Bilateral Eyelid Research Articles

Case study on the applicability of the international classification of functioning, disability, and health in a patient with mitochondrial myopathy treated in the rehabilitation service

Background: Mitochondrial myopathies are rare neuromuscular diseases characterized by heterogeneous symptoms and severity. They affect multiple organs, including the brain, peripheral nervous system, muscles, kidneys, and liver. Objective: To illustrate how the application of the International Classification of Functioning, Disability, and Health (ICF) can help in managing a patient with mitochondrial myopathy in a rehabilitation setting. Methods: We present the case of a 26-year-old male diagnosed with a neuromuscular disease at age 12, exhibiting bilateral eyelid ptosis, dysphonia, dysphagia, and motor disorders. The patient underwent a thorough physical evaluation and various scales. The ICF model was employed to document and quantify deficits using a standardized template and numerical qualifiers. Results: Priority treatment areas included reeducation of postural and gait patterns, improving aerobic capacity through physical therapy, and managing pain via myofascial infiltration. Post-treatment, significant improvements were observed, although persistent challenges in participation domains, such as mobility in urban environments and employment, remained. Conclusions: This case study highlights the utility of the ICF framework in structuring rehabilitation plans, setting clear objectives, and evaluating outcomes for patients with rare diseases like mitochondrial myopathy. The ICF facilitates standardized assessment and comparison across different pathologies, promoting an integrative biopsychosocial model in rehabilitation.

Multicentric Mucinous Adenocarcinoma of Bilateral Eyelids.

A 59-year-old female patient presented with a purple, fluid-filled lesion on her left upper eyelid that contained a solid component. Excisional biopsy revealed a diagnosis of mucinous adenocarcinoma. Extensive oncological workup was negative for a distant primary tumor or metastasis and confirmed a diagnosis of primary mucinous adenocarcinoma. Further excision and eyelid reconstruction were required. One year later, another suspicious, fluid-filled lesion was excised from the patients' left lower eyelid. Biopsy and subsequent oncological workup confirmed a mucinous adenocarcinoma in situ, a known precursor of primary mucinous adenocarcinoma. This case contributes to the limited literature reporting multicentric primary mucinous adenocarcinoma of the eyelids and suggests that there may be underlying factors that heighten a patient's risk for developing these tumors.

Early grafting using AlloDerm to lengthen the levator aponeurosis and correct upper eyelid retraction due to cosmetic blepharoplasty

Summary: Upper eyelid retraction (UER) often results from overcorrection of the levator palpebrae muscle during upper eyelid surgery. In such patients, the time between wound healing and reoperation may be prolonged and could result in symptoms, including dry eye. Therefore, the correction surgery, in which the levator aponeurosis which was shortened by cosmetic blepharoplasty is lengthened, should be performed as early as possible for better patient satisfaction and surgical outcomes. Between August 2020 and September 2022, we performed spacer grafting using AlloDerm dermal matrix after detaching the levator palpebrae muscle from the tarsus in 64 patients who experienced UER after bilateral eyelid surgery and cosmetic blepharoplasty. Among 64 patients, 50 (78%) had satisfactory results, 8 (12%) had blepharoptosis, and 6 (10%) had insufficient correction. Our method produced a normalized levator aponeurosis position, symmetric eyes, and reduced adverse effects, including surprised and dry eyes. In addition, the method is easy to follow and safe.

Surgical management of bilateral symblepharon accompanied by ankyloblepharon in a cat

Feline herpesvirus infections, frequently observed in cats, lead to chronic conjunctival adhesions resulting in vision impairment in affected animals, following intense inflammatory responses occurring in the eye and periocular tissues. These adhesions are classified as symblepharon or ankyloblepharon according to the anatomical types. This case report describes the clinical evaluation of symblepharon and ankyloblepharon seen together in a kitten, along with the treatment approach. In the study, a 3-month-old male kitten, presented with bilateral eyelid deformations and extensive conjunctival adhesions on the cornea, was diagnosed with severe symblepharon and ankyloblepharon. Subsequently, surgical intervention was performed and the adhesions were carefully separated. During the surgery, it was observed that the conjunctiva did not adhere to the cornea and limbus area. In the animal that experienced a sole postoperative recurrence, growth and adhesion were observed exclusively in the palpebral conjunctivae, which were subsequently removed and supported with medical treatment. No recurrence was observed in the cat, which was followed for approximately 5 months.

Paediatric IgG4 related ophthalmic disease (IgG4-ROD) presenting as bilateral dacryoadenitis. A case report

A 15-year-old male presented with recurrent, episodic, bilateral eyelid swelling over two days. On examination, he exhibited bilateral eyelid edema, a superotemporal mass, proptosis, and limitation in extraocular motility. Laboratory findings revealed elevated ESR, CRP, and IgG4 serum levels, with negative ANA, ANCA, and ACE. MRI reported symmetrical enlargement of the lacrimal glands with homogeneous enhancement and diffuse restriction. The diagnosis was orbital IgG4-related disease (IgG4-RD) manifesting as bilateral dacryoadenitis, which responded remarkably to systemic steroids. After two years of treatment with immunosuppressants, he experienced no relapses. We share this case to alert clinicians to IgG4-related orbitopathy (IgG4-ROD) in young patients, so that prompt diagnosis and management can be instituted for optimal results.

A Combination of Conventional Transconjunctival Lower Blepharoplasty and Percutaneous Nanofat Grafting in a Young Chinese Population With Eyelid Bags and Tear Trough Deformities.

A simple and minimally invasive combined procedure, including transconjunctival orbital fat removal and transcutaneous resected orbital fat injection, was performed based on the anatomical characteristics of the lower eyelids in our young Chinese patients. Our study aimed to investigate the efficacy and safety of this procedure in our study population. In our retrospective study, a total of 183 consecutive patients underwent a combination of traditional transconjunctival blepharoplasty and nanofat grafting between February 2020 and June 2024. After transconjunctival septal fat removal, the resected orbital fat was processed into fat emulsion (nanofat) and then injected percutaneously into the depressed tear trough zone. The mean age of the 183 patients was 26.9 years old, and the average surgery time was 36.1 min. The mean volume of nanofat injected for bilateral lower eyelids in each patient was 1.1 mL. All the patients were followed for at least 6 months after surgery, and the subjective patient satisfaction was 96.6% (175/183) with fewer complications. In the objective assessment of the surgical outcomes according to the five anatomical elements of lower eyelids, orbital fat prolapse, tear trough depression and dark circles were all improved, orbicularis prominence was more evident, while skin elasticity did not vary significantly after operation. Our study provided a simple, effective, and safe combination of transconjunctival lower blepharoplasty and percutaneous nanofat grafting for the treatment of lower eyelid bags with high patient satisfaction, quick recovery and low complication rate. Thus, this combined application may be a promising alternative choice for the young Chinese with lower eyelid bags.

Bleb Reformation After Lateral Cantholysis in a Case of Prostaglandin-associated Periorbitopathy.

An 84-year-old male with uncontrolled intraocular pressure (IOP), despite maximum topical medications including prostaglandin F2α analog, had bilateral prostaglandin-associated periorbitopathy-related tight upper eyelids. One day after trabeculectomy of the left eyelid, IOP was 24 mm Hg, with a flat bleb. Daily ocular massage failed to maintain bleb filtration. IOP was reduced to 4 mm Hg after lifting the left upper eyelid; hence, ocular compression from a tight upper eyelid was the suspected cause preventing flow from the scleral flap. A lateral cantholysis was performed to release the eyelid pressure. On the first postoperative day, the bleb was documented to be large and diffuse, with subsequent IOP reduction to 10 mm Hg. At the third month of follow-up, the IOP was 8 mm Hg in the left eyelid, with a well-formed bleb.

Comparing the Waste and Environmental Impact of Blepharoplasty at an Office-based Operating Room Versus an Ambulatory Surgery Center in the United States.

The aim of the study was to evaluate the environmental impact of a blepharoplasty as performed by a single surgeon at an office-based operating room (OR) versus at an ambulatory surgery center. We employed life cycle analyses on routine, uncomplicated bilateral upper lid blepharoplasties as performed by a single surgeon. Life cycle phases of production, use, and end-of-life treatment were included. Study boundaries encompassed all waste products exiting the OR in addition to utility energy and water use. We conducted waste audits to collect data on surgical waste by item, material, and weight. Building energy and water use were approximated using data obtained from utility companies. Environmental impact is reported as global warming potential (GW100a; kg carbon dioxide equivalents). The office-based OR generated 784 g of physical waste per blepharoplasty as compared to 1323 g at the ambulatory surgery center. The life cycle analyses found that a blepharoplasty contributed a total of 6.42 kg carbon dioxide equivalents at the office-based OR and 7.78 at the ambulatory surgery center. The production phase contributed the majority of these carbon dioxide equivalents. Plastic supplies contributed the most waste by weight and emissions associated with production. Nonwoven polypropylene contributed the largest waste and emissions by material. The ambulatory surgery center produces more waste and carbon dioxide equivalents per blepharoplasty than the office-based OR. Use of supplies including drapes and gowns made of nonwoven polypropylene can be reduced to increase the environmental sustainability of blepharoplasty.

Orbital and Premaxillary Emphysema as a Result of Nose-Blowing Following Blepharoplasty

AbstractA 41-year-old man presented with sudden-onset swelling, redness, and pain in the right eye, 4 days after bilateral upper and lower eyelid blepharoplasty. The symptoms were preceded by a forceful nose-blowing episode. Upon examination, periorbital edema and subcutaneous crepitus were observed, along with limitations in upward gaze. Computed tomography revealed bilateral premaxillary and extraconal air accumulation. Since there was no optic nerve ischemia or orbital compartment syndrome, the patient was closely monitored. Spontaneous regression of the emphysema was observed during follow-ups. Orbital emphysema, although commonly associated with trauma, can also arise from compelling movements such as severe nose-blowing, as demonstrated in this unique case postblepharoplasty. The structural changes during surgery may contribute to weakened support, predisposing patients to emphysema following sudden pressure changes. Clinicians should be vigilant for periorbital edema and subcutaneous crepitus after facial surgeries, emphasizing the importance of timely imaging for diagnosis. Awareness campaigns advising against forceful actions like sneezing, coughing, and nose-blowing during the initial postoperative period are crucial to prevent potential complications.

Plasma cell type Castleman's disease of lacrimal gland: a case report and literature review

BackgroundOrbital Castleman's disease is a rare benign lymphoproliferative disorder of extranodal origin.Case presentationA 72-year-old man presented with bilateral upper eyelid swelling. Radiology revealed enlarged lacrimal glands in both eyes. Castleman's disease (plasma cell type) was confirmed by histo-immunochemical examinations after excision of the left orbital mass. No extraorbital involvement was found in systemic evaluation. Postoperatively, corticosteroid therapy was given. After 1 year of follow-up, there was no recurrence in the left orbit, and the swelling of the right eyelid was improved.ConclusionsHere, we report a case of orbital Castleman's disease involving the lacrimal gland bilaterally and summarize previously reported cases. For bilateral orbital masses, the possibility of Castleman's disease should be considered. Before the diagnosis, it is necessary to fully distinguish from other diseases such as IgG4-related eye diseases.

12387 Late New-onset Graves' Orbitopathy: 14 Years Post-radioactive Iodine Treatment Of Graves' Disease: Case Report

Abstract Disclosure: F.F. Altaleb: None. K. Alaybaa: None. N. Aljohani: None. Introduction: Graves' orbitopathy (GO) is an autoimmune condition affecting the orbit and retro-ocular tissues, often accompanied by hyperthyroidism associated with Graves' disease, but it is rarely observed in euthyroid or hypothyroid individuals. Radioactive iodine (RAI) therapy for Graves' disease and smoking are recognized risk factors for GO development and progression. Individuals who smoke and undergo RAI treatment are significantly more likely to experience ocular lesions and worsening of GO compared to non-smokers. The exacerbation of GO post RAI therapy is attributed to elevated levels of TSH receptor antibodies, which may persist for up to a year post-treatment. Our case presents a rare occurrence of severe new-onset GO manifesting 14 years after achieving prolonged euthyroid status and successful RAI treatment for Graves' disease, accompanied by persistent TSH receptor antibody positivity that is unlikely to be suppressed by long term levothyroxine therapy. Clinical case: A 55-year-old male who’s a smoker and previously diagnosed with Grave’s hyperthyroidism, received treatment with RAI ablation therapy 14 years ago. At the time of diagnosis, there were no symptoms or signs of GO, and no history of thyroid eye disease was detected. Following the RAI treatment, he developed hypothyroidism and was promptly started on a daily dosage of 100 mcg of levothyroxine.Upon ocular examination: Visual acuity: 20/30 in both eyes. Significant restriction in extraocular muscle movements, with reported diplopia and pain. Bilateral lid retraction, proptosis, right conjunctival chemosis, and injection of the bulbar conjunctiva and caruncle, as well as lagophthalmos, were evident. No relative afferent pupillary defect observed. Color vision: 3/15 in the right eye, 15/15 in the left eye. Intraocular pressure: 22 mmHg (right eye), 16 mmHg (left eye). Optic discs unremarkable. Proptosis measurements: 26 mm (right eye), 23 mm (left eye). Ophthalmopathy clinical activity score: 7.Our laboratory analysis indicated normal thyroid function test However, the TSH receptor antibody and TPO antibody returned positive.We initiated treatment with IV methylprednisolone at a dosage of 500 Mg weekly for a duration of 4 weeks. Additionally, we introduced local measures, along with selenium supplementation. Within a week of initiating treatment, the conjunctival chemosis resolved, and there was improvement in ocular movement, resulting in mild to moderate restriction in all directions of gaze. Conclusion: This case illustrates the unexpected development of GO in a patient who had been euthyroid and effectively cured of Grave's disease for a span of 14 years following RAI treatment. The presence of TSH receptor antibodies, which are likely unresponsive to suppression by levothyroxine, as well as smoking cigarette might have contributed to the late new onset of the disease. Presentation: 6/3/2024

Further insights into anti-IgLON5 disease: a case with complex clinical presentation

BackgroundAnti-IgLON5 disease is an autoimmune encephalitis overlapping with neurodegenerative disorders due to pathological accumulation of hyperphosphorylated tau. It is characterized by several clinical manifestations determined by involvement of different brain areas, and mild response to first-line immunotherapies. We report a case of anti-IgLON5 disease with a multifaceted semiology and an unusually good response to glucocorticoid monotherapy.Case presentationA 68-year-old man with type 2 diabetes was evaluated for an 8-month history of progressive gait disorder causing frequent falls. He also suffered from obstructive sleep apneas and complained of dysphonia, dysarthria, occasional dysphagia, urinary incontinence, and upper limb action tremor. Neurological examination demonstrated bilateral eyelid ptosis, limitation of ocular horizontal smooth pursuit movements, slow horizontal saccades, and lack of inhibition of the vestibulo-ocular reflex during rapid horizontal head torsions. The patient also displayed involuntary, slow, rhythmic movements of the left periorbital and perioral muscles, spreading to the ipsilateral hemipalate and hemitongue, along with bilateral negative upper limb myoclonus. There were proximal muscle wasting in the upper limbs, proximal weakness of the four limbs, and diffuse fasciculations. Ataxia of stance and gait and of the four limbs was noted. MRI of the brain and spine was unremarkable; nerve conduction studies revealed a chronic, predominantly demyelinating, sensory-motor polyneuropathy, probably due to diabetes. Routine CSF examination was unrevealing and serum GFAP level was 89.6 pg/mL; however, the autoimmunity tests revealed a high-titer positivity for anti-IgLON5 autoantibodies in both CSF and serum, leading to the diagnosis of anti-IgLON5 disease. Symptoms improved significantly after intravenous methylprednisolone.ConclusionsHemifacial and hemiorolingual myorhythmia along with peculiar oculomotor abnormalities characterizes the multifaceted clinical picture of our case. The complex semiology of our patient may reflect multifocal targeting of the autoimmune process or sequential spreading of tau inclusions in different brain areas. Our patient’s optimal response to glucocorticoid monotherapy could be underpinned by a slightly different phenotype in which autoimmunity plays a greater pathogenic role than tauopathy, with a lower burden of tau deposition. In such patients, neurodegeneration and tau accumulation could be merely secondary to immune-mediated neuronal dysfunction, supporting the existence of a group of glucocorticoid-responsive patients.

Orange palpebral spots on bilateral upper eyelids.

Orange palpebral spots on bilateral upper eyelids.

Ultrasound-based histological differences in thickness between puffy eyelids and normal eyelids in Asian monolid women

BackgroundUpper eyelid tissue swelling is a common characteristic among Asian monolid individuals and is associated with a high incidence of complications following eyelid surgery. Currently, there is no precise definition for upper eyelid tissue swelling, necessitating further research to elucidate the specific causes contributing to upper eyelid puffiness. MethodBetween June 2023 and February 2024, we recruited 84 Asian monolid women categorized into groups based on the severity of upper eyelid tissue swelling: the puffy eyelid group and the normal eyelid group. High-frequency ultrasound was employed to capture images of the upper eyelids and measure the thickness of various tissue layers. This study aims to conduct a comparative analysis to identify the factors contributing to upper eyelid fullness, focusing on elucidating the underlying causes of this condition. ResultAll volunteers underwent bilateral upper eyelid ultrasound imaging. Significant differences were observed in the thickness of subcutaneous fat, pre-tarsal fat, retro-orbicularis oculi fat（ROOF）, and composite fat(ROOF and pre-aponeurotic fat) layer between the puffy eyelid group and the normal eyelid group. However, no significant differences were found in skin thickness or orbicularis oculi muscle thickness. Additionally, no significant differences were observed in the thickness of various layers of the upper eyelid tissue between the left and right eyes in all participants. ConclusionThickening of the upper eyelid fat layer is a primary cause of upper eyelid puffiness. In upper blepharoplasty, targeted removal of pre-aponeurotic fat, ROOF, and pre-tarsal fat can achieve precise reduction to correct upper eyelid puffiness effectively.

Cutler Beard Procedure for Bilateral Upper Eyelid Coloboma in Charge’s Syndrom: Surgical Outcome

Ocular coloboma is one of the anomalies that commonly seen in CHARGE syndrome. This syndrome is an autosomal dominant malformation which includes six major features: coloboma, heart defect, atresia of the choanae, retarded growth and development delay, genital hypoplasia, ear anomalies. Cutler-Beard procedure is one of the major technic when a total or near total upper eyelid is missing. To report the surgical outcome in bilateral upper eyelid coloboma in CHARGE syndrome patient after Cutler Beard’s procedure. A 8 month-old boy presented to the hospital with bilateral upper eyelid coloboma since birth. Other clinical manifestations including bilateral optic nerve coloboma, external ear anomalies, bilateral undecensus testis, growth and developmental delay, and CHARGE facies which were consistent with 2 and 4 major and minor diagnostic criteria. The patient underwent eyelid reconstruction by using Cutler Beard procedure in both of eyes. Cutler Beard procedure may be used as the primary reconstruction method in bilateral upper eyelid coloboma in CHARGE syndrome.

Orbital Myositis Leading to Compressive Optic Neuropathy after COVID-19 mRNA Vaccination: A Case Report

Purpose: We present a case of bilateral compressive optic neuropathy secondary to orbital myositis after COVID-19 messenger ribonucleic acid (mRNA) vaccination.Case summary: A 51-year-old man developed acute bilateral visual loss and painful ophthalmoplegia shortly after receiving the second dose of the BNT162b2 COVID-19 mRNA vaccine (Comirnaty, Pfizer®, New York, NY, USA). His best-corrected visual acuity was counting fingers at 30 cm and 50 cm in the right and left eyes, respectively. Bilateral eyelid swelling, erythema, conjunctival injection, and color vision deficit were observed. Orbital magnetic resonance imaging revealed diffuse enhancement and hypertrophy of the bilateral extraocular muscles. The patient had no significant ophthalmic history and systemic work-up revealed no evidence of underlying inflammatory disease. Based on the clinical presentation and imaging findings, he was tentatively diagnosed with bilateral compressive optic neuropathy secondary to orbital myositis after COVID-19 mRNA vaccination. He was treated with intravenous corticosteroids for 3 days followed by low-dose oral corticosteroids. One month later, his visual acuity and color vision improved; moreover, the inflammatory signs in the eyelids, conjunctiva, and extraocular muscles resolved. However, after developing COVID-19, he experienced a recurrence of symptoms and was retreated with corticosteroids. Radiotherapy was administered to address persistent color vision deficit in the right eye and recurrent eyelid edema, erythema, and conjunctival injection. This treatment effectively resolved all inflammatory signs and color vision deficits, without signs of recurrence.Conclusions: Acute fulminant orbital myositis with associated compressive optic neuropathy can manifest after COVID-19 mRNA vaccination and onset of COVID-19. Anti-inflammatory treatment measures can effectively control these manifestations.

Selection of Optimal Double-Lid Blepharoplasty Based on Asian Upper Eyelid Tissue Structure.

To investigate the postoperative effect of double-lid blepharoplasty based on the histological difference in the upper eyelid of Asian patients. A total of 76 patients with poor bilateral upper eyelid morphology or a single eyelid were included in this study. Different techniques of double-eyelid blepharoplasty were performed based on the thickness of the palpebral tissue. The improved PARK method (group A: 15 participants) was employed for patients with orbicularis oculi muscle being thinner, and the fat bulge of orbital septum was less. The improved traditional method (group B: 52 participants) was employed for patients with hypertrophy of the eyelid skin, orbicularis oculi muscle, and fat bulge in the orbital septum. All 76 patients achieved satisfactory outcomes in a single surgical procedure. Postoperative follow-up ranged from 3 to 6 months. In group A, there was no obvious swelling of flap near the palpebral margin and the double blepharon line becomes shallow. Although some patients in group B experienced varying degrees of bruising in the early postoperative period, all patients returned to a more natural shape 1-3months after surgery. Furthermore, after 3-6months postoperatively, there were no obvious scar adhesion and ladder sensation in the both sides of the incision. Preoperative analysis of the thickness of the upper eyelid tissue is essential to determine the appropriate surgical technique for double-eyelid blepharoplasty. The improved traditional method is recommended for patients with hypertrophy of the upper eyelid tissue (group A), as it minimizes scar adhesion and reduces the stair-step sensation in the lower eyelid tissue during long-term follow-up. For patients with thin upper eyelid tissue, the improved PARK method should be employed to avoid issues such as tissue accumulation, double eyelid crease became shallower, or disappearance. In order to obtain natural and long-term surgical results, different surgical methods should be provided according to the patient's eye tissue condition. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Genetic analysis of a fetus with cryptophthalmos due to variants of FREM2 gene

To explore the genetic etiology of a fetus with cryptophthalmos detected by prenatal ultrasonography. A fetus undergoing induced labor at 32nd gestational week due to absence of bilateral eye fissures detected by prenatal ultrasonography in January 2017 was selected as the study subject. Umbilical cord blood sample from the fetus and peripheral blood samples from its parents were collected for the extraction of genomic DNA. Pathogenic variants were screened through whole exome sequencing (WES) and verified by Sanger sequencing. Pathogenicity of candidate variants was verified by bioinformatic analysis and protein structure simulation. Based on the results of genetic testing, prenatal diagnosis was provided to the couple upon their subsequent pregnancy. The couple had four adverse pregnancies previously. The aborted fetus was the fifth, with fused bilateral upper and lower eyelids, poorly developed eyeballs, adhesion of the cornea with the upper eyelid, low-set ears, and abnormal plantar creases, and was diagnosed with cryptophthalmos. WES and Sanger sequencing revealed that the fetus has harbored compound heterozygous variants of the FREM2 gene, namely c.4537G>A (p.D1513N) and c.7292C>T (p.T2431M). Both variants were unreported associated with cryptophthalmos previously. Protein structure simulation showed that they may lead to loss of hydrogen bonds in the protein product. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were predicted to be likely pathogenic (PM1_Supporting+PM2_Supporting+PM5+PP3+PP4; PM2_Supporting+PM3+PP3+PP4). The mother was performed prenatal diagnosis in her sixth pregnancy based on the variants detected in this family, and delivered a daughter with normal phenotype. The FREM2: c.4537G>A and c.7292C>T compound heterozygous variants probably underlay the pathogenesis of cryptophthalmos in this fetus. Above finding has enriched the mutational spectrum of the FREM2 gene.

Management of bilateral lower eyelid entropion in a black Angus bull by temporary tacking and modified Hotz Celsus

AbstractThe objective was to evaluate the progression and management of eyelid tacking sutures before permanent eyelid surgical correction. A 1‐year‐old Aberdeen black Angus bull presented with a 1‐month history of bilateral corneal ulcers. Ophthalmic examination revealed an infected stromal corneal ulcer on the left eye and bilateral lower eyelid entropion. Lower eyelid tacking sutures were placed bilaterally to allow corneal healing, prevent recurrent corneal ulceration and allow resolution of concurrent moist dermatitis. Approximately 2 weeks after eyelid tacking, permanent entropion repair using a modified Hotz Celsus technique was performed on both lower eyelids. This report details the successful treatment of bilateral lower eyelid entropion in a bull using temporary tacking sutures to stabilise corneal and eyelid disease before permanent eyelid surgical correction.

Effects of Preoperative Intravenous Versus Subcutaneous Tranexamic Acid on Postoperative Periorbital Ecchymosis and Edema Following Upper Eyelid Blepharoplasty: A Prospective, Randomized, Double-Blinded, Placebo-Controlled, Comparative Study.

To compare the effects of preoperative tranexamic acid (TXA) administered intravenously (IV) versus subcutaneously on postoperative ecchymosis and edema in patients undergoing bilateral upper eyelid blepharoplasty. A prospective, double-blinded, placebo-controlled study of patients undergoing bilateral upper eyelid blepharoplasty at a single-center. Eligible participants were randomized to preoperatively receive either (1) 1 g of TXA in 100 ml normal saline IV, (2) 50 µl/ml of TXA in local anesthesia, or (3) no TXA. Primary outcomes included ecchymosis and edema at postoperative day 1 (POD1) and 7 (POD7). Secondary outcomes included operative time, pain, time until resuming activities of daily living, patient satisfaction, and adverse events. By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), ecchymosis scores were significantly lower on POD1 (1.31 vs. 1.56 vs. 2.09, p = 0.02) and on POD7 (0.51 vs. 0.66 vs. 0.98, p = 0.04) among those that received TXA. By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), significant reductions in edema scores occurred in those that received TXA on POD1 (1.59 vs. 1.43 vs. 1.91, p = 0.005) and on POD7 (0.85 vs. 0.60 vs. 0.99, p = 0.04). By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA) patients treated with intravenous and local subcutaneous TXA preoperatively were more likely to experience shorter operative times (10.8 vs. 11.8 vs. 12.9 minutes, p = 0.01), reduced time to resuming activities of daily livings (1.6 vs. 1.6 vs. 2.3 days, p < 0.0001), and higher satisfaction scores at POD1 (8.8 vs. 8.7 vs. 7.9, p = 0.0002). No adverse events occurred were reported. In an analysis of 106 patients, preoperative TXA administered either IV or subcutaneously safely reduced postoperative ecchymosis and edema in patients undergoing upper eyelid blepharoplasty. While statistical superiority between intravenous versus local subcutaneous TXA treatment was not definitively identified, our results suggest clinical superiority with IV dosing.