title: Dynamic diagnosis of "fishmouthing" syndrome, an overlooked complication of blepharoplasty.
abstract: BACKGROUND
  Dysfunction and/or dehiscence of the lateral canthus is 1 source of symptomatic eyelid closure disorder after blepharoplasty. Because the resulting concentric blinking movement resembles mouth closure in a fish, the name "fishmouthing" syndrome (FS) was given to this condition. Fishmouthing syndrome appears to be an overlooked complication of blepharoplasty.
  
  
  OBJECTIVE
  The authors performed dynamic assessments of patients who had eyelid discomfort after blepharoplasty to establish the clinical signs of FS.
  
  
  METHODS
  Preoperative and postoperative videos of 36 patients who presented for secondary blepharoplasty were analyzed retrospectively. All 36 patients experienced symptoms of dry eyes and eye discomfort after their initial blepharoplasty and desired symptomatic and cosmetic improvement. The dynamic signs and diagnostic criteria for FS were established clinically and through video analysis of patients' blinking movements.
  
  
  RESULTS
  The most common clinical characteristics of FS included lash deformity ("cow lash" sign), abnormal medial displacement of the lateral canthus during blinking, deformity (rounding/narrowing) of the lateral scleral triangle, and visible eyelid closure deficiency or gapping. Other characteristics were lower-lid retraction and compensatory hypercontraction of the orbicularis oculi adjacent to the inner canthus.
  
  
  CONCLUSIONS
  Patients with FS present with a combination of clinical symptoms and signs and are best diagnosed through dynamic visualization of the animated tissue during blinking. Evaluation of preoperative videos is an essential tool for surgical planning and for analyzing the results, both before and after corrective surgery, in patients with potential FS.
  
  
  METHODS
  4.
authors.forename: Clinton D
authors.initials: CD
authors.lastname: McCord
authors.forename: Gabriele C
authors.initials: GC
authors.lastname: Miotto
mesh_terms: D000368:Aged; D019882:Blepharoplasty / Q000009:adverse effects* / Q000379:methods; D001767:Blinking; D015331:Cohort Studies; D003231:Conjunctivitis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D005143:Eyelids / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013577:Syndrome; D016896:Treatment Outcome; D014741:Video Recording
keywords: blepharoplasty; canthal dehiscence; canthoplasty; drill-hole canthopexy; dry eye; fishmouthing syndrome; oculoplastic surgery