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LETTERS TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 5  |  Page : 728

Response to comment on: Upper eyelid levator-recession and anterior lamella repositioning through the gray-line – Avoiding a skin-crease incision


1 Department of Orbit and Oculoplasty, Indira Gandhi Eye Hospital, Lucknow, Uttar Pradesh, India; Department of Corneo - Plastics, Queen Victoria Hospital, East Grinstead, Surrey, United Kingdom
2 Department of Corneo - Plastics, Queen Victoria Hospital, East Grinstead; Department of Ophthalmology, Frimley Park Hospital, Surrey, United Kingdom
3 Department of Corneo - Plastics, Queen Victoria Hospital, East Grinstead, Surrey, United Kingdom

Date of Web Publication20-Apr-2018

Correspondence Address:
Dr. Nidhi Pandey
Indira Gandhi Eye Hospital, 1, BN Road, Qaiserbagh, Lucknow - 226 001, Uttar Pradesh

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_385_18

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How to cite this article:
Pandey N, Jayaprakasam A, Feldman I, Malhotra R. Response to comment on: Upper eyelid levator-recession and anterior lamella repositioning through the gray-line – Avoiding a skin-crease incision. Indian J Ophthalmol 2018;66:728

How to cite this URL:
Pandey N, Jayaprakasam A, Feldman I, Malhotra R. Response to comment on: Upper eyelid levator-recession and anterior lamella repositioning through the gray-line – Avoiding a skin-crease incision. Indian J Ophthalmol [serial online] 2018 [cited 2024 Mar 29];66:728. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2018/66/5/728/230677



Sir,

We thank the authors [1] for their interest toward our article [2] and insightful points raised. The main pathology for  Meibomian gland More Details inversion in patients with facial nerve palsy is meibomian gland dysfunction. This has been demonstrated to progress on the ipsilateral side in facial palsy based on meibography in at least two studies.[3],[4]

With regard to upper eyelid retraction, in many patients with upper eyelid cicatricial margin entropion, upper eyelid retraction may appear variably when the patient visually concentrates on a target in primary position and also be concealed by the upper eyelid skin fold. In such patients, we deliberately aim for a mild ptosis both to anticipate for late rise in eyelid height and also for the benefit in dry eye. We agree with your hypothesis that a levator recession is essential in most cases of upper eyelid cicatricial margin entropion in order to minimize incomplete correction or early failure. These cases often require multiple procedures due to ongoing cicatricial disease. This may also explain the relatively high rate of revision surgery in most of the published series.

Trichiasis is often due to metaplastic lashes in the presence of cicatricial margin entropion. We would not label lash contact as a result of anterior lamella droop being trichiasis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yadalla D, Rajagopalan J, Bakthavatchalam J. Comment on: Upper eyelid levator-recession and anterior lamella repositioning through the gray-line – Avoiding a skin-crease incision. Indian J Ophthalmol 2018;66:727.  Back to cited text no. 1
  [Full text]  
2.
Pandey N, Jayaprakasam A, Feldman I, Malhotra R. Upper eyelid levator-recession and anterior lamella repositioning through the grey-line: Avoiding a skin-crease incision. Indian J Ophthalmol 2018;66:273-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Allen RC, Wise RJ. Orbicularis oculi weakness and obstructive meibomian gland disease. JAMA Ophthalmol 2014;132:1490-1.  Back to cited text no. 3
[PUBMED]    
4.
Takahashi Y, Kakizaki H. Meibomian gland dysfunction in cranial nerve VII palsy. Ophthal Plast Reconstr Surg 2015;31:179-81.  Back to cited text no. 4
[PUBMED]    



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