title: Levator-Muller's muscle recession with tarsorrhaphy: a technique for corneal protection in cases with cicatricial upper eyelid retraction.
abstract: OBJECTIVE
  Cicatricial upper eyelid retraction with exposure keratopathy and impending corneal perforation requires prompt intervention. Standard procedures such as isolated levator recession, botulinum toxin, and lid weights will only induce a partial ptosis. Conventional tarsorrhaphy, though ideal to achieve complete closure, is likely to result in dehiscence in these cases. We describe a one-stage technique of levator and Muller's muscle recession combined with a tarsorrhaphy used in four patients with an impending corneal perforation due to cicatricial lagophthalmos.
  
  
  METHODS
  This is an interventional, non-comparative retrospective case series of four patients who had undergone tarsorrhaphy in combination with levator recession.
  
  
  RESULTS
  In all four cases, it was not possible to mechanically close the eyelids preoperatively due to cicatricial lid retraction involving the middle lamella. The aetiology for lagophthalmos was varied: (Case 1) bilateral sclerosing metastatic breast cancer involving the lids; (Case 2) severe anterior and middle lamella shortening due to actinic changes; (Case 3) middle and posterior lamella shortening due to glaucoma treatment and multiple surgery (Case 4) due to traumatic facial scarring and seventh nerve palsy. In all cases, the corneal thinning and epithelial defects resolved completely following surgery. In one case, we were able to partially reopen the tarsorrhaphy for further corneal surgery.
  
  
  CONCLUSIONS
  We describe a safe, effective and reversible surgical procedure for managing cases with cicatricial upper eyelid retraction, which would otherwise lead to serious corneal complications.
authors.affiliation: University Hospital Coventry, Coventry, United Kingdom. amanna@doctors.org.uk
authors.forename: Avinash
authors.initials: A
authors.lastname: Manna
authors.forename: Purnima
authors.initials: P
authors.lastname: Mehta
authors.forename: Harpreet
authors.initials: H
authors.lastname: Ahluwalia
mesh_terms: D000369:Aged, 80 and over; D002921:Cicatrix / Q000150:complications / Q000601:surgery*; D003316:Corneal Diseases / Q000517:prevention & control*; D004483:Ectropion / Q000209:etiology / Q000601:surgery*; D005142:Eyelid Neoplasms / Q000150:complications / Q000601:surgery; D005151:Facial Injuries / Q000150:complications / Q000601:surgery; D005260:Female; D005901:Glaucoma / Q000150:complications; D006258:Head and Neck Neoplasms / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D062326:Re-Epithelialization