University of Iowa Health Care

Ophthalmology and Visual Sciences

Repair of epicanthus inversus & telecanthus in blepharophimosis

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This is Richard Allen at the University of Iowa.  This video demonstrates repair of epicanthus inversus and telecanthus in a patient with blepharophimosis-epicanthus inversus syndrome.  A Y to V and double Z plasty are marked on each side.  The 15 blade is the used to make an incision along the axis of the Y to V plasty with extension to the upper and lower eyelids.  The 15 blade is then used to make an incision along the double Z plasty.  The flaps are then undermined beneath the orbicularis muscle with Westcott scissors.  This is performed bilaterally, usually.  The area of the anterior limb of the medial canthal tendon is then identified.  The soft tissue is then dissected from the surface of the medial canthal tendon.  The periosteum medially is then exposed.  A 4-0 vicryl suture is then used to engage the periosteum medially.  This should be a relatively posterior pass.  The suture then engages the medial canthal tendon.  Tying the sutures results in plication of the medial canthal tendon and repair of the telecanthus.  This also places the Y to V plasty into position.  The double Z plasty is then addressed and placed into appropriate tranpostion superiorly.  This is performed with interrupted 7-0 Vicryl sutures.  In this case the same is performed along the area of the lower eyelid with transposition of the flaps and placement into appropriate position.  7-0 vicryl suture is used to close the skin. Inspection of the area shows that the telecanthus as well as the epicanthus inversus to be repaired.  The procedure is the performed on the contralateral side with transposition of the flaps and correction of the telecathus.  Antibiotic ointment is placed of the repair and the patient returns in approximately one week for reevaluation. 

last updated: 09/01/2015
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