CONCLUSIONES

REFERENCES

Biglan AW. Control of eyelid retraction associated with Graves’ disease with botulinum toxin A toxin. Ophthal Surg 1994; 25:186–188.

Bodker FS, Putterman AM, Laris A, et al. The effect of hyperthyroidism on Müller’s muscle contractility. Ophthal Plast Reconstr Surg 1997; 13:161–167.

Cruz AA, Coelho RP, Baccega A, et al. Digital image processing measurement of the upper eyelid contour in Graves’ disease and congenital blepharoptosis. Ophthalmology 1998; 105:913–918.

Dutton JJ. Atlas of ophthalmic surgery. Oculoplastic, Lacrimal, and Orbital Surgery. Vol. II. St Louis: Mosby Year Book, 1992: 144–153.

Elner VM, Hassan AS, Frueh BR. Graded full-thickness anterior blepharotomy for upper eyelid retraction. Trans Am Ophthalmol Soc 2003; 101:67–73.

Feldman KA, Putterman AM, Farber MD. Surgical treatment of thyroid-related lower eyelid retraction: a modified approach.

Ophthal Plast Reconstr Surg 1992; 8:278–286.

Grove AS Jr. Levator lengthening by marginal myotomy. Arch Ophthalmol 1980; 98:1433–1438.

Kim JW, Ellis DS, Stewart WB. Correction of lower eyelid retraction by transconjunctival retractor excision and lateral eyelid suspension. Ophthal Plast Reconstr Surg 1999; 15:341–348.

Morton AD, Alner VM, Lemke BN, White VA. Lateral extension of the Muller muscle. Arch Ophthalmol 1996; 114:1486–1488.

Morton AD, Nelson C, Ikada Y, Elner VM. Porous polyethylene as a spacer graft in thee treatment of lower eyelid retraction.

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Mourits MP, Sasim IV. A single technique to correct various degrees of upper lid retraction in patients with Graves’ orbitopathy.

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Retraction of the Eyelid

Steatoblepharon

CLINICAL PRESENTATION The eyelids appear full as the prolapsed orbital fat protrudes beneath the eyelid skin. In the upper eyelid the medial fat pocket is typically the most prominent. Bulging in the lateral upper eyelid is usually not fat, but almost always the result of a prolapsed lacrimal gland.

In the lower eyelid there are three compartmentalized fat pockets in 70% of individuals. Other variations include two pockets or even one contiguous pocket. The lateral pocket is typically the most prominent, but fat prolaps often also involves the medial and central fat pockets with a bulging contour across the entire lower eyelid. Steatoblepharon is usually associated with dermatocholasis and in the upper lid may be obscured by extensive overhanging skin folds.

Excessive steatoblepharon is typically associated with some systemic disease such as Graves’

orbital disease where the fat can be edematous and also increased in volume.

TREATMENT Treatment is surgical, and often combined with a blepharoplasty. If skin is also to be excised the incision is anterior. For mild fat prolapse the orbital septum can be tightened with light cautery.

For more significant degrees of fat prolapse the septum is opened and each fat pocket is isolated, cauterized, and excised. If the lacrimal gland is prolapsed into the lateral upper lid, it is reposi-tioned beneath the superior lateral orbital rim with a suture. In the lower lid when only steatoblepharon is present without dermatochalasis, as in younger patients, a transconjunctival incision can be used. Here the lower capsulopalpebral fascia is opened and the fat pockets excised without disturbing the orbital septum. Care should be taken not to put excessive traction on the fat to avoid possible orbital hemorrhage. When excess skin is also present in the lower lid, a transcutaneous incision is preferred, and the skin is tightened laterally. The modern trend is to reposition most of the fat into the tear trough and beneath the descended malar fat pad.

Steatoblepharon

REFERENCES

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Choo PH, Rathbun JE. Cautery of the orbital septum during blepharoplasty. Ophthalm Plast Reconstr Surg 2003; 19:1–4.

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Goldberg RA, Edelstein C, Shorr N. Fat repositioning in lower blepharoplasty to maintain infraorbital rim contour.

Facial Plast Surg 1999; 15:225–229.

Goldberg RA, McCann JD, Fiaschetti D, Ben Simon GJ. What causes eyelid bags? Analysis of 114 consecutive patients.

INTRODUCTION The tarsal kink syndrome is a variant of congen-ital entropion in which there is a horizontal kink or bend in the tarsal plate of the upper eyelid. The cause is unknown, but may be related to in utero environmental factors.

CLINICAL PRESENTATION Typically seen in newborn infants, the eye is red and there may be corneal abrasion. Frank corneal ulceration is not an uncommon sequel, and if not managed early, amblyopia may ensue. The

upper eyelid is swollen, with entropion of the lash-bearing margin. The horizontal lid crease is absent, exacerbating the entropion, and there may also be some degree of ptosis. A horizontal ridge representing the tarsal kink may be felt on palpation 3 to 4 mm from the lid margin. Reflex blepharospasm is not uncommon as a result of the corneal irritation. On eversion of the upper eyelid a kink is seen on the tarsus as a concavity just beneath the conjunctiva. The condition is frequently misdiagnosed and treated as conjunctivitis, thus prolonging corneal injury.

TREATMENT Prompt recognition and treatment of this condition is essential to prevent significant corneal injury and amblyopia. Treatment depends upon the severity of the tarsal deformity. In some cases simple everting eyelid sutures may cure the condition, as will resection of a horizontal strip of skin and orbicularis muscle. In more marked cases a horizontal blepharotomy incision in the region of the kink combined with sutures may be needed. A full marginal rotation procedure through a skin incision will permanently reshape the tarsus in even the most severe situations.

REFERENCES

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Dutton JJ, Tawfik HA, DeBacker CM, Lipham WJ. Anterior V-wedge resection for cicatricial entropion. Ophthal Plast Reconstr Surg 2000; 16:126–130.

Lucci LM, Fukumoto WK, Alvarenga LS. Trisomy 13: a rare case of congenital tarsal kink. Ophthal Plast Reconstr Surg 2003;

19:408–410.

McCarthy RW. Lamellar tarsoplasty—a new technique for correction of horizontal tarsal kink. Ophthalmic Surg 1984;

15:859–860.

Salour H, Owji N, Razavi ME, Zeaei H. Tarsal kink syndrome associated with congenital corneal ulcer. Ophthal Plast Reconstr Surg 2003; 19:81–83.