Correction Of Ectropion Research Articles

The effect of lateral tarsal strip surgery on corneal biomechanical parameters measured by Corvis ST

PurposeTo evaluate the effect of lateral tarsal strip (LTS) surgery for involutional ectropion on corneal biomechanical properties measured by the Corvis ST device. MethodsThis prospective clinical study examined 23 patients (mean age 67.7 years) undergoing LTS for involutional ectropion. Corneal biomechanics were evaluated preoperatively and at 1 month postoperatively using the Corvis ST. Deformation amplitude, applanation length, highest concavity measurements, and corneal biomechanical indices were compared before and after LTS. ResultsThe second applanation deformation amplitude was significantly reduced after LTS compared to before (0.471 vs 0.428 mm, p = 0.031) indicating improved corneal stiffness. First applanation deflection length also decreased significantly following surgery (2.342 vs 1.967 mm, p = 0.043) suggesting enhanced corneal stability. Highest concavity deformation parameters were unchanged. Corneal biomechanical index, stiffness parameter, and intraocular pressure compensatory effect showed no significant differences pre- versus post-operatively. ConclusionsLTS surgery leads to measurable improvements in select corneal biomechanical parameters, specifically applanation deformation amplitude and deflection length. This preliminary analysis reveals subtle beneficial impacts on corneal stiffness and stability after surgical correction of ectropion. LTS appears to marginally augment corneal biomechanical properties based on Corvis ST assessment.

More Than Under-Eye Bags: Treatment of Formidable Festoons.

A 64-year-old male with no medical care over the last decade was transferred from his local emergency room to a level 1 trauma center following an unwitnessed fall. Upon ophthalmic evaluation, he was noted to have significant lethargy and bilateral large festoons with secondary ectropion. Laboratory workup revealed severe hypothyroidism, consistent with myxedema coma, and his lethargy improved with medical treatment. The festoons were surgically removed to address the ectropion, and the patient was satisfied with the results following a single procedure. This case report features the largest reported festoons to date in the literature and emphasizes the importance of balancing cosmesis with function during surgical excision and correction of ectropion.

THE MANAGEMENT OF CICATRICIAL ECTROPION CAUSED BY BURN INJURY: A CASE REPORT

Introduction: Eyelid reconstruction in cicatricial ectropion caused by facial burns represents a surgical challange. Surgical management consists in correcting the lid defect often associated with a skin graft and lid tightening. Case Description: a 18-years-old man was referred because suffered cicatricial ectropion on superior-inferior eyelid of right eye after got burn injury 4 months before come to our outclinic, with cicatricial tissue on 50% on right face after facial burns. Ocular examination revealed a visual acuity 20/20 on both eyes, lagophthalmos but a good Bell’s phenomenon, and diffused ectropion on the eyelid of right eye. Reconstruction was made a release contracture tissue, lid tightening and full thickness skin grafts from donor site which recommended from supraclavicular 60 x 30 mm for superior eyelid and 50 x 40 mm for inferior eyelid, place the graft and fix it with a bolster and Frozt suture. We follow up the patient, 1 day, 1 week, and 6 months post operation. Discussion: Major issues when addresing cicatricial ectropion followed by severe burns are : right donor site selection, slightly oversized graft allowed for some contraction and full eyelid closure. For further plan is consultation to plastic surgery to manage other cicatricial tissue of part of body. Conclusion: Reconstruction for diffused ectropion by using full thickness skin graft and lid tightening are better option for correction of cicatricial ectropion.

Treatment of Cicatricial Lower Eyelid Ectropion with Suture of Horner Muscle Combined with Fascia Transplantation.

This case series aimed to describe a new technique for correcting contractures and deformities that reliably addresses lacrimal punctum deviation and severe cicatricial lower eyelid ectropion. This was a technical description and a retrospective interventional case series. Eyelid ectropion and lacrimal punctum deviation were treated surgically by grafting the fascia lata and suturing the tarsus-Horner muscle. In total, three patients underwent this surgery: one for burns, one for lower eyelid tumor resection, and the other for an orbital floor fracture following a motorcycle accident, all resulting in ectropion. All patients previously had failed ectropion correction procedures, including scar revision, skin grafting, auricular cartilage grafting, and lateral tarsal strips. The mean follow-up was 15.8 (12.5-18.5) months. Furthermore, all patients showed resolution of lower eyelid ectropion and significant improvement in lower eyelid contracture, with a mean increase of 4.0 (2.5-5) mm. No severe complications were observed, and they reported a significant improvement in ocular surface symptoms. Our study shows that tacking of the tarsus and Horner muscles in combination with fascia lata grafting is effective in correcting refractory cicatricial lower eyelid ectropion with deviation of the tear punctum.

The 'Invisible Lazy-T' Procedure for Correction of Medial Ectropion.

No accepted standard for the correction of medial ectropion has been established. The most critical part of the surgical treatment for medial ectropion is the tightening of both horizontal and vertical laxity. To correct this ectropion, we have applied a combination procedure which includes tightening of the conjunctiva and the eyelid retractors (posterior lamellae) and the lateral tarsal strip procedure. Our imitation of the 'Lazy-T', a surgical operation performed on the medial ectropion, is tentatively named 'Invisible Lazy-T'. It is a versatile technique with a less visible scar than alternative techniques because skin incision is made along the crease line of the 'the crow's feet'. Results suggest a satisfactory solution to this problem and with better outcomes than by other techniques. We propose this novel combination technique is the best strategy for the medial ectropion, and it does not require specialized surgical skill, so ectropion can be managed by craniofacial surgeons.

Evaluation of Bicanalicular Nasolacrimal Duct Intubation as an Adjunct in Surgical Ectropion Correction.

Background and Objectives: We aimed to analyze and compare the outcomes of conventional ectropion surgery procedures with and without concurrent bicanalicular nasolacrimal duct intubation to identify if the combination of procedures could serve as a novel surgical approach to treat lower eyelid ectropion. Materials and Methods: A retrospective review of all patients who underwent surgical correction for lower eyelid ectropion at the Cantonal Hospital of Aarau between January 2019 and December 2020 was performed. Patient medical records were examined for etiology, surgical correction technique and intra- and postoperative complications. The postoperative punctal position, the pre- and postoperative epiphora and reoperation rate were also documented. Two study groups consisting of cases with isolated and combined procedures were compared, with respect to postoperative punctual and lower lid position. Results: A total of 53 lower eyelids (35 patients) were included in this study. Six months postoperatively, the correct punctum position (p = 0.1188) and improvement of epiphora (p = 0.7739) did not significantly differ between the two groups. More complications were seen in the nasolacrimal duct intubation group (p = 0.0041), which consisted of cheese wiring and one tube dislocation. Conclusion: In our study, bicanalicular nasolacrimal intubation during ectropion surgery does not seem to improve the outcome of ectropion surgery and is, therefore, not recommended on a routine basis.

Clinical features, surgical outcomes and genetic analysis of ectodermal dysplasia with ocular diseases.

To report on the clinical features, surgical outcomes and gene mutation analysis of three ectodermal dysplasia probands with ocular diseases. A case-note review of three unrelated probands diagnosing with ectodermal dysplasia with ocular diseases was undertaken. Patient clinical features and the outcomes of surgery were analysed. The suspected pathogenic genes were analysed by whole exome sequencing from patients with ectodermal dysplasia and Sanger sequencing from family members. The ocular clinical features of ectodermal dysplasia with ocular diseases mainly include eyelid ectropion, lagophthalmos and absence of lacrimal punctum. All the probands underwent surgeries of full-thickness free skin flap grafting to correct ectropion. They achieved good recovery, and there were no obvious complications during the follow-up. The gene sequencing results did not show any meaningful genetic mutations. Lid ectropion is one of the key clinical traits of ectodermal dysplasia with ocular diseases. Ectropion correction with full-thickness free skin flap grafting is an effective procedure to correct ectropion for ectodermal dysplasia patients with ichthyosis-like tissue. The suspected pathogenic genes of ectodermal dysplasia with ectropion should be further verified or confirmed by large samples of the family.

Surgical Correction of Ectropion: Comparison Between Full Thickness Skin Grafts and Local Flaps

Objective: To compare the effectiveness of two reconstruction techniques, i.e., full-thickness skin graft and local flap, for patients undergoing reconstructive surgery for ectropion repair.
 Study Design: Prospective comparative study.
 Place and Duration of Study: Department of Plastic & Reconstructive Surgery, Dr Ruth K.M. Pfau Civil Hospital Karachi, from Feb to Aug 2020.
 Methodology: The study was conducted after acquiring approval from the Institutional Review Board of Dow University of Health Sciences. Patients advised repairing ectropion were admitted to the ward prior to a day or night of the procedure. The consultant surgeon decided on the operative management, either using a full-thickness skin graft or a local flap, depending on the type of ectropion.
 Results: 60 patients were recruited for the study, with 30 patients in each group. At follow-up of two weeks, one month, and three months’ skin colour match and pliability were significantly better in patients who received local flap than those treated with a full-thickness skin graft. Out of 30, 2 (6.7%) patients developed ectropion recurrence when they received full-thickness skin graft coverage, whereas ectropion recurrence was not observed in patients managed with local flap.
 Conclusion: Local flap appears to be more effective than full-thickness skin graft in achieving excellent aesthetic effects in patients who underwent correction of ectropion.

Lateral Tarsal Strip Complications With and Without Conjunctiva Stripping.

The lateral tarsal strip (LTS) procedure is commonly used to correct eyelid malposition. When performing LTS, some surgeons elect to remove conjunctiva from the tarsal strip, while others do not. It has been hypothesized that without conjunctival stripping, the buried conjunctival tissue can cause complications such as inclusion cysts and granulomas. However, there is limited data comparing LTS cases with and without conjunctiva removal. The authors sought to evaluate whether conjunctival stripping had any impact on complication rates with LTS. LTS operations for ectropion correction were retrospectively reviewed and were separated into 2 cohorts, Con (conjunctiva not removed) or Coff (conjunctival removed). Charts were reviewed for outcomes and complications including inclusion cyst formation, granuloma formation, wound dehiscence, infection, and focal rim tenderness. The complication rate was 10% versus 8% for Con versus Coff respectively ( p = 0.54). The common complications of LTS surgery were granuloma (4%), wound dehiscence (3%), focal rim tenderness (3%), and infection requiring antibiotics (<1%). There was no significant difference in these complications between the Con and Coff cohorts. Complications in both groups were minimal, similar to prior studies, and there was no difference between the 2 cohorts. While it has been suggested that buried conjunctiva may result in increased complication rates, the author's findings suggest that removing the tarsal conjunctiva is a superfluous step in the LTS surgery and does not affect complication rates.

Lateral Tarsoplasty for Managing Ectropion and Laxity of the Lower Eyelid.

The most challenging complication associated with lower blepharoplasty is ectropion, and the traditional lateral canthopexy or canthoplasty procedure may carry the risk of eyelid malposition or subsequent chemosis. We propose lateral tarsoplasty with a detailed description of the techniques to treat and even prevent ectropion by not involving the medial or lateral canthal ligament so as to avoid complications. Lower eyelid laxity was analyzed with the snap-back test and distraction test before surgery. Approximately 5 mm medial to the lateral canthus, lateral tarsoplasty is performed through a full-thickness pentagonal tarsal-conjunctival resection according to the "overlapping test" for an accurate measurement of the amount of the tarsus to be resected. Seventy-two eyelids that received either ectropion correction or prevention with lateral tarsoplasty over an 8-year period at a single institution were collected and analyzed for this retrospective review. Lateral tarsoplasty was performed in 39 patients with a mean age of 63.8 years. Thirteen patients with 20 eyelids presented for ectropion correction, in whom 5 to 10 mm of tarsus was resected, 6.0 mm in average. The other 26 patients with 52 eyelids presented for ectropion prevention, in whom 3 to 7 mm of tarsus was resected, 4.1 mm in average. Apart from temporary mild chemosis, all patients experienced highly satisfactory results without any ectropion or malposition of the involved lower eyelids after a follow-up of 8.1 months in average. For patients with moderate and severe laxity of lower eyelids, lateral tarsoplasty without involvement of the lateral canthal ligament proves to be an effective way to treat and prevent lower eyelid ectropion.

Burn Scar Ectropion Correction: Surgical Technique for Functional Outcomes.

Eyelid scarring after severe burn injury of the face is a significant complication endangering vision in addition to the burn scar sequelae. Scar contraction leads to asymmetry and malposition of the eyelid axis, resulting in corneal exposure, eyelid retraction, and incomplete eyelid closure. In consequence, dryness and irritation of the cornea can lead to keratitis, corneal opacity, and vision impairment. In this study, we present our surgical technique for lateral canthopexy in combination with full-thickness skin grafting (FTSGing) in patients with eyelid axis distortion after scar contraction of the periorbital region after severe burn injuries of the face. In this retrospective, single-center case study, we present 5 consecutive patients who experienced severe burn injuries to the face between 2014 and 2019. Patients were suffering from ectropion and malposition of the eyelid axis. In all cases, we performed lateral transosseous canthopexy and FTSGing. Improved symmetry and complete eyelid closure were restored in all 5 patients. The following ophthalmological examinations showed resolved corneal erosions, as well as reduction of chemosis and epiphora. Further vision impairment was successfully prohibited. Surgical revision with FTSGing was required in 2 patients because of recurrence of unilateral lower eyelid retraction. Lateral transosseous canthopexy represents a suitable surgical method to durably correct eyelid malposition, ectropion, and incomplete lid closure in patients with severe scarring of the periorbital region after burns of the face. Early detection of patients at risk and timing of surgical intervention are of great importance.

Lateral Tarsal Strip Technique in Correction of Eyelid Ectropion and Entropion

Ectropion and entropion are eyelid malpositions associated with a number of unpleasant symptoms. One of several surgical methods that can correct these problems is referred to as the lateral tarsal strip technique. In this paper, we evaluate the postoperative results and quality of this technique. We also examine the complications associated with this surgical method. The study took place from April 2018 to April 2020 at the Military University Hospital in Prague. The operation was performed by two surgeons. The study included 43 eyes of 33 patients (17 women and 16 men), average age was 79 years. Before the operation, 23 eyes were affected by ectropion and 20 eyes affected by entropion, 35 of the 43 were cases of involutional origin. The study does not include patients who underwent other surgical techniques. There were no perioperative or postoperative complications in the entropion surgery group. Successful correction was achieved, and adverse symptoms disappeared in 91.3% of cases. Correct position of the eyelid was not achieved in two cases. For patients with ectropion, surgical correction was successful in 95% of cases. Ectropion persisted after surgery only in one patient. The lateral tarsal strip technique is a safe, reliable and highly effective surgical technique. Correction of eyelid malposition was achieved in more than 90% of cases. The vast majority of patients were satisfied and reported relief from preoperative symptoms.

Lateral tarsal strip (LTS): Surgical technique and outcomes

Aims: To assess the outcome of lateral tarsal strip (LTS) for the involutional entropion and ectropion. Materials and Methods: A quasi study was carried out in a tertiary eye hospital of Dhaka, Bangladesh, between January 2013 and December 2020. This study included all patients who underwent lateral tarsal strip (LTS) procedure for the correction of involutional entropion and ectropion. Group A patients were presented with involutional entropion and group B patients were presented with involutional ectropion. We assessed surgical outcome and postoperative complications. Results: Out of 48 lower eyelids marginal malposition of 43 patients were studied in this study and 5 cases were presented bilateral lower lid marginal malposition. Lateral tarsal strip (LTS) procedure was a unique procedure to correct the involutional entropion (24 eyelids 50%), involutional ectropion (24 eyelids 50%), involving the lower eyelid. The male to female ratio was almost 2.6:1. The mean age was 68.49 years with 54 years to 90 years age range. The surgical correction was satisfactory in 95.9%, and 91.7% of lower eyelids involutional entropion, and involutional ectropion respectively. Conclusions: Lateral tarsal strip (LTS) is a unique procedure to achieve better cosmetic and functional outcome for the correction involutional eyelid marginal malposition (entropion, and ectropion). Keywords: Lateral tarsal strip, Involutional, Entropion, Ectropion.

Osteoradionecrosis of the Midface and Mandible: Pathogenesis and Management.

Radiation therapy is an important and commonly used treatment modality for head and neck cancers. Osteoradionecrosis (ORN) is a potential debilitating complication of treatment, which most commonly affects the mandible. Management strategies are tailored to the severity of disease. Medical management including oral rinses, irrigations, antibiotics, and pharmacological treatments is viable for mild-to-moderate ORN. More severe disease is best addressed with a combination of medical management and surgical intervention aimed at aggressively removing devitalized tissue until bleeding bone is encountered and reconstructing the soft tissue and bone defect. Reconstruction with either regional vascularized flaps or vascularized osteocutaneous free flaps in case of larger full-thickness bone defects (greater than 6 cm) or anterior mandible (medial to mental foramen) is most appropriate. Maxillary ORN complications can present with a wide range of functional problems and facial disfigurement. Life-threatening and time-sensitive problems should be treated first, such as skull base bone coverage or correction of severe ectropion, to avoid blindness from exposure keratopathy. Then, less time-sensitive issues can be addressed next, such as nasal obstruction, velopharyngeal insufficiency, and chronic tearing. It may require a combination of specialists from different disciplines to address various issues that can arise from maxillary ORN.

Anesthetic management of burn-associated dilated cardiomyopathy with difficult intubation for bilateral correction of ectropion

Anesthetic management of patients with dilated cardiomyopathy (DCM) can be challenging for anesthesiologists because it is associated with high perioperative mortality rate.
 This case report describes successful management and important anesthetic considerations in a 15-year-old boy, a known case of burn-associated dilated cardiomyopathy, who underwent bilateral ectropion correction surgery.
 In such patients, it is imperative to have meticulous preoperative planning, wise selection of medications, and tailored anesthetic technique in order to achieve a favourable outcome.
 Key words: Anesthesia; Burns; Cardiomyopathy, Dilated; Ketamine; Propofol; Dopamine
 Citation: Sheikh N, Salik M, Faraz A, Aldahish MM. Anesthetic management of burn-associated dilated cardiomyopathy with difficult intubation for bilateral correction of ectropion. Anaesth. pain intensive care 2020;24(5):
 Received: 22 August 2020, Reviewed: 23 August 2020, Accepted: 28 August 2020

Patterns, etiology and surgical intervention in cases of epiphora referrals in a tertiary care centre

To analyse the etiology of epiphora in the adult age group in a tertiary care centre in a developing country and the type of surgical intervention needed in those not amenable to medical management. Ninety-eight adult patients with primary complaint of epiphora were analysed retrospectively. The patients included were those who had either some obstruction in the lacrimal drainage pathway or had poor apposition of punctum to the globe. Reflex tearing or primary hypersecretion as a causative factor was excluded from the study. Descriptive statistics of the continuous data was presented using mean± standard deviation / median (interquartile) and range while categorical data in frequency (%). To compare the proportions between the groups, Fisher exact test was used where the expected frequency in at least any cell was less than 5. P value <0.05 was considered as statistically significant. Mean± standard deviation and median (interquartile) of the patients age (in years) was 53.37±13.71 and 57(42-65) respectively with range of 20-77 years. External dacryocystorhinostomy (with or without intubation) was the most common surgery performed (n=50, 51%) followed by punctal surgeries (n=21, 21.4%) and lower lid ectropion correction (n=17, 17.3%). In the 98 patients studied, external dacryocystorhinostomy was the most performed surgery for lacrimal passage obstruction. Older female patients are more susceptible to nasolacrimal blockage than the male patients while obstruction in the upper lacrimal apparatus is more common in younger males. Lateral tarsal strip is the most performed surgery for lower lid ectropion.

Efficacy of pre-expanded forehead flap based on the superficial temporal artery in correction of cicatricial ectropion of the lower eyelid

Lower eyelid retraction or ectropion bring suffering to the patients both physically and mentally. Efforts to explore pertinent surgical treatments are still needed. Here we have described our preferred surgical technique for lower eyelid ectropion repair with pre-expanded island forehead flaps or pedicled forehead flaps. Between July 2007 and March 2017, a retrospective review of 12 patients who suffered from cicatricial lower eyelid ectropion as a result of trauma, surgery, or infection was conducted. Forehead skin flap based on the superficial temporal artery was expanded depending on the area of defect of the lower eyelid. Tissue expansion, flap transfer, pedicle delaying and division were involved in this process. There were no major complications, such as expander exposure, infection, haematoma or large skin flap necrosis in all the 12 patients. Venous congestion was reported in two patients. No recurrent ectropion was noted in any patient. During the three-month to two-year follow-up all patients were satisfied with the results in terms of the skin texture, colour, and flexibility after the treatment with an expanded forehead skin flap. This study suggests that expanded forehead skin flaps are effective for correction of cicatricial lower eyelid ectropion.

Successful correction of ichthyosis-related ectropion by autografts.

Ectropion is a rather frequent complication of ichthyosis with negative functional and esthetic impact. Lid surgery can provide significant improvement. We report on a series of four ichthyosis patients with ongoing bilateral eye problems despite intense medical treatment (mean age 27.8 ± 14.1 years). All patients suffered from lagophthalmos. Two of the patients had only lower lid ectropion. In two of the patients' ectropion was forming on the upper lid in addition to the lower lid when closing the eye. In three of four patients, ectropion was repaired by skin grafts from the supraclavicular region. In a child with lower and upper lid ectropion prepuce was used for repair surgery. At the end of the follow-up period of about 23.0 ± 12.7 months, none of the patients revealed lagophthalmos or corneal exposure. No intraoperative or postoperative complications have been observed in our patients. Ichthyosis patients with ectropion resistant to medical treatment, benefit from surgical treatment with full layer autografts. In boys, prepuce can be successfully used as autograft.

Surgical Correction of Upper Eyelid Ectropion Presenting Dry Eye Symptoms.

Upper eyelid ectropion occurs as a post-blepharoplasty complication or involution change, and it causes dry eye symptoms that cannot be resolved with conservative management. The aim of this study is to describe the authors' surgical technique of anatomical correction of upper eyelid ectropion, including tarsal scoring incision. The technique involves the following 4 steps: (1) adhesiolysis at the preaponeurotic layer; (2) undermining and redraping of the pretarsal flap in a pretarsal plane; (3) optional, partial thickness tarsal scoring incision over the central two-thirds; and (4) downward repositioning of the pretarsal flap and lower fixation to the tarsus. Outcomes were assessed based on the position of eyelid margin and the improvement of the dry eye symptoms. A retrospective review of 54 cases of patients who underwent ectropion correction, including tarsal scoring incision, was performed. The eyelid margin was well positioned in 51 patients (94.4%). Of the 32 patients involved in the study assessed with the 7-point Patient Global Impression of Improvement, 29 (90.6%) reported the resolution of dry eye symptoms. Furthermore, in the 22 patients assessed with the Ocular Surface Disease Index, the mean score significantly decreased from 43.2 ± 24.1 before surgery to 29.8 ± 23.3 (P = 0.006) after surgery. The combination of partial-thickness tarsal plate scoring and lower flap redraping surgical techniques resolved the upper eyelid ectropion, reducing the dry eye symptoms.

Management of facial paralysis following treatment of neurosurgical tumours

The purpose of this study is to present our experience on improving the quality of life of patients with facial paralysis due to an operated intracranial tumour, by performing minimally invasive static reanimation procedures. We reviewed the clinical information pertaining to neurosurgical patients with facial paralysis that underwent static reanimation. The study included 11 patients with complete facial nerve paralysis of all nerve branches, that reported different primary complaints upon presentation. The performed procedures consisted of gold plate insertion into the superior eyelid, inferior eyelid ectropion correction or suture suspension. The functional results were favourable in all cases and the resulting appearance was acceptable. The choice of the different techniques used is discussed. Good outcomes are possible using static reanimation with an adequate adaptation of the techniques to the main patient complaint.