- Experiencing dry eyes from excessive width of medial canthus (both eyes). - Problem from ages 20-24; I do not know what caused it. - My oculoplastic surgeon performed lower eyelid lengthening with sclera graft (both eyes). - I believe lagophthalmos is a result of excessive canthus width. - I do not know what caused ptosis. - Unable to fully close eyes. - I have never been able to wink with my right eye my entire life. What options are available to help me?
Excessive Width of Medial Canthus - Lagophthalmos - Ptosis - Dry Eyes
Doctor Answers 4
There is no substitute with a personal consultation with a true expert.
Your history with regard to your issues and the time of the surgery is not clear. Aggressive lateral canthoplasty can pull the medial canthal tendon as you illustrate in your photos. Unintended side effects of a large canthotomy, a step in the lateral canthal tightening procedure can actually weaken or paralyze the orbicularis oculi muscle of the upper eyelid platform worsening eyelid closure and lagophthalmos. There is room for debate but some patients experience inflammation of sclera grafts which because they are foreign material often get removed by the body after surgery. For this reason, there is an argument to be made for other posterior lower eyelid spacer graft material. I still prefer hard palate graft. However, this also means borrowing tissue from the roof of the mouth. In my hands, this tends to be a more robust procedure than other products.
Dry eye and ptosis
I would strongly recommend another opinion from an ophthalmic plastic surgeon. It is hard to tell from the history given and photos what the cause of your issues are. A detailed examination would shed light on this. Be patient and attain data to make the best informed decision. Avoid surgical intervention until you have all the information you need.
Eyelids are very complex structures, and correction of small problems (what you refer to as canthal width) may not be possible. This is certainly a case for an oculoplastic surgeon. Be prepared to accept his advice if he suggests that surgery is inappropriate at this stage.
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