Floppy eyelid syndrome plasty procedure: Employment of a periosteal transposition flap for surgery of floppy eyelid syndrome

Importance Floppy eyelid syndrome plasty (FESplasty) is a surgical technique that addresses underlying superior tarsal plate and lateral canthal instability in floppy eyelid syndrome (FES) and aims to restore normal anatomical and physiological function to the upper eyelid. Background To describe the use of FESplasty in the surgical management of FES, and to report outcomes in an initial patient cohort. Design Retrospective study. Participants Seven patients (nine eyelids) with FES undergoing FESplasty. Methods A single surgeon (G.W.) performed all procedures. FESplasty utilizes a periosteal flap based at the inferolateral orbital rim, and applied to the anterior surface of the upper tarsal plate. It is combined with a titrated shortening procedure of the upper eyelid. Patient demographics, comorbidities and ocular symptoms and signs were recorded preoperatively. Pre- and postoperative upper eyelid distractibility were graded and documented. Main Outcome Measures Postoperative improvement in upper eyelid distractibility and symptomatology, operative complications and FES recurrence. Results FES symptoms and upper eyelid laxity improved at last follow-up (average 24 weeks) in all patients, with no FES recurrences after a maximum follow-up of 36 weeks. One patient, in whom FESplasty exacerbated his pre-existing aponeurotic ptosis, required definitive ptosis surgery subsequently. There was one case of postoperative wound infection. Obstructive sleep apnoea was present in four of the seven patients. The remaining three patients were awaiting assessment. Conclusions and Relevance FESplasty is likely to confer long-term effective stabilization of the lateral canthal tendon, lateral commissure and superior tarsal plate. Anatomical and functional results appeared to have been successfully achieved.