A Temporal Tarsorrhaphy Increases the Effect of Lower Lid Lengthening in Patients with Graves' Orbitopathy

Objective: The aim of this study was to compare outcomes of lower lid lengthening with and without an additional temporal tarsorrhaphy. Methods: Lower lid lengthening was performed in 39 patients (16 without tarsorrhaphy [group 1], 23 with tarsorrhaphy [group 2]) via a posterior subtarsal transconjunctival ac-ess. A bovine pericardial transplant (Tutopatch (R), length = amount of retraction + 4mm) was placed between the recessed retractors and the tarsus. Results: Mean preoperative lower lid retraction was 2.3 mm in group 1 and 2.6 mm in group 2 (n.s.). Lower lid lengthening and simultaneous tarsorrhaphy resulted in significantly increased reduction of lower lid retraction: 2.3 mm (1.5 - 4.5) (p = 0.003) compared to patients without tarsorrhaphy: 1.4mm (0 - 3.0). Patients with tarsorrhaphy presented a higher success rate concerning the elimination of lagophthalmos (success = lagophthalmos <= 0.5mm: 21/23 (91.3%) as opposed to patients without tarsorrhaphy: 8/16 (50%); (p = 0.004). Scleral show was eliminated in 78% of group 2 in comparison to only 50% in group 1 (p = 0.06). Conclusions: Lower lid lengthening should be combined with simultaneous temporal tarsorrhaphy in patients with lower lid retraction exceeding 1.5 mm. The tarsorrhaphy increases the effect of lower lid lengthening by about 1 mm.