Photo Credit: VladimirFLoyd

The following is a summary of “Cutaneous lower eyelid retractor release averts lower lid malposition after inferior rectus muscle recession,” published in the October 2024 issue of Ophthalmology by Lai et al. 

Researchers conducted a retrospective study to assess the effectiveness of cutaneous lower eyelid retractor release (CLERR) in eliminating lower lid retraction associated with inferior rectus (IR) muscle recession for the treatment of amblyopia.  

They reviewed 89 consecutive IR recessions performed by a surgeon between September 2019 and May 2024, of which 71 performed CLERR after local anesthetic infiltration in 2-3 minutes by dissection of the retractors from the inferior margin of the tarsus via skin incision over the lateral orbital rim, using scissors blades visualized through the intact inferior tarsal conjunctiva. The inferior scleral show was measured with an average of 116 days postoperatively.  

The results showed that mean IR recession was more significant at 4.6±1.8 mm (standard deviation, range 2-8mm) with CLERR than 3.2±1.2mm (range 2-6mm) without it (P=0.003), but inferior scleral show averaged less with CLERR at 0.2±0.9mm than 0.7±1.0mm without it (P=0.043). The procedure was also effective in thyroid ophthalmopathy. Lower lid ecchymosis occurred in 22 (31%) cases with CLERR but resolved within 1 week without patient complaints. The skin incision healed without visible scar in 5-7 days with a complication of severing an IR hang-back suture that was repaired during suture adjustment.  

Investigators concluded that CLERR is an effective and simple procedure that prevents lower eyelid retraction and inferior scleral show following an IR recession, avoiding inferior scleral and new dry eye symptoms without conjunctival dissection. 

Source: ajo.com/article/S0002-9394(24)00460-4/fulltext