Full-Thickness Blepharotomy

Abstract

The use of a full-thickness graded blepharotomy technique through the levator aponeurosis, Muller’s muscle, and conjunctiva provides both an effective and predictable surgical treatment to help patients with mild to severe eyelid retraction. Patients who suffer from upper eyelid retraction from thyroid eye disease, cicatricial trauma, graft-versus-host disease, and paralytic facial nerve palsy may all benefit from symptomatic relief of lagophthalmos and dry eyes, as well as cosmetic improvement of eyelid malposition. Many surgeons have modified this procedure using partial-thickness techniques, rotation sutures, and en bloc resections. These variations of eyelid blepharotomy can also be applied in mild blepharoptosis. Nonsurgical options such as symptomatic relief with lubrication, botulinum toxin injections to decrease retraction, and soft tissue fillers can often provide temporary relief. In conclusion, full-thickness and partial-thickness blepharotomy techniques can be reliable procedures to correct eyelid height and contour abnormalities such as retraction and ptosis.