FEB 15, 2011
In en-glove fashion through a small lateral upper lid crease incision, the lower eyelid retractors are separated from the conjunctiva, inferior tarsus and septum. Middle lamellar scar is lysed. A postauricular dermis strip graft is threaded through the pocket created using a guarded Keith needle, and fixated to the medial and lateral canthal tendons. Lateral canthal resuspension is performed without canthotomy. A reverse Frost suture stents the eyelid for one week. The combination of retractor release, reconstitution of eyelid volume, and re-establishment of a buffer between skin and retractors, results in decreased sclera show and irritative symptoms. En-glove lysis combined with dermis strip graft provides a minimally invasive approach to address cicatricial lower eyelid retraction.