Senile Spastic Lid Deformities—Their Surgical Correction
SENILE lid deformities usually involve the lower lid and result from spastic disorders. The correction of either entropion or ectropion must be aimed toward obtaining proper physiologic position of the lid border in order to avoid epiphora, trichiasis or deformity of the orbital fissure. The ideal operation is one which would produce permanent results so that the aged patient would not be subjected to subsequent operative procedures which entail added risks for the elderly patient.
If the underlying cause is understood, a surgical means for correction is more easily chosen. The musculature of the lids and the tarsal plate are the bases of the deformity and must be used to correct the malposition. By examining the muscle fibers of the lid, it can be observed that the orbicularis muscle describes arcs having curvatures in two different directions.1 One direction is the semi-encirclement of the palpebral fissure with the arc being directed downward in the lower lid and upward in the upper lid (fig. 1a). The second direction is an arc with its concavity toward the orbit formed by the muscles being molded to the shape of the eyeball (fig. 1b). These muscles have their attachments from the lateral and medial raphe; from this area comes their main support on contracture. The muscles pass over a tarsal plate which contributes to the maintenance of the lid’s form.2 With aging there is a loss of orbital fat, a loss of skin tone, and as a result when the muscles of the orbicularis. . .