Eyelid Ectropion Research Articles

Clinical Manifestations in Patients Wearing Ocular Prostheses.

This study aimed to assess upper and lower eyelid shapes and changes in patients wearing ocular prostheses. The authors retrospectively reviewed the clinical records of patients wearing ocular prostheses. Clinical manifestations, including superior sulcus deepening, ptosis, upper and lower eyelid entropion, upper and lower eyelid ectropion, upper and lower eyelid retraction, and upper and lower eyelid socket contracture were investigated. For those patients who underwent evisceration, the most common clinical manifestations of the eyelid were superior sulcus deepening and ptosis (35%, respectively), whereas lower eyelid entropion and lower eyelid retraction were the second most common manifestations (25%, respectively). Among those patients who underwent enucleation, the most common eyelid changes were lower eyelid entropion (45.5%), and ptosis and lower eyelid socket contracture were the second most common alterations (36.4%, respectively). Finally, superior sulcus deepening, upper eyelid entropion, and lower eyelid retraction occurred in 27.3% of patients, respectively. Upper eyelid ptosis, superior sulcus deepening, and lower eyelid entropion and retraction were the most common clinical manifestations in patients wearing ocular prostheses. When following up with patients with ocular prostheses, it is important to check these eyelid changes and consider making appropriate corrections.

Periorbital Reconstruction in Facial Paralysis

The primary function of the eyelids is to maintain ocular health and protection. In facial paralysis, neurogenic dysfunction of the orbicularis oculi muscle complex leads to a spectrum of ocular and periocular issues including xerophthalmia, exposure keratopathy, and lower eyelid malposition contributing to epiphora and facial deformity. Conservative techniques can foster a safe environment for patients awaiting surgical intervention. Eyelid coupling using a combined lower eyelid tightening and modified tarsoconjunctival flap is our preferred technique for older patients with flaccid facial paralysis, usually performed with a platinum weight. Medial eyelid ectropion remains a difficult area for those with senile changes. For best lower eyelid outcomes, the midface must be lifted with reanimation, facial sling, or temporalis tendon transfer. Herein we describe several chosen techniques to improve patients' ocular and cosmetic outcomes after facial paralysis.

Surgical Correction of Lower Lid Epiblepharon With Skin-Only Resection Using a Novel Design.

This study is to report the surgical outcome of lower lid epiblepharon repair with skin-only resection using a newly designed incision line. A retrospective, noncomparative, interventional case series analysis of 134 eyes of 67 patients, who underwent surgical correction of lower lid epiblepharon with skin-only resection using the new incision design, was performed. After marking the 4 vertical lines at the medial canthus, punctum, midpoint, and lateral canthus, the upper and lower incision lines were drawn from the medial canthus through punctum to the lateral canthus with novel design. After incising the skin along the marked line, gentle dissection of the skin flap from the underlying orbicularis muscle was performed. Only skin flap was excised and closed. The patients were followed up for more than 6months. The mean age of patients was 7.9 ± 3.7 years (range 4-13 years) and the mean follow-up period was 18.0 ± 5.7 months (range 13-31 months). During the follow-up period, recurrence of the epiblepharon was not observed. There was no occurrence of complications such as lower lid ectropion or retraction. Skin-only resection using a newly designed incision line is a simple and effective method to fully correct the medial portion of the lower lid epiblepharon and prevent dog-ear formation or overcorrection at the lateral portion, and prominent lid crease.

Use of Buried Guide Needle to Fix Inferior Eyelid Orbital Septum Fat for Tear Trough Depression Filling.

Fat fixation is a key step in filling tear trough depression with inferior eyelid orbital septum fat. The ideal position for inferior eyelid fat fixation is to cross the tear trough ligament causing tear trough depression and the orbicularis retaining ligament, with the distal end fixed at the farthest end of the dissected lacuna deep down the inferior orbicularis oculi muscle. Traditional suturing is difficult in the deep narrow lacunae, but a buried guide needle can be used to suture and fix the fat in the deepest lacuna. In this study, 264 patients who underwent tear trough filling using a buried guide needle to fix the released inferior eyelid orbital septum fat from 2017 to 2020 were followed up. The preoperative and postoperative imaging findings were compared to evaluate the effectiveness of the operation and postoperative complications. The inferior eyelid bulging, loose skin, and tear trough depression significantly improved than that before the operation. None of the patients had any severe complications, such as inferior eyelid ectropion, lagophthalmos, scar hyperplasia, and diplopia, in the long term (6 months) postoperatively. Five patients showed mild eyelid-eyeball separation and recovered in 1 month. Four patients had diplopia, and 3 patients had chemosis; all recovered in 7 days. The tear trough depression was not corrected completely in 2 patients. The operation showed satisfactory results in the improvement of tear trough depression in addition to alleviation of inferior eyelid bulging and loose inferior eyelid skin that is caused by the traditional inferior eyelid pouch removal.

Lateral tarsal strip procedure for involutional ectropion: A retrospective analysis of 85 cases and a comprehensive literature review

PurposeTo evaluate the postoperative effect of the lateral tarsal strip (LTS) procedure in treating lower eyelid involutional ectropion. MethodsA retrospective study was performed on 85 eyelids in 67 patients with involutional ectropion who underwent LTS procedure. Pre- and postoperative lower eyelid laxity and ocular symptoms as well as perioperative complications were evaluated. Snap back test was performed to evaluate the elasticity of lateral canthal tendon loosening and, a lower lid distraction test was performed to evaluate the degree of severity before surgery. Ocular surface diseases were evaluated by the Ocular Surface Disease Index (OSDI), and symptoms including conjunctivitis, corneal ulcer, dry eye syndrome, and ocular pain were recorded. All patients were evaluated within one week and during the follow-up period of 4.2 ​± ​8.3 months. Furthermore, we reviewed the studies that also investigated the surgical effect of the LTS procedure in the literature from 1979 to 2019. ResultsThe success rate was 95%. Only four eyelids required a second surgical intervention. Seventy-three (86%) eyelids had an excellent position after surgery, 9 (11%) only little improvement, and three had no improvement. No significant difference was found in the postoperative effects between different degrees of ectropion (p ​> ​0.05). No statistical correlation was found between surgical improvements and the ectropion severity (P ​> ​0.05). Fifty-two out of 85 eyes had no discomfort after the surgery. Mild complications included epiphora in 13 eyes (three cases caused by lacrimal punctum eversion), ocular pain in 12 eyes, wound hemorrhage in 12 eyes, and edema in 9 eyelids immediately after surgery, in which 91.2% (n ​= ​21) disappeared within one week and did not need any further treatment. ConclusionsThe lateral tarsal strip procedure can provide an aesthetically pleasing result for correcting the mild to moderate lower eyelid ectropion while maintaining decent eyelid function.

Cheek-midface lifting with lateral canthoplasy for the repair of complex iatrogenic lower eyelid ectropion.

To assess the efficiency and safety of cheek-midface lifting for the ophthalmoplastic reconstructive surgical repair of cicatricial lower eyelid malpositions after previously failed surgery. In two ophthalmoplastic clinics, 14 eyelids of 13 patients underwent transconjunctival cheek-midface lifting. In a retrospective audit, changes in margin-reflex distance 2 (MRD2), snap-back test, the position of the eyelid after surgery including improving of the presurgical scleral show, the overall patient's satisfaction as well as complications after surgery were recorded. Following transconjunctival cheek-midface lifting, there was a significant improvement of MRD2, snap-back test, and the scleral show (p < 0.001, respectively). However, in three patients the scleral show persisted despite improved MRD2. All patients were satisfied with the results of the surgery. No post-surgical long-term complications were developed. Cheek-midface lifting can be a useful technique in severe cicatricial lower eyelid ectropion after previously failed surgery and is a safe and effective reconstructive method for ophthalmic surgeons with good cosmetical results and little postoperative long-term complications.

Clinical Effect of the Anterior Fascia of Tarsus Tightening Combined With Lower Eyelid Blepharoplasty for Senile Entropion.

A majority of patients with senile entropion have a lower eyelid pouch. This study aimed to explore a modified method to correct the entropion and enhance ophthalmic cosmetology. Patients with senile entropion and lower eyelid pouches, who underwent anterior fascia of tarsus tightening combined with lower eyelid pouch plastic surgery from 2018 to 2019, were enrolled in the study. The data on operation time, postoperative effect, degree of eyelid swelling after surgery, patient satisfaction, and recurrence rate were recorded. The lower eyelid entropion was well corrected in all of the 46 patients after the surgery, and the lower eyelid pouch and saggy skin were satisfactorily repaired. After 1-year follow-up, no recurrence of lower eyelid eversion and ectropion was observed. The shape of the orbital areas was natural in all the patients, the incision scar was hidden, and the patient achieved a high degree of satisfaction. In patients with senile entropion and lower eyelid pouch, anterior tarsal fascia tightening combined with lower eyelid blepharoplasty could not only increase the cure rate and reduce the recurrence rate but also achieve good appearance and improve patient satisfaction.

Transconjunctival Lower Blepharoplasty Using Midcheek Spaces for Orbital Fat Transposition (S.O.F.T.).

The subperiosteum, supraperiosteum, and intrasuborbicularis oculi fat have been used as planes of dissection for orbital fat transposition in transconjunctival lower blepharoplasty. The steep learning curve due to the anatomic complexity in using any of the 3 planes may deter plastic surgeons from performing the procedure. We present the use of clear anatomical midcheek spaces, the premaxillary and prezygomatic spaces, as the plane for orbital fat transposition in transconjunctival lower blepharoplasty. We performed a retrospective study of 184 consecutive patients who underwent transconjunctival orbital fat transposition using the midcheek spaces from November 2013 to July 2019. Recorded data included the patient's age, duration of surgery, postoperative complications (chemosis; bleeding; lower eyelid swelling; orbital and/or lower eyelid infection; eye misalignment on primary gaze; binocular diplopia; numbness involving the lower eyelid, cheek, and upper lip; orbicularis oculi paralysis, inferior scleral show, and lower eyelid ectropion), aesthetic result, and patient satisfaction. The mean age is 35.48 ± 6.66 years. Significant aesthetic improvement was achieved not only for herniated orbital fat and prominent lid-cheek junction but also for midcheek depression over an average follow-up of 22.41 ± 16.04 months. The patient satisfaction score (98.91%) was high. No major complications occurred. The mean operating time was 46.74 ± 6.67 minutes. The natural midcheek spaces could be used as an ideal plane for orbital fat transposition in transconjunctival lower blepharoplasty. By using the midcheek spaces, transconjunctival orbital fat transposition can become a safe and effective technique without the steep learning curve.

Direct Brow Lift and Skin Contraction in Facial Nerve Palsy: A Switch Technique.

The authors present a case series of 4 patients with facial nerve palsy who underwent a direct brow lift to correct brow ptosis, using the excised brow skin as a full-thickness skin graft to correct lower eyelid skin contracture, ectropion, and retraction. Functional outcomes were measured using the validated cornea, static asymmetry, dynamic function, synkinesis (CADS) grading system and by photographic assessment of lower eyelid height via margin reflex distance. Aesthetic outcomes were measured using a published grading scale specific to eyelid skin grafts.

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.

Relationship Between Eyelid Pressure and Lacrimal Status in Mild Facial Nerve Palsy.

Purpose: Facial nerve palsy is frequently associated with both epiphora and dry eye, and orbicularis oculi muscle weakness or paralysis is the main cause of these symptoms. Eyelid pressure is a quantitatively measurable parameter for evaluating the tone and function of the orbicularis oculi muscle. The aim of this study was to examine the relationship between eyelid pressure and lacrimal status in patients with mild facial nerve palsy.Methods: This prospective, interventional study included 10 patients with unilateral facial nerve palsy. The severity of facial nerve palsy was determined using the CADS scale (cornea, static asymmetry, dynamic function, and synkinesis). Eyelid pressure was measured using a blepharo-tensiometer. Lacrimal status was quantified through tear meniscus height (TMH), clinical assessment of meibomian gland dysfunction (MGD) (eyelid margin abnormalities, Marx line, meibum expression, and loss of meibomian glands), corneal fluorescein staining, tear break-up time, and Schirmer test I results.Results: All 10 patients suffered from mild facial nerve palsy without eyelid ectropion or entropion, or gustatory epiphora. Lower eyelid pressure during forceful eye closure was significantly decreased in affected eyes (P = 0.007), but upper eyelid pressure during forceful eye closure and static upper and lower eyelid pressure were not significantly different between the affected and unaffected sides (P > 0.050). The TMH, MGD, and dry eye measurements showed no significant difference between the affected and unaffected eyes (P > 0.050).Conclusions: Mild facial nerve palsy is associated with decreased lower eyelid pressure during forceful eye closure. However, no other differences in upper eyelid pressure during forceful eye closure, static eyelid pressure, TMH, MGD, or dry eye disease symptoms were noted. These results imply that eyelid pressure slightly decreases due to mild facial nerve palsy, but this change may be clinically negligible.

To implant or not to implant: emergency orbital eviscerations with primary orbital implants.

To evaluate the outcomes of orbital evisceration with primary implant placement in acutely infected/inflamed eyes, using implant exposure/extrusion as a surrogate of success. To contextualise this with previously published literature. A retrospective case series of all patients with acutely infected/inflamed eyes undergoing urgent orbital evisceration with primary implants, at a British tertiary centre between January 2006 and August 2018. A systematic literature review of orbital eviscerations with primary implant placement in acute endophthalmitis/infection and recent trauma. Twenty-six eyes were eviscerated in the context of acute infection/inflammation. Twenty-four eyes had primary orbital implants. Indications for evisceration included endophthalmitis (18/26, 69%), microbial keratitis with corneal perforation (4/26, 15%), non-infectious corneal perforation (3/26, 12%), and recent trauma (1/26, 4.8%). The implants used were acrylic (15/24, 63%), MEDPOR (5/24, 21%), and silicone (4/24, 17%). The follow-up period was 15 months to 14 years. Implant exposure occurred in two (8.3%), managed with implant exchange and scleral reformation in one, and implant removal with dermis fat grafting in the other. One patient (4.2%) had conjunctival wound dehiscence with spontaneous healing. Six (25%) required further surgery for minor complications as follows: conjunctival prolapse, upper lid ptosis with slight sulcus loss, lower lid entropion with shortened fornix, and lower lid ectropion. The systematic literature review showed that the mean rate of orbital implant exposure/extrusion in this subset of patients was 7.8% (95% CI: 2.7%, 12.9%, SD 8.0%), range 0-27%. In acutely infected/inflamed eyes, the implant exposure/extrusion rate following orbital evisceration with primary implant placement is acceptable.

Application of modified V-Y advancement flap for reconstruction of facial defect

Objective:To investigate the clinical effect of modified V-Y advancement flap for reconstruction of facial skin defect. Methods:Thirty-eight patients with facial skin tumors underwent individual tumor resection according to pathological type and lesion depth. Based on the defect site and size, appropriate V-Y advancement flap was designed to reconstruct the skin defect in one stage. There were 9 cases of classic subcutaneous tissue pedicle V-Y advancement flap, 24 cases of modified subcutaneous tissue pedicle V-Y advancement flap and 5 cases of perforated V-Y advancement flap in our study. Results:Among the 38 patients, 34 cases had primary healing. Two cases developed necrosis at the edge of the flap and healed after debridement. Local infection occurred in 2 cases, which healed after short-term dressing change. Postoperative mild eyelid ectropion occurred in 2 cases and oral horn displacement in 1 case. The patients were followed up for 6-36 months postoperatively, and the function and appearance recovered well. One case had local recurrence and 3 cases had parotid lymph node metastasis, which were removed again and supplemented with radiotherapy. Conclusion:The improved design of V-Y advancement flap can enlarge the scope of facial defect reconstruction, and achieve good appearance and function.

Multifocal Cutaneous Sarcoidosis Presenting as Lid Ectropion.

Multifocal Cutaneous Sarcoidosis Presenting as Lid Ectropion.

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis

A descriptive-observational study of a series case report of patients diagnosed with orbito-zygomatic complex (OZMC) fracture with lateral wall involvement, was conducted. All patients were assessed in the Oral and Maxillofacial Surgery Service at Hospital El Carmen, Maipu, Santiago, Chile. The purpose of this study was to evaluate a single-institution experience with the transconjunctival approach to the orbit, utilizing a lateral skin extension as unique approach to access to fronto-zygomatic suture, infraorbital rim and/or orbital floor. The authors identified 41 patients with OZMC fractures who underwent to surgical treatment over a 45 months period. Among this group, 21 patients needed fixation with osteosynthesis of the frontozygomatic suture, and 16 of whom were treated with the approach being studied. The authors assessed scleral exposure, eyelid position changes, ectropion, and entropion as outcome measures, and reported satisfactory outcomes at a minimum of 9 months follow-up. This study concludes that in our experience, the transconjunctival approach utilizing a lateral skin extension allows a direct, easy, and quick access to the entire infra orbital rim, orbital floor, fronto-zygomatic suture and lateral wall of the orbit, up to spheno-zygomatic suture, with low associated morbidity and complications.

Antegrade Foreheadplasty: A Novel Surgical Approach for Upper Eyelid Contracture Deformities in Pediatric Patients.

The intricate and delicate structure of the periorbital region, particularly in pediatric patients, presents challenges to eyelid reconstruction. Much like the more common lower eyelid ectropion, upper eyelid ectropion can result from lack of tissue, scar contracture, or over-resection as in blepharoplasty. In burns and trauma, the cause of cicatricial ectropion is typically direct scar contracture from injuries to the eyelid. However, in some cases, extrinsic wounds involving contracture to the forehead or eyebrow can result in upper eyelid cicatricial ectropion. Direct reconstruction and skin grafting of the eyelid present complex challenges, especially in the acute inflammatory phase of traumatic injury and burn care. Furthermore, in many of these cases the periorbital and lamellae anatomy is preserved, but rather severely displaced due to scar contracture forces. The authors discuss our experience with treatment of extrinsic upper eyelid cicatricial ectropion in a series of 4 pediatric patients with burns or trauma to the forehead and periorbital regions. In all 4 cases, the antegrade foreheadplasty procedure helped to provide globe coverage, while avoiding skin matching difficulties and the intrinsic risks of operating on the eyelid during the acute phase of recovery. There is currently very limited data for the use of this technique to correct such defects. With this study, the authors hope to establish the antegrade foreheadplasty as a reconstructive option for a select patient population.

A Patient With Traumatic Upper Eyelid Ectropion and Their Management by Canthopexy

Upper eyelid ectropion is rare. When it does occur, the cicatricial subset of upper eyelid ectropion is its most common manifestation. Due to its rarity, little has been published regarding its treatment. Herein, we present the case of a 27-year-old patient who suffered significant left sided facial trauma in a high-velocity motor vehicle accident, resulting in a soft tissue defect in the left lateral supra-orbital region, including loss of the lateral half of the left eyebrow. The defect was left to heal by secondary intention causing severe cicatricial upper eyelid ectropion. Several reconstructive techniques were subsequently utilized including recreating the defect and replacing like with like tissues according to the facial sub-units. Right sided upper eyelid skin was used to replace the deficient left upper eyelid skin and a scalp composite graft was harvested to replace the deficient left lateral eyebrow. Temporary tarsorrhaphy, and steroid injections were used on multiple occasions to counteract the cicatricial forces. Ultimately, permanent lateral tarsorrhaphy and upper eyelid canthopexy was needed to obtain a satisfactory functional and cosmetic result.

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 &amp;#60;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.

Commentary on: Surgical Correction of Upper Eyelid Ectropion Presenting Dry Eye Symptoms.

Commentary on: Surgical Correction of Upper Eyelid Ectropion Presenting Dry Eye Symptoms.