The surgical treatment of eyelid “webbing” and “folds”

I recently took care of a young girl with a history of blepharophimosis syndrome: the eyelids droop, they are shortened horizontally, and there is a fold of tissue along the inside corner of the eyelids that runs from the upper lid down to the lower lid (the “epicanthal” fold). She had already undergone eyelid surgery in the past, both to lift the lid and also to tighten it. It is no simple matter to reduce this type of tissue webbing.
 
This picture shows the “epicanthal” fold, marked in yellow, on the right.
 

 
Sometimes small eyelid corrections, particularly for problems like this, can take a lot of work: hers was a 2 hour surgery involving the placement of wires across the nose connecting the right and left eyelids together, as well as some excision and rearrangement of the webbed tissue. After one week, the child was returned to the operating room to remove those wires. The wires were fixated over buttons to keep the tissue compressed during the first postoperative week.
 
Finally, a montage of the left eye showing the preoperative and postoperative (one month later) condition is depicted below.
 
 
The right half of the picture, the preoperative panel, shows the web of tissue leading to the appearance of a small eye (horizontally).  There is very little “white” of the eye visible along the inside corner of the eyelids.  The postoperative panel, to the right, shows the one month postoperative result. The eye appears lengthened, there is more white of the eye visible, and there is no webbing present.
 
In terms of the postoperative condition of the patient, she did spend an evening in the hospital just to make sure that she was comfortable, though she really didn’t report a significant amount of pain. Pain was not a problem during the week after surgery either. One month after the surgery, she is in good shape to return to school for the fall term.