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Full-Thickness Eyelid Resection in the Treatment of Secondary Ptosis

Purpose: To describe horizontal full-thickness eyelid resection for the treatment of ptosis as related to overcorrections after levator recession for eyelid retraction in Graves disease or repeatedly failed external levator advancement. Methods: The authors present a retrospective case study of 19 eyelids of 17 patients with refractory ptosis. Patients were selected based on history of horizontal full-thickness eyelid resection to treat ptosis secondary to over-recessed Müller and levator muscles, persistent ptosis after levator advancement/resection, or persistent ptosis after internal levator advancement. Results were graded from eyelid measurements taken before and at least 6 weeks after treatment. Results: All eyelids were measured preoperatively and postoperatively for the following parameters: palpebral fissure in primary gaze nasally (N), centrally (C), and temporally (T); upper eyelid margin to light reflex distance in primary gaze; upper eyelid margin to crease distance; and upper eyelid margin to fold distance. Final postoperative measurements were taken at a minimum of 2 months. Thirteen eyelids had a history of previous Müller muscle excision/levator recession, 3 eyelids had a history of previous levator advancement/resection, 2 eyelids had previous internal levator advancement, and 1 eyelid had previous cosmetic eyelid surgery. All 17 patients were women. Patients ranged in age from 41 to 63 years. All patients had cosmetically and functionally satisfactory results. Conclusions: Horizontal full-thickness eyelid resection is a unique procedure that can provide an excellent result for patients with residual ptosis with no recurrence of ptosis during an average of 2 to 3 months follow-up.