Purpose:
Eyelid retraction can lead to lagophthalmos, ocular surface exposure, irritation, and in severe cases vision-threatening corneal decompensation. Surgical correction of severe cicatricial lid retraction is challenging, in large part due to recurrent cicatrix formation and residual lid retraction. Use of intraoperative Mitomycin C has previously been described during pterigium excision and trabeculectomy. We report the presentation, radiography, and treatment outcomes in 2 patients with marked cicatricial lid retraction treated with adjunctive intraoperative Mitomycin C (MMC).
Methods:
Records of 2 patients with severe cicatricial lid retraction treated with intraoperative 0.5% MMC for 5 minutes to the area of cicatrix after cicatrix lysis were reviewed.
Results:
2 females had a median age of 52 years (range 30 - 74). Both patients presented after previous surgical intervention. One patient had incision of a right lower lid and lateral canthal abscess in Africa as a child (Fig 1A). The other patient had a left subciliary approach to repair an orbital floor fracture (Fig 2A). Both patients had lagophthalmos and resultant exposure keratopathy/conjunctivitis (Fig 1B, 2B). Patient 1 had repair consisting of lateral canthotomy and cantholysis, cicatrix lysis, MMC, suborbicularis oculi fat lift, and skin grafting. Patient 2 had repair consisting of lateral canthotomy and cantholysis, cicatrix lysis, MMC, and posterior lamellar spacer. At 3 months following surgery, both patients had resolution of lagophthalmos and ocular surface symptoms, and achieved improved cosmesis (Fig 1C, 1D, 2C, 2D).
Conclusions:
Severe cicatricial lid retraction challenges the surgeon to restore more normal lid anatomy and position, while attempting to decrease the likelihood of recurrence. Prevention of future cicatrix formation represents the most difficult clinical dilemma in such cases. We propose a novel adjunctive use of intraoperative MMC to the lysed cicatrix bed to retard future scar formation and recurrence of lid retraction. This may be the first report of MMC used in this fashion and future studies may confirm the success we had in our cases.
Keywords: eyelid • conjunctiva • inflammation