To report surgical outcomes of levator recession and anterior lamellar repositioning for restoring eyelid position

Surgery consisting of upper eyelid grey-line split, levator recession, correction of curled tarsus and anterior lamellar repositioning was undertaken for those consenting to surgical treatment. The curled tarsus was unfurled using a 15-blade until the endpoint of a uniform tarsus position was achieved (Figure 3). The combination of the levator recession and anterior lamellar repositioning helped restore eyelid position, preventing early MGI recurrence. A retrospective case series of patients with MGI undergoing surgery at a single-centre over a 5-year period. Outcomes and adverse effect were recorded.

A total of 21 eyelids of 13 patients (mean age 68.5±15.4, range 32–88 years) were analyzed. All patients previously had consulted the ophthalmologist(s) and/or neurologist. Those with preoperative superior corneal punctate stain (n=14 lids) (Figure 4), blink-related discomfort (n=8) and pseudo-blepharospasm (n=3) had complete resolution postoperatively. The majority improved: gritty sensation-79%, sore eye-80%, burning sensation/watery eye-86% (Figure 5). However, 88% of eyes still experienced dry eye. There was 1 case of recurrence at 1-month postoperatively; patient was listed for revision. Median follow-up for the other patients was 5 (range 3-12) months.

MGI is a subtle clinical finding that can be easily overlooked; Patients symptoms were attributed to dry eye, MGD or blepharospasm. It is plausible that MGI is in the early spectrum of upper eyelid entropion before becoming clinically apparent. MGI can be managed surgically with good outcomes though all patients are advised to adhere to MGD treatments.