THE GILLIES METHOD FOR THE CORRECTlON OF LAGOPHTHALMOS AND ECTROPION lN LEPROSYN. Verma
Lagophthalmos resulting from paralysis of the facial nerve with resultant ectropion and exposure keratitis and ultimate loss of vision is commonly seen in leprosy.
There are various methods described to surgically correct this condition and can basically be divided into static and dynamic slings that restore the function of the lids and protection of the globe. The motor division of the Vth nerve is spared and therefore the temporalis muscle remains a useful alternative source of power for the eyelids if corrected by a fascial sling. This procedure is referred to as a dynamic sling and is in contrast to the static type in which the lid tissues are either shortened or a sub cutaneous strip of fascia lata is used to encircle the palpebral fissure and re appose the lids to the globe. Quite understandably, this has a role in paresis of the orbicularis oculi states rather than a total paralysis of the muscle.
The aim of this presentation is to outline a modification of the Gillies method of temporalis transfer in 17 cases of lagophthalmos and compare the results with 18 cases of static slings. All procedures were carried out under local anesthesia and the lid "power", corneal and tear film morphology as well as the cosmetic appearance and patient satisfaction was compared between the two groups. In general, dynamic procedures were found to be better and more acceptable to patients than static ones. The advantages of the Gillies over the Johnson's method for temporalis transfer are presented.