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1Introduction

Closure of the upper eyelid reduces symptoms of exposure, but does not address the causes related to the drainage system. Therefore, improving lower eyelid position also needs to be considered to further reduce tearing.

Caution should be taken in performing a simultaneous upper lid procedure, as the requirement for upper lid closure may change following lower lid tightening and suspension.

The lower lid tendon suspension will improve upper lid closure even in the paralyzed eye by increasing the tension on the upper eyelid orbicularis oculi muscle.