Möbius Syndrome: Surgical Treatment for Eyelid Dysfunction
We present the case of a 44-year-old woman with Möbius syndrome and congenital craniofacial cleft. During her childhood, she had undergone multiple surgeries in the Departments of Traumatology, Plastic Surgery and Maxillofacial Surgery.\nThe patient was being monitored due to her eye problems derived from the facial paralysis. Four years ago, she had undergone a permanent partial bilateral tarsorrhaphy that improved her eyelid closure problems. However, at the last checkups, the lower eyelids had retracted again, and she presented recurrent lower keratitis caused by a scleral exposure of 1–2 mm in both eyes, in spite of a good Bell's phenomenon and an intensive treatment with lubricants (fig. ).\nWe decided to introduce a graft for the lower eyelid in order to alleviate the retraction and reduce the scleral exposure. In view of the fact that the patient had undergone surgery of the palatal area on several occasions due to her craniofacial malformations (fig. ), we used an auricular cartilage instead of a hard palate.\nWe performed an incision at the end of the lower conjunctival sac, we separated the retractor muscles from the tarsal plate, and we disinserted the capsulopalpebral ligament, so that the tarsal plate was left free and completely exposed. A 6 × 20 mm section of auricular cartilage was extracted and its upper border was sewn into the lower edge of the lower tarsal plate with 7-0 vicryl. The lower edge of the graft was sutured to the retractors, and the incision in the conjunctival sac was also sutured with 7-0 vicryl.