Tratamento cirúrgico do lagoftalmo paralítico: combinação de enxerto de cartilagem auricular para alongamento da aponeurose do músculo levantador e correção do ectrópio

Abstract

Paralytic lagophthalmos can have devastating consequences for vision if left untreated. Several surgical techniques have been described, including the use of alloplastic and autologous materials. The objective of this study is to evaluate the effectiveness of the surgical treatment of paralytic lagophthalmos with combined techniques using autologous material and involving the upper and lower eyelids. Patients with paralytic lagophthalmos underwent stretching of the levator aponeurosis with interposition of conchal cartilage in the upper eyelid associated with sectioning of the orbitomalar ligament and lateral canthoplasty in the lower eyelid. The effectiveness of the technique was evaluated using subjective (symptomatology) and objective parameters (ophthalmologic evaluation and measurements of lagophthalmos and marginal reflex distances 1 and 2 [MRD1 and MRD2]). Eight patients with paralytic lagophthalmos were subjected to the proposed technique. In the postoperative period, 85.7 % reported complete improvement of symptoms and 62.5 % presented a normal eye examination. The mean lagophthalmos measurement was reduced by 5.93 mm, the mean MRD2 was reduced by 2.61 mm, and the mean MRD1 was reduced by 0.69 mm. In conclusion, the technique presented herein, using autologous material associated with sectioning of the orbitomalar ligament and lateral canthoplasty, was effective in the treatment of paralytic lagophthalmos and did not present significant complications, such as extrusion