title: Composite septo-retractor recession; a surgical technique for lower-eyelid retraction and review of the literature.
abstract: OBJECTIVE
  To report the outcomes of a technique for correcting lower-eyelid retraction with composite recession of the inferior retractor and orbital septum complex, release of the lateral horn of the lower-eyelid retractors, and the orbito-malar ligament (OML) followed by skin, orbicularis, and conjunctival advancement.
  
  
  METHODS
  We performed a retrospective, noncomparative review of consecutive procedures performed on patients with lower-eyelid retraction undergoing composite septo-retractor recession for lower-eyelid retraction over a 4-year period, performed or supervised by a single surgeon (RM). Outcomes are based on postoperative standard photographs, including central pupil to lower-eyelid distance, inferior scleral show, and subjective improvement in lower-eyelid lateral flare.
  
  
  RESULTS
  We reviewed 26 eyes of 16 patients (12 men, 4 women; mean age, 61.0 ± 14.3 years). Causes of lower-eyelid retraction included involutional (n = 6), thyroid orbitopathy (n = 4), previous lower-eyelid surgery (n = 3), mechanical secondary to proptosis (n = 1), Crouzon syndrome (n = 1), and longstanding facial nerve palsy (n = 1). Mean lower-eyelid elevation achieved was 1.4 mm ± 1.3 mm (range, 0.2 to 6.6 mm; p = 0.001). Scleral show improved by 1.0 ± 0.7 mm (range, 0.0 to 2.9; p = <0.001). Preoperatively, all patients had an altered lower-eyelid contour with lateral flare, 89% cases being graded "significant." Lower-eyelid contour improved postoperatively, with only 19% graded "significant" lateral flare (p = <0.0001). No significant complications occurred, although one patient required excision of a secondary lateral canthal cyst.
  
  
  CONCLUSIONS
  Composite recession of the inferior retractor and orbital septum complex combined with release of the inferior retractor lateral horn and the OML significantly improves lower-eyelid height and contour in cases of lower-eyelid retraction and should be considered a useful option for this condition.
authors.affiliation: Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Norris
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000772:Anesthesia, Local / Q000379:methods; D005141:Eyelid Diseases / Q000601:surgery*; D005152:Facial Muscles / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies