MMCR failure. What can be done? (Photo)

Question

Hello, I have acquired Horners syndrome after a thyroidectomy. I recently had MMCR surgery to repair my left lid. Surgery does not appear to be a success and the eye appears worse than before. The lower lid looks higher and eye asymmetry is more noticeable. I did see a great occuloaastic eye surgeon. What can be done

Kenneth D. Steinsapir, MD · Answer

As a surgeon I expect the photo to be "anatomically' oriented. That means the eye on the right side of the image is the left eye and the eye on the left side to be the right eye. Often the public post the image reversed. That makes for a lot of confusion. Horner's syndrome in upper eyelid ptosis and pupillary constriction, the affected skin also does not sweat (anhidrosis), These eyes have equal pupillary size so it is not possible to identify right from left on this basis in this image. What the photo does show is one eyelid with upper eyelid retraction. The upper eyelid fold are asymmetric with less platform show on the side with upper eyelid margin retraction (eye is too open). It is difficult to know for sure from this photo but it appears that the eye with retraction may also be more prominent but this may just the the result of the retraction. These are issues that can be addressed with revisional surgery. The first step is a detailed, in person assessment.

Allan E. Wulc, MD · Answer

Hi Cheerful331303
You are definitely asymmetric. If anything the right upper eyelid appears retracted. That would be consistent with your history of thyroidectomy--you may have thyroid related upper eyelid retraction. You and your doctor would need to look at pictures of you from years ago before you developed any thyroid problems to see whether the right upper eyelid has changed position--actually gone upwards. I also don't see any asymmetry of the pupils in this photo--something I would expect in a patient with Horner's syndrome.
Your options are to consider additional ptosis surgery to the left eye--either using an internal approach as was done prior and which has been described, or more likely an anterior approach where the tendon to the muscle not affected by the Horner's syndrome, the levator muscle and its aponeurosis can be tightened.
Another option--one that I would probably recommend-- would be to lower the right upper eyelid. This procedure would probably give you the most natural and aesthetically appearing result. The procedure, like the MMCR, can be done with an internal approach.
Good luck!

Ayse Dolar Bilge, MD · Answer

I think your other eyelid has retraction so retraction surgery for your retracted eyelid is a better surgical option.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your experience and posting your photo. You should have revision surgery with an oculofacial surgeon. Most are skilled enough to manage your problem. 
Good luck,

Michael A. Burnstine, MD · Answer

Before having additional surgery, I advice getting thyroid function tests. These include T3, T4, TSH, Thyroid Peroxides Antibody and Thyroid Stimulating Antibody. My concern is that you have thyroid eye disease. Comparing your current photograph to a driver's license or older photos will help to determine weather the right upper eyelid is retracted. It is critical to compare old photo eyelid position to your present photo.

Alan Gonzalez, MD, FACS · Answer

Hello @Cheerful331303, thank you for your question. To make an informed recommendation, more information is needed. A consultation is vital to establishing a surgical plan that meets your needs, meets your expectations, and takes into account what is possible. Best wishes! Alan Gonzalez MD, FACS.  American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Cameron Nabavi, MD, FACS · Answer

If I am reading this correctly, the left lid in the picture was lower and MMC has resulted in it being now higher than the unaffected lid. If this is the case, surgery can be done to correct this. This can be done internally through the inside oft he upper lid or externally through an eyelid crease incision. It can be a challenging surgery as there is unpredictability where it can look perfectly symmetric at the time of surgery but can come back up or become droopier. There can be times where several surgeries may be necessary to achieve the final result.

MMCR failure. What can be done? (Photo)

Answers (7)

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