RESOLVING LAGOPHTHALMOS FOLLOWING DACRYOC YSTORHINOSTOMY

The authors report two cases of postoperative lagophthalmos immediatly following ab externo dacryocystorhinostomy (DCR). Two female patients , aged 67 and 62 years, underwent under general analgesia for chronic dacryocystitis with mucocele. An inferior surgical approach, sparing t he inner canthal ligament was chosen in both cases. Lagophthalmos was observed on the operated side on the first postoperative day. Normal l id occlusion was present on the contralateral side. Impairement of pal pebral occlusion was predominant in the nasal portion of the lid fissu re. Upon voluntary and reflex blinking, a reduction in the downward mo vement of the superior lid was observed. This reduction was not as app arent when the patients were asked to produce a forced blink. Lagophth almos disappeared progressively over 3 postoperative months in both ca ses. Neither epiphora nor any corneal complications were observed. Lag ophthalmos following DCR via an inferior approach is a previously unre ported complication and may be related to the disinsertion of the nasa l portion of the orbicularis muscle and periosteum at the time of peri osteal cleavage. Recovery of normal lid function may be due to reattac hment of the periosteum.