Eversion of upper eyelid during dermolipoma excision: a useful maneuver to avoid postoperative blepharoptosis and dry eye

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Abstract Purpose: To describe the benefit for upper eyelid eversion during surgical excision of dermolipoma to avoid postoperative ptosis and dry eye Method: This retrospective non-comparative interventional clinical study included 32 dermolipoma cases presented to orbit clinic of Assiut university hospital who underwent surgical excision of the lesion. The surgery started with conjunctival incision at the junction between adherent and non-adherent parts followed by dissection between the lesion and tenon capsule. The lateral rectus was hooked and the lesion was separated from the muscle and its covering sheath. The upper lid was then everted using Desmarres retractor and the lesion was pulled downward allowing dissection between the lesion and upper bulbar conjunctiva sparing the fornical conjunctiva which harbor the lacrimal ductules orifices. Then, the deeper part of the lesion is dissected from the adjacent levator under vision. The deep part was dissected from normal orbital tissue using scissors. The bulbar conjunctiva is sutured to the lateral canthus. Result: Thirty-two dermolipomas in 29 patients were excised. The surgery was successful in all patients without permanent complications. None of our patients suffered from post operative dry eye, blepharoptosis or permanent strabismus. Two patients had temporary limitation of adduction lasting for 1 months. Conclusion: Everting the upper lid and dissecting the lesion from the underlying levator-muller complex sparing the fornix is an important modification during excision of dermolipoma to avoid postoperative dry eye and blepharoptosis. To the bast of the authors knowledge, this maneuver is first to be reported in the literature.

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