Upper eyelid retraction after glaucoma filtering surgery and topical application of mitomycin C

Changes in eyelid position after glaucoma filtering surgery

BACKGROUND

While ptosis is a well-known consequence of glaucoma surgery, some isolated case reports point to the possibility of upper eyelid retraction occurring after glaucoma surgery. This study aims to analyze the occurrence of ptosis and eyelid retraction after glaucoma surgery and to evaluate factors contributing to these palpebral fissure changes.

METHODS

Cross-sectional study including 100 eyes of 100 patients that had undergone unilateral glaucoma surgery. Upper eyelid height in the operated eye was measured by digital photography and compared with the fellow, non-operated eye. The main outcome was to determine if ptosis or retraction occurred in the operated eye in comparison with the fellow eye. The secondary outcome was to determine if any variable was associated with ptosis or retraction. A clinically significant difference (either toward ptosis or retraction) was defined as a difference ≥1 mm between both eyes.

RESULTS

Of 100 eyes included 81 (81%) showed no change in eyelid height (-0.133 mm ± 0.496), 11 (11%) showed ptosis (-1.348 mm ± 0.387) and 8 eyes (8%) showed retraction (1.705 ± 0.634). A statistically significant relation was found between ptosis and pseudoexfoliation glaucoma (p = 0.003). A trend toward lower postoperative IOP and higher conjunctival blebs was found in eyes with postoperative eyelid retraction.

CONCLUSIONS

Eyelid retraction was present in 8% of patients and ptosis in 11%. Patients with eyelid retraction showed around a 3 mmHg lower postoperative IOP than eyes without retraction. The presence of pseudoexfoliation may be a risk factor for this complication. A prospective study with a large number of patients would be required to confirm these results.

Non-aesthetic indications for periocular hyaluronic acid filler treatment: a review

Dermal fillers have been in use for many years for aesthetic rejuvenation of the face. More recently, however, fillers have been increasingly used as an alternative to traditional surgical procedures for non-aesthetic indications. These indications include lagophthalmos, eyelid malpositions and orbital volume deficiency. The advantages of these filler injections are multiple: minimally invasive, repeatable, titratable and even reversible (depending on the product used). We review the current literature of functional uses of filler injections as mentioned above and evaluate the safety profile and efficacy of filler injections for this purpose.

Repair of eyelid retraction due to a trabeculectomy bleb: case series and review of the literature

Superior limbal trabeculectomy remains a common surgical treatment for glaucoma. Positional effects on the overlying upper eyelid-both ptosis and retraction-have been associated with the procedure. More than 1 mechanism may explain retraction; however, the eyelid may elevate mechanically due to the underlying raised superior bulbar conjunctiva.

Hyaluronic acid treatment for upper eyelid retraction after glaucoma filtering surgery

A 51-year old female presented with upper lid retraction after glaucoma filtering surgery. After two surgical procedures to correct the retraction with only transient effect, she was finally treated with hyaluronic acid gel filling achieving good aesthetic and functional result.

Lid retraction following glaucoma filtering surgery: a case series and literature review

PURPOSE

To describe 5 cases of lid retraction associated with large cystic glaucoma filtering blebs.

METHODS

Retrospective case reports and literature review.

RESULTS

All 5 patients had lid retraction due to glaucoma filtering blebs. Two were successfully managed surgically by graded blepharotomy with resolution of lid retraction and bleb dysesthesia symptoms. Three patients were managed symptomatically.

CONCLUSIONS

Lid retraction due to cystic glaucoma blebs is an unusual entity and a diagnosis of exclusion. The exact pathogenesis of the condition is unclear. Conservative, medical and surgical interventions exist to manage the lid retraction and any associated bleb dysesthesia.