CASE REPORT How to Repair the Lower Eyelid Retraction, Resulting From the Primary Surgery for Epiblepharon?

Objective: Among the surgical procedures used to correct the positions of the eyelids or improve their cosmetic appearance, procedures for treating eyelid retraction are some of the most challenging. Lower eyelid retraction can occur iatrogenically after various surgical procedures. We performed a successful corrective procedure for lower eyelid retraction, which had occurred at some point in the 2 decades after primary surgery for epiblepharon. Method: A 23-year-old woman underwent primary surgery for bilateral epiblepharon at the age of 5 years. However, at the age of 17, she noticed that an abnormally large proportion of her right sclera was visible when her eyes were in their natural position. In the primary position of gaze, the distance from the lower limbus of the right cornea to the upper margin of the lower eyelid was approximately 2 mm. An incision was made in the lower eyelid along the scar caused by the previous operation. Subsequently, the connections between the tarsus and the lower eyelid retractors were broken, and harvested auricular cartilage was placed between the lower edge of the tarsus and the lower eyelid retractors. Results: One year after the operation, there was no gross difference in the distance between the lower margin of the corneal limbus and the lower eyelid on either side, and the patient was extremely happy with the results. Conclusion: Using a novel surgical technique, we successfully lengthened the posterior layer of the lower eyelid retractors with a small amount auricular cartilage, resulting in good functional and cosmetic outcomes.