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Lateral Orbital Rim Fixated

Porcine Acellular Dermal Matrix

Splint for Refractory Lower Eyelid

Retraction and Poor Eye Prosthesis

Retention

Presented in part at: American Society of Ophthalmic Plastic and Reconstructive Surgery
Fall Scientific Symposium in New Orleans, Louisiana, November 10, 2017

ABSTRACT

Ocular prosthesis retention may be poor in the setting of lower eyelid
retraction and loss of eyelid ligamentous support. Lateral canthoplasty alone
is often insufficient. We report a surgical technique and describe outcomes
with the novel use of an acellular dermal collagen-matrix graft fixated
to the lateral orbital rim. The series included six patients with lower eyelid
malposition and poor prosthesis retention who had failed previous surgical
Authors: interventions. The laterally fixated graft was effective in improving lower
Giancarlo A. Garcia, Byers Eye eyelid stability and ocular prosthesis retention in this small series of patients
Institute, Stanford University,
Palo Alto, California with anophthalmic sockets and refractory lower eyelid malposition.
Emily S. Charlson, Byers Eye
Institute, Stanford University,
Palo Alto, California
Thomas A. Vo, Albert Einstein Introduction
College of Medicine, Bronx,
New York Inadequate ocular prosthesis retention is a common problem in patients
with an anophthalmic socket. Lower eyelid retraction with ligamentous
1,2
Marc A. Yonkers, Kaiser Permanente,
3
San Francisco, California laxity may cause an eye prosthesis to prolapse or fall out spontaneously.
Don S. Minckler, Gavin Herbert Eye Excessive lid laxity, and in particular, floppy eyelid syndrome, may
Institute, University of California, significantly hinder prosthesis fit and function.
Irvine, California A poorly fitting ocular prosthesis itself may stretch the lower eyelid over
Jeremiah P. Tao, Gavin Herbert Eye time. Kaltreider demonstrated that larger prosthetic volume (in the range
4
Institute, University of California, of 3 to 4 mL) is associated with a greater incidence of lower eyelid laxity and
Irvine, California
malposition. This has been similarly described with the addition of acrylic
on the posterosuperior aspect of the prosthesis, which contributes excess
Correspondence to: weight, which can lead to sagging of the lower eyelid. Thinning the
5
Giancarlo A. Garcia, MD prosthesis is an option in some cases; however, upper eyelid ptosis and
Byers Eye Institute, Stanford University other facial asymmetry may ensue.
2452 Watson Court Surgical repair of recalcitrant cases of lower eyelid retraction—
Palo Alto, California 94303 particularly those associated with longstanding poor prosthesis fit—
650-723-6995 • 650-725-6619 (F)
gcgarcia@stanford.edu may be challenging. A lateral canthoplasty, such as the lateral tarsal strip
procedure, may improve some cases; however, often the improvements
Keywords: are short-lived or otherwise insufficient.
Anophthalmic socket, eyelid retraction,
floppy eyelid, spacer graft, acellular
dermal matrix, eye prosthesis,
ectropion, eyelid laxity

26 | GARCIA JOURNAL OF OPHTHALMIC PROSTHETICS