O
Oesteogenesis
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So ive been diagnosed with Lagophthalmos which means my eyes cant close fully, now i can easily think of 1 main reason this is happening, which is a lack of under eye support leading to sagging eyelids. Ive made alot of threads about my issue before aswell (Probably my last thread on it lol) but im just quite unsure now of which solution/s would be ideal since i thought orbital decompression was 100% required until they told me my hertel measurement was normal (18mm)
I need some advice on what to actually do with my situation, ill provide pictures of my eyes below aswell. But through the NHS for Lagophthalmos you can get 3 surgeries (Within the NHS):
However something you must know is that this condition is urgent and is a significant risk to my sight if left untreated. Aesthetics aside im also trying to not get corneal ulcers whilst waiting.
1. Gold weighted Eye implant
Now for obvious reasons this would not be an ideal solution for my problem as it doesn't really fix the actual issue of my lower eyelid sagging with scleral show.
2. Tarsorrhaphy
This procedure is probably the worst one out of all of them, as it directly reduces PFL when lateral tarso is done. Thus making the eye more round, which for obvious reasons is unideal.
3. Canthoplasty/ Lower eyelid retraction
This is the best out of all 3 solutions provided by the NHS publicly for Lagophthalmos, however my issue is that i have a negative orbital vector and ive read that if a canthoplasty is performed on an individual with a negative orbital vector (lack of malar support and infra support) it would look weird and also results would just not last. Especially with prominent eyes like mine (Hertel measurement of 18mm).
Bonus Solutions:
1. autologous graft, Spacer graft,
(Actually pretty accurate of how my lagophthalmos looks like in the before picture, however my scleral show isnt as bad ofc)
Spacer: (Pretty sure this is never done by the NHS or is rarely done)
link.springer.com
Although not publicly listed on the NHS, it has been used for other conditions and could be a viable solution for lagophthalmos as shown above. Im not very educated on this one so some help would be appreciated, and if you know anything about the NHS doing this as a solution. The only issue i have is that my eyes in my opinion arent bad enough for such expensive solutions like this so im not sure if its possible, but i will try bring it up next appointment.
2. Fat grafting
This likely would have to be combined with a canthoplasty, however the issue is that the NHS legit never does these and always claims that they are cosmetic, but in my case ideally structural support would be great combined with something like a cantho.
Pictures of my Eyes and side profile
Eye Front:
Please let me know if these images arent enough, i dont really want to post my full face for obvious reasons and if needed i can PM you the full images. (Holy subhuman eyes and side)
Also any plans would be ideal too, because if i would need something outside the NHS , its likely it would take me quite a while to save up and then get it. Some advice like idfk e.g Fat grafting first then cantho or whatever. What i was thinking of doing was still getting a canthoplasty and trying to get an implant or fat grafting in 2-3 years (maybe 1 year for fat grafting). Advice on what to tell the NHS would be amazing aswell, if you do know anything even a small tip please let me know.
My urgent appointment with my local A&E (Eye causalities) is in 3-4 weeks aswell, so theres a good chance of me yk getting a surgery because the eye drops and ointment they gave defo help but the dryness is still painful.
So now the main question is, Whats the right procedure to pursue in my situation?
@yussimania @lurking truecel @Nahorscend @vermicel @tweaqo
I need some advice on what to actually do with my situation, ill provide pictures of my eyes below aswell. But through the NHS for Lagophthalmos you can get 3 surgeries (Within the NHS):
However something you must know is that this condition is urgent and is a significant risk to my sight if left untreated. Aesthetics aside im also trying to not get corneal ulcers whilst waiting.
1. Gold weighted Eye implant
Now for obvious reasons this would not be an ideal solution for my problem as it doesn't really fix the actual issue of my lower eyelid sagging with scleral show.
2. Tarsorrhaphy
This procedure is probably the worst one out of all of them, as it directly reduces PFL when lateral tarso is done. Thus making the eye more round, which for obvious reasons is unideal.
3. Canthoplasty/ Lower eyelid retraction
This is the best out of all 3 solutions provided by the NHS publicly for Lagophthalmos, however my issue is that i have a negative orbital vector and ive read that if a canthoplasty is performed on an individual with a negative orbital vector (lack of malar support and infra support) it would look weird and also results would just not last. Especially with prominent eyes like mine (Hertel measurement of 18mm).
Bonus Solutions:
1. autologous graft, Spacer graft,
(Actually pretty accurate of how my lagophthalmos looks like in the before picture, however my scleral show isnt as bad ofc)
Spacer: (Pretty sure this is never done by the NHS or is rarely done)
Lower eyelid retraction repair using autologous auricular scapha cartilage - International Ophthalmology
Purpose To assess the efficacy of lower eyelid retraction surgery utilizing autologous auricular scapha cartilage (located within the anterior surface groove between the helix and anti-helix) and to present the surgical outcomes in a patient cohort. Methods Medical records of 21 patients who...
link.springer.com
Although not publicly listed on the NHS, it has been used for other conditions and could be a viable solution for lagophthalmos as shown above. Im not very educated on this one so some help would be appreciated, and if you know anything about the NHS doing this as a solution. The only issue i have is that my eyes in my opinion arent bad enough for such expensive solutions like this so im not sure if its possible, but i will try bring it up next appointment.
2. Fat grafting
This likely would have to be combined with a canthoplasty, however the issue is that the NHS legit never does these and always claims that they are cosmetic, but in my case ideally structural support would be great combined with something like a cantho.
Pictures of my Eyes and side profile
Eye Front:
Please let me know if these images arent enough, i dont really want to post my full face for obvious reasons and if needed i can PM you the full images. (Holy subhuman eyes and side)
Also any plans would be ideal too, because if i would need something outside the NHS , its likely it would take me quite a while to save up and then get it. Some advice like idfk e.g Fat grafting first then cantho or whatever. What i was thinking of doing was still getting a canthoplasty and trying to get an implant or fat grafting in 2-3 years (maybe 1 year for fat grafting). Advice on what to tell the NHS would be amazing aswell, if you do know anything even a small tip please let me know.
My urgent appointment with my local A&E (Eye causalities) is in 3-4 weeks aswell, so theres a good chance of me yk getting a surgery because the eye drops and ointment they gave defo help but the dryness is still painful.
So now the main question is, Whats the right procedure to pursue in my situation?
@yussimania @lurking truecel @Nahorscend @vermicel @tweaqo
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