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Canthoplasty for Lagopthalmos?

asked 2 years ago by amcmillen in little rock, arkansas
Latest answer by Chris Thiagarajah, MD
Question viewed 1,062 times
Tags: eyelids, droopy, lagophthalmos

I have lagopthalmos of the left eye from brain surgery, resulting in facial paralysis. I wear an external lid weight for full closure. The bottom lid droops. The eye still sags. I just had a lateral canthal suspension on both eyes in April. It did nothing to fix the problem and even made the rounding of the bad eye worse. I was told it would require a canthoplasty to fix the shape and sagging. Would they undo what was done (undo suspenison and start from scratch)? Is it possible to get insurance coverage for this?

8 answers to Canthoplasty for Lagopthalmos?

Cheeklift for lagophthalmos

In addition to treatment of the upper eyelid, it may be wise to resuspend the lower eyelid via a cheeklift, especially if a canthopexy has failed in the past. With facial paralysis, the orbicularis (eye closing) muscle is deactivated. The cheek droops, literally like a weight dragging down the lower eyelid. Canthopexy or canthoplasty (especially if the lower eyelid is lax) is helpful but we have achieved our best results combining them with a cheek resuspension such as the USIC... more

Brent Moelleken, MD
Beverly Hills Plastic Surgeon

www.drbrent.com

Canthopexy can be undone and insurance could/should pay for future surgeries

It's relatively simple to undo the canthopexy which was done in an attempt to improve your situation. To clarify, lagophthalmos is the inability of the eyelids to close completely. This commonly occurs after nerve damge, as is the case with you. The upper eyelid is being managed with the eyelid weight but the lower lid still is drooping because the nerve to the muscles that hold up the cheek are compromised from your brain surgery. So, now we need to find the best way to get your lower... more

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon

Canthoplasty for lower lid

To help with lagophthalmos after facial nerve palsy, the gold weight in the upper eyelid is helpful. A couple things may help you even more in the lower eyelid 1. Releasing the retractors and raising the lower lid. This can be done with or without a spacer graft 2. Raising the cheek to help raise the eyelid I believe that tightening laterally the eyelid if it is low can help raise the eyelid only to a certain extent. After that the lid has to elevated in some manner. It is my... more

Chris Thiagarajah, MD
Washington DC Oculoplastic Surgeon

Consult with oculoplastic surgeon.

It is possible to get insurance to cover this since it is of medical necessity in nature. It sounds as though you have got weakness and paralysis of the upper and lower eyelid closure mechanism. A canthoplasty can certainly be performed and the lower lid brought up so that the cornea does not dry out. An oculoplastic surgeon with many years of experience who has performed thousands of these types of procedures would be the best person to look for.

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

I am sorry to hear that you are having this difficulty

I am sorry to hear that you are having this difficulty. There are a variety of very useful procedures to help you and others. With such complex problems revision procedures are sometimes needed to get the best results for the patient. While every insurance company is different, in our experience many insurance companies will help.

J. Timothy Heffernan, MD
Seattle Oculoplastic Surgeon

drtimheffernan.com

Canthoplasty will not get this job done

Dear A McMillen This is a not so uncommon situation. I was able to help a woman with severe facial paralysis following the resection of an acoustic neuroma from the brain stem. She had numerous canthoplasties without success. I was able to make a significant difference for her with a surgery that I have developed to address these types of problems. The key is to understand that simply tightening the lower eyelid, no matter how artfully, will never correct the situation. Generally the weight... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Different surgical techniques available for lagopthalmos

Canthoplasty is a more powerful procedure that enables the surgeon to have more control on the lower eye lid tension, position, etc. In cases of paralytic ectropion,a combination of upper eye lid gold weight and lower lid reconstruction. Lower lid techniques include canthopexy, canthoplasty, fascia lata or alloderm sling, etc. Each case has to be reviewed separately and an advice from a plastic surgeon with expertise in this field is essential. Best of luck!

Hisham Seify, MD, PhD
Los Angeles Plastic Surgeon