Change in Eyelid Position
Change in the position of the eyelids is most likely to occur with surgery on the vertical rectus muscles. Pulling the inferior rectus muscle forward, as in a resection, advances the lower eyelid upward; recessing this muscle pulls the lower eyelid down, exposing sclera below the lower limbus (Fig 14-9). Surgery on the superior rectus muscle is less likely to affect upper eyelid position.
Changes in eyelid position can be obviated somewhat by careful dissection. In general, all intermuscular septum and fascial connections of the vertical rectus muscle must be severed at least 12–15 mm posterior to the muscle insertion. Release of the lower eyelid retractors or advancement of the capsulopalpebral head is helpful to prevent lower eyelid retraction after inferior rectus muscle recession.
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.