Euryblepharon is associated with both vertical shortening and horizontal lengthening of the lower eyelids and may be associated with BPES (Figs 10-4, 10-5). The lateral portion of the eyelid is typically more involved than the medial aspect, and the palpebral fissure often has a downward slant due to an inferiorly displaced lateral canthal tendon. Impaired blinking and lagophthalmos may lead to exposure keratitis. If the condition causes symptoms, reconstruction may include lateral canthal repositioning along with suspension of the suborbicularis oculi fat to the lateral orbital rim to support the lower eyelid. If excess horizontal length is present, a lateral tarsal strip or eyelid margin resection may be required. Skin grafts may occasionally be necessary.
Figure 10-2 The 5-flap technique for blepharophimosis syndrome. A, The telecanthus is addressed with multiple Z-plasties or Y-V-plasties, marked along the epicanthal folds. B, After the flaps are elevated, the medial canthal tendon is repositioned with suture or transnasal wiring. C, The transposed flaps are sutured. D, Elevation of the upper eyelid demonstrates the improved medial canthal position and increased visibility of the medial sclera.
(Courtesy of Cat N. Burkat, MD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.