Will An Orbital Floor Implant Help My Lower Eyelid Retraction?

Q: Dr. Eppley, I saw an article on your website wherein you discuss an orbital floor implant of hydroxyapatite cement. I was wondering if this is something you still do.

I ask because I initially underwent a bridge-of-bone canthopexy with a lower lid skin pinch blepharoplasty. In other words: the canthus of both eyes was secured subperiosteally through a drill hole in the lateral orbital rim. Unfortunately the canthus of each eye was mispositioned thereafter.As a result I underwent a revision bridge-of-bone canthopexy but the  

lateral canthus of each eye still seems to be mispositioned. The canthus is placed so lateral that it is removed from the eyeball and there is a gap in between the eyeball and the lower eyelid . In addition the lower lashline seems to be too long vertically (there is a horizontal enlargement of the palpebral fissure), and thus the lower eyelids are a bit droopy. As a result I suffer from dryness and itching eyes. Frankly the result looks rather unnatural to me also.

I was recommended an orbital floor implant since my eyes are deep set, and it was thought an orbital floor implant could resolve some of my issues at the canthal area. After seeing your article about an hydroxyapatite orbital floor implant this raised my interest. Is this something you still perform, and if so, would you potentially consider me a candidate for such bilateral surgery or not?

A: Thank you for your inquiry, sending your picture and detailing your surgical history and current lower eyelid concerns. While I perform a wide variety of orbital procedures, including orbital floor augmentation with hydroxyapatite and custom made implants, these procedures do not seem to be appropriate to improving your lower eyelid malposition in which the lower eyelids lack good apposition against the eyeball due to vertical lower lid shortness and outer corner malposition. While I don’t know exactly how your prior canthoplasty procedures were performed (I know what you said they did) or whom recommended an orbital floor implant for your lower eyelid concerns, trying to bring your eyeball up and forward a bit, in and of itself, would exacerbate your current problems. Orbital floor augmentation may or may not be part of the solution but, more importantly, lower eyelid lengthening with spacer grafts (particularly in the right eye) and better position of the eye corner would be what would be the standard and accepted approach to get your eyelids up and in better position back against the eyeball. That is the key in relieving your eye symptoms and appearance.

Dr. Barry Eppley

Indianapolis, Indiana