Drill Hole Canthoplasty to Improve Upper Eyelid Closure

By Joseph Walrath, MD | May 29, 2017 | Eyelid Malposition, Reconstruction

Many patients cannot close their eyes properly, due to surgical complications or paralysis or aging.  This video demonstrates that, in patients with some degree of eyelid function intact, it is often possible to leverage that function with a lid tightening procedure known as a canthoplasty.  In these cases, I often prefer to use a drill hole for fixation.  This is particularly important for patients who have had multiple cosmetic surgeries, because the tissue itself is abnormal and unreliable.  The fixation with a drill hole improves the durability of the procedure.

The video presented is in a gentleman with weakness of eye closure from a partial paralysis.  This happens in some people, is a fairly random event, and may be due to some type of common viral infection that comes and goes but leaves the facial nerve damaged.  This is called  Bell’s palsy.

Preoperatively, closure is poor.  However, there is some function.  Canthoplasty is my first line of treatment; I reserve upper lid weight implantation if the patient is still having problems after canthoplasty surgery.

Notice that the left upper lid does not close fully, and barely moves during a normal spontaneous eyelid blink.  After surgery, spontaneous blink is significantly better and forced closure is complete.