The lower-eyelid tarsal-strip procedure

Ear, Nose & Throat Journal, Nov, 2005 by Dana S. Smith, Mark K. Wax

Facial paralysis affecting the orbicularis oculi can result in a loss of blink, an inability to achieve full eye closure, and lower-lid laxity. Subsequent catastrophic ophthalmologic complications, such as exposure keratitis and corneal ulceration, may occur if the periocular aspects of the paralysis are left untreated. An upper-eyelid gold-weight implant can help produce a gravity-dependent blink, but the eye may not close completely because of lower-lid canthal laxity. The tarsal-strip procedure is designed to correct lid laxity by shortening the lower canthus and suspending it from the medial surface of the lateral orbital rim.

The first step is to mark a 1-cm incision along a natural wrinkle line in the lateral canthal area. The marked area is infiltrated with 1% lidocaine in 1:100,000 epinephrine. Sharp scissors are used to cut through the orbicularis oculi all the way down to the lateral orbital rim. The anterior lamellar flap (skin and muscle) is dissected inferiorly and off the lateral aspect of the inferior canthal tendon (figure 1, A). Next, the conjunctiva is dissected from the inferior canthal tendon, and an inferior cantholysis is performed. The lower canthal tendon is stretched to the orbital rim so that the surgeon can estimate the amount of shortening required for proper lid tension (figure 1, B). The gray line is removed, and the flap of excess skin and muscle is trimmed. The lower canthal tendon is then suspended to the periosteum over Whitnall's tubercle with a 4-0 polydioxanone or 4-0 Mersilene suture (figure 1, C). The skin of the lateral canthus is then reapproximated with a running 6-0 fast-absorbing gut suture.

[FIGURE 1 OMITTED]

In the case illustrated in this article, the final cosmetic results are good (figure 2).

[FIGURE 2 OMITTED]

Dana S. Smith, MD; Mark K. Wax, MD

From the Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland.