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Lower eyelid laxity is part of the normal aging process. Sagging and malposition of the lower eyelid can be frequently seen in the elderly. Understanding the relevant surgical anatomy and how it can be affected by the aging process is crucial for assessing lower eyelid laxity. This helps the surgeons to formulate a reasonable patient-specific management plan to ensure good postoperative results. This activity reviews the relevant surgical anatomy of the lower eyelid, the effect of aging on the lower lid and periorbital region, and highlights the role of the interprofessional team in its management. Objectives: Review the anatomy of the lower eyelid and its relevance when assessing lower eyelid laxity. Understand the aging process of the periorbital region and its effect on the lower lid laxity. Identify different indications of lower lid laxity assessment. Describe how to assess lower eyelid laxity in a systemic approach. Access free multiple choice questions on this topic.
The anatomical and physiological integrity of the lower eyelid is important for both functional and aesthetic purposes. It helps in the protection of the cornea and maintenance of the lacrimal drainage system. Surgeons must understand the different techniques that can be used to assess lower eyelid position and laxity. This applies to assessment before cosmetic procedures, e.g., lower blepharoplasty or reconstructive procedure such as facial reanimation after facial nerve palsy. Accurate analysis and diagnosis of the site and the degree of lower eyelid laxity are paramount before any lower eyelid surgical procedure.[1][2][3] Conditions When Lower Eyelid Laxity Assessment Is Essential Before upper and lower blepharoplasty After a trauma to the lower eyelid and periorbital region When assessing skin cancer in the lower eyelid or lid-cheek junction or adnexal tumors Dry eye or epiphora Lagophthalmos[4] Exposure keratopathy[5] Thyroid orbitopathy[6] Facial palsy[7]
A thorough understanding of the lower eyelid anatomy and the effect of the aging process on the periorbital regions helps surgeons preoperatively assess the laxity of the lower eyelid and plan the appropriate surgical technique to decrease the chances of lower eyelid malposition. This evaluation may need an interaction between different specialties, especially in complex cases such as facial palsy, dry eye syndrome, or thyroid eye disease. This can be done through interprofessional communication between a facial plastic surgeon, an ophthalmologist, and an endocrinologist if needed. This holistic and integrated approach optimizes the preoperative assessment of these cases. [Level5]