Kikkawa | 1Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel |
| Bobby | Korn | 1Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel |
