# Techniques for the surgical correction of lagophthalmos secondary to leprosy: A systematic review

## TL;DR

This paper reviews surgical techniques for correcting eyelid closure issues caused by leprosy, highlighting the most common methods and their effectiveness in preventing vision loss.

## Contribution

The paper provides the first systematic review of surgical techniques for lagophthalmos correction in leprosy patients, emphasizing practical considerations for low-resource settings.

## Key findings

- Temporalis muscle transfer was the most commonly studied surgical technique for lagophthalmos correction.
- Gold weight implantation showed a higher risk of complications like extrusion and allergic reactions.
- Surgical techniques were generally well-tolerated with minimal side effects across most methods.

## Abstract

Leprosy is an infectious neglected tropical disease that can result in chronic immune mediated nerve damage. When this involves the facial nerve, this can lead to lagophthalmos, with the later stages requiring surgical correction. If untreated lagophthalmos can cause keratopathies leading to visual impairment and eventual blindness. However, to date no paper has systematically reviewed the surgical management of lagophthalmos in those affected by leprosy.

A systematic review was conducted on the 16/11/2024 with data from PubMed, Infolep, Web of Sciences Core Collection and Medline ALL. Data extraction and analysis followed PRISMA guidelines. Included were English-language studies on the outcomes of surgical procedures for the surgical management of lagophthalmos, regardless the year of publication.

The 12 papers identified contained data from seven countries. The majority of papers studied Temporalis Muscle transfer. Gillies technique or modifications of this technique were reported in five papers. Three papers reported modifications of Johnson’s method of temporalis tendon transfer. One paper reported TMT using a silicone sling. Patients also received TMT using the Brown-McDonnell and the McCord-Cordner techniques. Lagophthalmos was also corrected using gold or steel weight implant techniques. One paper each studied lateral tarsal strip, modified tarsorrhaphy and scapha graft.

Treatment of lagophthalmos is vital to preserve vision in those affected by leprosy, however, it is important to take into consideration the practical advantages of the five broad techniques identified by this review. Factors such as the type of anaesthesia, level of expertise, success rate, incidence and risk of complications, and longevity and stability of the results, are vital to consider when conducting these surgical procedures in reduced resource settings. Therefore, operations which are more cost effective, show a reduced complication rate and yield better long-term results without complicated follow-up are more likely to be adopted in lower resource settings.

Leprosy is a chronic infectious neglected tropical disease. Leprosy has a high burden of visual impairment if left untreated, with both cataracts and corneal opacification being the main contributors to ocular morbidity. Lagophthalmos in those affected by leprosy, an inability to close the eyelids fully, can lead to exposure keratitis and eventual corneal opacification and blindness. The main way to avoid and prevent the progression of visual impairment once lagophthalmos is established is corrective surgery. We identified 12 studies from seven countries researching five main techniques for surgical correction of lagophthalmos, with the majority of papers (seven) investigating methods of temporalis muscle transfer. With three papers studying weight implantation, and one paper each covering scapha grafting, modified tarsorrhaphy and lateral tarsal strip. Surgical techniques were mostly well tolerated with minimal side effects noted across techniques. Of note however was the high incidence of extrusion and local allergic reactions within the gold weight technique. Ultimately, this paper presents a compelling case for more comparative studies between different techniques for lagophthalmos correction secondary to leprosy. Our recommendations emphasise the need to evaluate these techniques further in lower-resources settings and to prioritize techniques that allow good outcome with the minimal need for follow-up.