Autogenous hard palate mucosa: the ideal lower eyelid spacer?

Background/aims-Raising a displaced lower eyelid frequently involves recess ion of the lower eyelid retractors with interposition of a "spacer," and se veral materials for this purpose have been described. This study reviewed t he results of autogenous palatal mucosa in the treatment of lower eyelid di splacement, including assessment of any donor site morbidity. Methods-A retrospective case note review of consecutive patients treated at Moorfields Eye Hospital between 1993 and 1998. All patients underwent inse rtion of hard palate mucosa between the inferior border of the tarsus and t he recessed conjunctiva and lower eyelid retractors. Parameters studied inc luded the underlying diagnosis, measurements of lower lid displacement or r etraction, related previous surgery, the experience of the operating surgeo n, intraoperative and postoperative complications, surgical outcome, and le ngth of follow up. The main outcome measure was the position of the lower e yelid relative to the globe in primary position of gaze. Results-102 lower eyelids of 68 patients were included and a satisfactory l id position was achieved in 87/102 (85%), with inadequate lengthening or si gnificant recurrence of displacement occurring in 15 cases. Donor site haem orrhage requiring treatment in the early postoperative period occurred in s even patients (10%). Conclusion-Autogenous hard palate mucosa is an effecti ve eyelid spacer and provides good long term support for the lower eyelid. Donor site complications are the main disadvantage, but may be minimised by attention to meticulous surgical technique and appropriate postoperative m anagement.