A Novel Percutaneous Surgical Approach Using Silicone Sheets for Lower Eyelid Lengthening: A Descriptive Case Series.

Background: Lower eyelid lengthening is essential to correct eyelid retraction and preserve ocular surface integrity. We evaluated the efficacy of a novel percutaneous surgical technique that utilizes a silicone sheet to elongate the lower eyelids to minimize ocular surface inflammation and corneal damage. Methods: This case series included 15 patients (22 eyelids) with lower eyelid retraction who underwent a novel silicone-sheet-based lower eyelid elongation surgery by the same surgeon and completed at least 3 months of follow-up that involved consistent methods (ie, slit-lamp examination) between November 2014 and November 2023. Corneal epithelial damage and changes in the margin reflex distance-2 were measured preoperatively and postoperatively. Ocular surface discharge and foreign body sensation were assessed in patient interviews within the first postoperative week. Results: During a mean postoperative follow-up of 31.9 months, the mean margin reflex distance-2 decreased from 7.17 to 5.89 mm. No recurrence or complications were observed. In all cases, superficial punctate keratopathy diminished within the first postoperative week and resolved within 1 month. Ocular discharge and foreign body sensation significantly decreased within a few days after surgery. Conclusions: A novel surgical technique using silicone-sheet spacers for lower eyelid elongation showed promising results in reducing ocular surface damage and improving patient outcomes. Despite its potential benefits over traditional methods, further large-scale, multicenter studies, including clinical trials, with diverse study populations are needed to generate robust data to validate and expand the applicability of this technique for managing lower eyelid retraction, particularly when involving eyelash contact with the ocular surface.