Latest advancement in blepharophimosis surgery in India

Posted by Oculoplastic Eyelid Orbit Surgery on July 19th, 2017

Blepharophimosis or BPES syndrome is characterised by malformations in the eyelid and four key features namely blepharophimsis, ptosis, as well as epicanthus inversus and telecanthus. These specific features give the syndrome its defining symptoms, whereby the bridge of the nose is flat and patients also have a hypoplastic orbital rim. BPES syndrome was first discovered as dysplasia of the eyelids as well as vision problems such as lazy eyes and strabismus.

Wide Array of Tests for BPES

The latest advancements in blepharophimosis surgery in India have seen a wide array of tests come to the fore for treating this syndrome. Endocrinology results for hypergonadotropic hypogonadism involve a test for high serum concentrate of FSH and luteinising hormones. This shows low serum amounts of estradiol and progestrone. Ultrasound examinations are also carried out.  Treatment of this condition involves a multi-faceted team of specialists including geneticists, oculoplastic surgeons, endocrinologists and gynaecologists. Surgery now involves medial canthoplasty for rectifying the damage caused at ages 3-5 due to telecanthus , epicanthus and blepharophimosis. Ptosis correction follows to correct brow suspension.

Progressive Surgery for BPES

Telecanthus is also surgically treated through reduction of the medial canthal tendon with a transnasal wire.For treatment of epicanthus, a Y-V traditional canthoplasty ma also be performed if folds are not large enough. If they are, a double Z canthoplasty is performed.  HRT also helps in countering women suffering from ovarian insufficiency.

Advances in Understanding of Aetiology

FOXL2 is the gene associated with BPES. This gene is responsible for the production of the FOXL2 protein known to be involved in the muscle development of the eyelid as well as growth and development of ovarian cells. Mutations in this gene result in syndrome related symptoms stemming in an autosomal dominant manner. Differential diagnosis of BPES also requires the correct skills on part of the clinician. Correct diagnosis based on the four clinical manifestations is a must.  In blepharophimosis, the dropping of the upper eyelid, skin gold in the lower eyelid and wide set eyes along with narrowing eyelids at birth forms a basis of a definitive diagnosis. Clinical signs blepharophimosis surgery that may be needed include elevated serum levels of LH ad FSH and low levels of progesterone and estradiol. Several genetic tests may also be carried out such as molecular genetic testing of FOXL2, sequence and duplication analysis and chromosome analysis.

Surgical treatment corrects the four clinical abnormalities associated with this disease. In India, surgical procedures have advanced with technology and new knowledge about the factors implicated in the aetiology of this disease. Currently, surgical treatment is carried out in India by oculoplastic surgeons with assistance as and when necessary from other specialists.  Repair of ptosis is generally undertaken first, followed by canthal repair. 

The surgery for blepharophimosis involves careful and detailed inputs using advanced analysis. Success of blepharophimosis surgery in India has greatly improved with well-established clinics offering extensive facilities and amenities to solve the symptoms and malformations associated with blepharophimosis to enable individuals to lead a normal life and routine.


About the Author: is a unique website started by top Oculoplastic Surgeon, Dr. Debraj Shome. This is a patient information tool on oculoplasty, Lacrimal surgery, eyelid surgery and orbital surgery.  Dr. Debraj Shome is one of the world's best surgeons, super specialized in Eyelid Surgery and facial plastic surgery. He started the Esthetic clinics, which are a chain of multiple centers located in Mumbai, India. Dr. Shome is trained from the best centers in the world in aesthetic facial plastic surgery.

Contact Details:

Contact Person: Dr. Akshay Mhatre,

Designation: Manager

Address: Oculoplastic Eyelid Orbit Surgery

Apollo Spectra Hospital (earlier Nova Specialty Surgery Hospital)

Sunder Baug, Ujagar Compound,

Opp. Deonar Bus Depot Main Gate,

Off. Sion–Trombay Road, Deonar,

Chembur, Mumbai, Maharashtra – 400088

Working Hours: 9 AM - 6 PM

Phone: +91-9619610388        



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Oculoplastic Eyelid Orbit Surgery

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Oculoplastic Eyelid Orbit Surgery
Joined: February 1st, 2016
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