This patient has narrow palpebral fissures and when the speculum is placed for cataract surgery, we cannot even expose limbus to limbus despite our best efforts. This is an issue we see frequently in our surgery center because of the high penetration of plastic surgery in our population. If we attempt to forcefully crank open the speculum, we may inadvertently induce levator muscle dehiscence which could also occur to a lesser degree even with gentle speculum placement. These patients have usually had a blepharoplasty surgery performed years ago by a surgeon who was not as intimately familiar with the eyelid anatomy. If I require a blepharoplasty in the future, I will certainly elect to have an oculo-plastic surgeon perform it instead of a general plastic surgeon or other physician. Fortunately, I operate from the temporal position which is far easier to access compared to sitting superior. In this video, a complete cataract case shown start to finish, I show my approach to performing this case when I can’t even place my fixation ring.
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