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PD Langer, A Yamani; SOOF (Suborbicularis Oculi Fat) Lift for the Repair of Severe Lower Eyelid Ectropion and Retraction in the Setting of Facial Palsy . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1474.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe the results of using a SOOF lift to repair lower eyelid malposition due to cranial seventh nerve palsy. Methods: Retrospective case series. Results: We report seven eyes in six patients (three male and three female) with mechanical ectropion and retraction of the lower eyelid due to facial palsy. Patient ages ranged from 40 to 89 years with mean age of 71. All eyelids preoperatively had severe ectropion and significant scleral show resulting in exposure keratopathy. All patients underwent transconjunctival SOOF lift under general or local anesthesia in conjunction with a lateral canthoplasty. Two surgeries of the seven were re-operations after the patients had unsuccessful primary repair of the ectropion without SOOF lift. Patient follow-up ranged from 4-21 months (mean 11 months). Two of the ectropion and retraction repairs with SOOF lift subsequently required medial canthoplasties for residual medial ectropion. 6 of the 7 eyes had Gold Weights placed in the upper eyelids to reduce the palpebral aperture either before, during, or after the SOOF lift. All seven eyes of the six patients had reduction of the ectropion and retraction, with the lower eyelid at or within one millimeter of the inferior limbus postoperatively, and all experienced resolution of exposure keratopthy. None of the patients experienced infra-orbital nerve anesthesia or recurrent retraction of the lower eyelid. Conclusion: Management of patients with mechanical ectropion resulting from facial palsy is challenging. Routine ectropion and/or retraction repair may ultimately fail because of chronic inferior traction on the lower eyelid from the sagging, paretic facial skin and muculature. The SOOF lift provides support for the midfacial tissues, thereby alleviating the inferior gravitational pull of the paretic face on the lower eyelid. Elevating and supporting the midface through a SOOF lift allows a canthal tightening procedure to support only the eyelid rather than supporting the entire midface. The fact that the SOOF is thinnest medially may account for two of our patients needing subsequent medial canthoplasties; one may therefore consider medial canthoplasty along with a SOOF lift and lateral canthoplasty in the most severe cases of mechanical ectropion and retraction in this setting. The SOOF lift is a promising adjuvant to lower eyelid mechanical ectropion repair in chronic facial palsy. Supported by: Research to Prevent Blindness, Inc., The NJ Lions Eye Research Foundation, The Eye Institute of New Jersey.
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