Outcomes of lower eyelid retractor recession and lateral horn lysis in lower eyelid elevation for facial nerve palsy

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Abstract
To report outcomes and complications of lower eyelid retractor recession and lateral horn lysis (RR) for lower eyelid elevation in patients with facial nerve palsy (FNP). Retrospective review. Patients with FNP undergoing RR alone (group 1) or with adjunctive procedures (canthal suspension—group 2, tarsorrhaphy—group 3, and full-thickness skin graft—group 4) during a 5-year period were included. Patient demographics, lagophthalmos, occurrence of eyelid malpositions, recurrent retraction, and repeat procedures were noted from medical records. Measures of lower eyelid height (LEH) and lid lag on downgaze were obtained from standard photographs. Forty-two patients (23 females, mean age was 59 years) were included. Mean follow-up was 24 months (range 6–77). Median improvement in LEH following surgery was significant in Group 1 (0.90 mm, IQR: 0.37–0.91, P=0.20) and in Group 2 (0.51 mm, IQR: 0.30–1.37, PP=0.02) in Group 1 and 3.50 mm (IQR: 1.75–5.00, PP=0.02) in Group 1 and 1.00 mm (IQR: 0–2.13, P=0.006) in Group 2. No new cases of ectropion were noted. 23.5% of patients required a repeat RR at a mean interval of 20 (range 1–70) months and a further 9.8% required a third procedure at a mean interval of 21 (range 18–29) months. RR improves lower eyelid retraction and lagophthalmos in FNP either alone or when combined as an adjunctive procedure. It does not aggravate paralytic ectropion although repeated retractor recessions may be required to improve retraction.

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