Eyelid Area Research Articles

Orbital dirofilariasis (case report)

Ocular Dirofilariasis is one of the frequent manifestations of this disease. The primary manifestations of dirofilariasis of the visual organ (soreness, redness, itching in the eyelid area) may be nonspecific and weakly expressed at the beginning of the disease. The peculiarity of this disease is that if earlier most cases of human infection with Dirofilaria repens were registered in southern countries and southern regions of the Russian Federation, recently there has been a tendency for this disease to spread to northern regions. Diagnosis of this disease based on the data of instrumental methods of investigation is difficult, although cases of detection of the parasite at the preoperative stage have been described in the literature. This publication presents a clinical case of the orbital form of dirofilariasis, which was diagnosed at the intraoperative stage using transconjunctival access. This access is sufficient for complete removal of the neoplasm, and the rehabilitation of patients after surgery with such an access is short and without the formation of a cosmetic defect. Surgical intervention is the main and only treatment tactic and does not require additional specific antiparasitic treatment.

Upper eyelid lymphatic anatomy is associated with blepharoplasty recovery

BackgroundLymphatic vessels support wound recovery and absorb excess fluid. Blepharoplasty involves excess tissue excision, and the present study investigated the relationship between the lymph vessel density of excised tissue and the postoperative course. MethodsForty eyelids from 21 blepharoptosis patients who underwent blepharoplasty were enrolled. Each resected excess tissue sample was divided into four parts by three parasagittal cuts—medial, central, and lateral—and the area percentages occupied by lymphatic vessels and elastic fibers in the cut-exposed inner tissue between skin and muscle were determined by histology. The wound healing process was assessed at 2 weeks and 1, 3, and 6 months postoperatively, by using a visual analogue scale (VAS) for estimating edema and the Vancouver Scar Scale (VSS). ResultsWith increasing age, the area percentage occupied by lymphatic vessels declined significantly (r=-0.581, p<0.001) while an increase in solar elastosis was observed. Percentages of lymphatic vessels were highest at the medial side of the eyelid (p<0.05), and here their relative distribution to the “shallow layer” close to the skin was also highest (p<0.01). Independent of age, the VSS values at 2 weeks and 1 month postoperatively were significantly lower in patients with a higher area percentage of lymphatic vessels (2 weeks: p<0.05; 1 month: p<0.01). ConclusionsIn patients undergoing blepharoplasty, upper eyelid area percentages of lymphatic vessels decreased with advancing age. Higher proportions of lymphatic vessels were associated with improved wound healing outcomes.

Enhancing Meibography Image Analysis Through Artificial Intelligence-Driven Quantification and Standardization for Dry Eye Research.

This study enhances Meibomian gland (MG) infrared image analysis in dry eye (DE) research through artificial intelligence (AI). It is comprised of two main stages: automated eyelid detection and tarsal plate segmentation to standardize meibography image analysis. The goal is to address limitations of existing assessment methods, bridge the curated and real-world dataset gap, and standardize MG image analysis. The approach involves a two-stage process: automated eyelid detection and tarsal plate segmentation. In the first stage, an AI model trained on curated data identifies relevant eyelid areas in non-curated datasets. The second stage refines the eyelid area in meibography images, enabling precise comparisons between normal and DE subjects. This approach also includes specular reflection removal and tarsal plate mask refinement. The methodology achieved a promising instance-wise accuracy of 80.8% for distinguishing meibography images from 399 DE and 235 non-DE subjects. By integrating diverse datasets and refining the area of interest, this approach enhances meibography feature extraction accuracy. Dimension reduction through Uniform Manifold Approximation and Projection (UMAP) allows feature visualization, revealing distinct clusters for DE and non-DE phenotypes. The AI-driven methodology presented here quantifies and classifies meibography image features and standardizes the analysis process. By bootstrapping the model from curated datasets, this methodology addresses real-world dataset challenges to enhance the accuracy of meibography image feature extraction. The study presents a standardized method for meibography image analysis. This method could serve as a valuable tool in facilitating more targeted investigations into MG characteristics.

Gender- and Age-Related Characterization of Lower Eyelid Morphology: Three-Dimensional Analysis in a Chinese Population.

The lower eyelid region is a critical component of the face. It is essential to establish anthropometric reference values for the evaluation of aging, surgical planning and assessment of outcomes in periocular esthetic and rejuvenation procedures. This study aims to provide comprehensive anthropometric data on the Chinese lower eyelid region, into account factors such as sex and age, through three-dimensional imaging analysis. Three-dimensional facial images were obtained from 84 healthy Chinese individuals aged between 20-35 and 50-65 years, as well as eight patients aged between 20 and 35 who presented with eyelid bags. A total of 27 landmarks were identified, leading to the generation of corresponding 21 lines, 5 curves, 4 angles, 2 areas and 5 ratios. The measurements were compared among different age groups, genders and young patients with or without eyelid bags. Compared to females, males exhibited a more elongated palpebral fissure, lower tear trough and lid-cheek junction, smaller inner and outer canthus angles, as well as a larger area and proportion of the lower palpebral region. As age progressed, the height and width of the palpebral fissure and inner canthus angle decreased gradually, which was accompanied by sagging of the tear trough and lid-cheek junction, an increase in lower eyelid area and swelling of the lower eyelid. Young patients undergoing eyelid bags demonstrated larger and more swelling lower eyelid which held clinical significance for rejuvenation surgery. Males exhibited a higher proportion of the brow-eye unit occupied by the lower eyelid region compared to females. Elderly individuals displayed noticeable drooping of the tear trough and lid-cheek junction, accompanied by swelling in the lower palpebral region. These findings can serve as standard references for esthetic procedures and reconstructive periocular operations. 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 Table of Contents or online Instructions to Authors www.springer.com/00266.

Line-Field Confocal Optical Coherence Tomography Evaluation of Eyelid Skin Lesions

Background: Periocular malignancies may be clinically different from the examples arising at other sites, with possible delayed diagnosis and greater challenges for treatment and repair. Line-field confocal optical coherence tomography (LC-OCT) is a recently developed technique characterized by an unprecedented capacity to acquire high-definition images in vertical and horizontal modes. In this study, we aimed to investigate the LC-OCT morphological features of a series of eyelid skin lesions, correlating them to histopathological findings. Methods: Patients with biopsy-proven equivocal skin lesion in the eyelid area, previously investigated by means of LC-OCT, were included in the study. Percentage overall agreement was estimated for LC-OCT and histopathological diagnosis for study cases. Results: A total of 51 patients (28 women, 23 men; mean age 66.4 years old), for a total of 51 skin lesions, were assessed. The histopathological diagnosis consisted of 30 malignant and 21 benign tumors. Different entities were characterized by peculiar findings in LC-OCT, alike to histopathological features, allowing for an accurate “in vivo” classification in almost all cases, with a diagnostic concordance with histopathology of 92.1% (47/51). Conclusions: By integrating this new imaging technique into the assessment of suspicious tumors in this area, diagnostic accuracy may increase, improving strategies adopted in multidisciplinary meetings and patient-centered care.

Quantifying Dermatochalasis Using 3-Dimensional Photogrammetry.

Creating an appropriate treatment plan for patients with dermatochalasis requires careful investigation of the periocular region. Utilizing photographic documentation can assist physicians in conducting preoperative analysis and managing expectations regarding surgical outcomes. This study aimed to quantify the periocular characteristics of dermatochalasis patients using standardized 3D imaging and to compare age and sex-related changes in periocular features. In this cross-sectional study, we recruited 145 Caucasian patients with periocular dermatochalasis, comprising 48 men and 97 women, aged between 35 and 91 years. Standardized three-dimensional facial photographs were taken using the 3D Imaging system VECTRA M3. Linear dimensions, curve length, angle, indices, and sizes were measured and analyzed, including palpebral fissure height (PFH), palpebral fissure width (PFW), upper lid fold-palpebral margin distance (FPD), upper palpebral margin length (UPML), lower palpebral margin length (LPML), canthal tilt (CT), palpebral fissure index (PFI), upper eyelid area, and ocular surface area. In the female group, the left-side PFH was slightly larger than the right-side PFH (P=0.023), but the difference was less than 1mm. The corresponding PFI also showed a difference in the female group (P=0.009). Statistically significant differences were shown in genders for specific parameters, except PFI (P=0.251) and CT (P=0.098). Among males, PFW (R=-0.523, p<0.001) and LPML (R = -0.514, P = 0.264) decreased moderately with age. The correlation between UPML and age was weak (R= -0.367, P= 0.010). Similarly, among females, moderate correlations were found between age and PFW (R=-0.566,P<0.001) and LPML (R=-0.537, P<0.001). Additionally, PFH (R=-0.315, P=0.002), UPML (R=-0.381, P<0.001), and ocular surface area (R=-0.457, P<0.001) showed weak correlations with age. The study found that dermatochalasis usually affects both eyes simultaneously, and age is a significant factor in the morphological changes of certain periocular features regardless of sex. The PFI is not influenced by age or sex. These findings may provide useful information for surgical planning and understanding age-related changes in the periocular area. 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 .

An Experimental Design to Compare the Compatibility of Absorbable and Nonabsorbable Suture Materials in the Lateral Canthus Area.

Polyglactin 910 (Vicryl) and polypropylene (Prolene) are common suture materials used in ophthalmic surgical procedures. However, there are limited studies assessing tissue reactions to different sutures in eyelid areas. In this study, these suture materials were used subcutaneously in 10 lateral canthi of 5 pigs. Clinical reactive score (CRS) was assessed 14 days and 60 days after surgery. On histology, subcutaneous tissue reactions were assessed by the presence of different inflammatory cells, and the aggregate tissue irritation score was calculated. CRS and the histology score did not differ between these sutures. None of the suture materials used were superior for use in the lateral canthi of pig eyes. Therefore, we recommend both of these sutures for use in the subcutaneous tissue of the eyelid area in animal experiments or clinical practice.

Routine eyelid care for those without dermatitis

The eye is a unique structural and functional anatomic unit of the face and requires specific care and attention. Often, dermatologists are not familiar with the routine needs of the eyelid area. Despite evidence showing that lid hygiene may serve as an important supplement to therapeutic management of eyelid disorders, lid hygiene is often overlooked. Ophthalmologists and dermatologists have an important role to play in educating patients on the importance of proper eyelid hygiene and ensuring patient compliance. We review eyelid anatomy and function to better understand how these structures relate to potential disease processes. We also review current recommendations for routine eyelid care and discuss the need for further advancements in promoting eyelid health.

Application of infraorbital rim augmentation with pocket fat filling to correct tear trough deformity.

Tear trough deformity is one of the most common complaints in clinical settings. The correction of this groove is challenging in facial rejuvenation. The lower eyelid blepharoplasty varies with different conditions. A novel approach of using orbital fat in the lower eyelid to increase the volume of the infraorbital rim with granule fat injection has been applied in our institution for more than 5 years. This article aims to describe the detailed steps of our technique and verify its effectiveness by a cadaveric head dissection after surgical simulation. In this study, a total of 172 patients with tear trough deformity underwent lower eyelid orbital rim augmentation with fat filling in the sub-periosteum pocket. According to Barton's grades, 152 patients underwent lower eyelid orbital rim augmentation with orbital fat filling, 12 patients had it combined with autologous granule fat from other body parts, and 8 patients received only transconjunctival fat removal to correct tear trough. The modified Goldberg score system was used to compare preoperative and postoperative photographs. Patients were satisfied with the cosmetic results. Excessive protruding fat was released, and the tear trough groove was flattened by using autologous orbital fat transplantation. The lower eyelid sulcus deformities were well-corrected. To further illustrate the anatomical structure of the lower eyelid area and injection layers, six cadaveric heads were used for surgical simulation and demonstrated the effectiveness of our technique. This study indicated that the infraorbital rim could be increased by transplanting orbital fat to the pocket, which was dissected under the periosteum, and the procedure has been verified as reliable and effective. Level II.

Evaluation of the Portable Next-Generation VECTRA H2 3D Imaging System for Measuring Upper Eyelid Area and Volume.

Although a portable 3-dimensional (3D) imaging system has been used for periocular measurement analysis, this system has yet to be tested and validated for periocular area and volume measurements. The aim of this study was to define the upper eyelid and upper eyelid fold region through a modified landmark strategy and validate a portable 3D imaging system for area and volume measurements in this periocular region. Eighty-one healthy adult Caucasians underwent 3D facial imaging with the VECTRA M3 (static) and VECTRA H2 (portable) 3D imaging systems (Canfield Scientific, Inc., Parsippany, NJ). Subsequently, the upper eyelid and upper eyelid fold regions were selected according to a modified landmark localization strategy. Direct measurements of area and volume were performed to assess intrarater, interrater, intramethod, and intermethod reliability, and to compare the agreement between the 2 devices. The VECTRA M3 and H2 showed high reliability on upper eyelid area measurements. Excellent intra-, inter-, and intramethod reliability agreements were observed in intraclass correlation coefficient; very good agreement in intrarater reliability was observed in the relative error of measurement (REM) and relative technical error of measurement (rTEM); and good inter- and intramethod reliability were observed in the REM and rTEM. For area measurement of the upper eyelid fold, the intrarater, interrater, and intramethod reliability of the M3 was lower than that of the H2. Both systems had poor intrarater, interrater, and intramethod reliability for volume measurements in the upper eyelid and upper eyelid fold region. This new portable 3D imaging system achieved excellent or very good reliability values for standardized direct measurements of the upper eyelid and upper eyelid fold region, although volume measurements seem less reliable.

A Very Rare Case of Juvenile Dermatomyositis with Typical Cutaneous Clinical Signs

A Very Rare Case of Juvenile Dermatomyositis with Typical Cutaneous Clinical Signs

A novel standardized approach for the 3D evaluation of upper eyelid area and volume.

Three-dimensional (3D) surface imaging and morphometrics are becoming the preferred craniofacial surface imaging modality. However, as a unique advantage of 3D imaging, areal and volumetric measurements have been rarely conducted and validated for evaluating soft tissue change in the periocular region, especially the upper eyelids. Therefore, based on an existing periocular landmark identification strategy, we proposed a novel modified method to define a standardized upper eyelid region for areal and volumetric measurements and validate its reliability for future clinical application. Forty-four healthy adult volunteers were enrolled in this cross-sectional study. Three-dimensional facial images were taken with a 3D imaging system. Subsequently, the upper eyelid region selection and areal and volumetric measurements were conducted using a modified landmarks localization strategy to evaluate their intrarater, interrater, and intramethod reliability. Areal measurement of the upper eyelid revealed highly reliable outcomes for intraclass correlation coefficient (ICC), mean absolute difference (MAD), relative error measurement (REM), technical error of measurement (TEM), and relative technical error of measurement (%TEM) of 0.982, 0.1620 cm2, 2.9%, 0.1510 cm2, and 2.7% for intrarater reliability, respectively; 0.969, 0.2076 cm2, 3.7%, 0.1930 cm2, and 3.5% for interrater reliability, respectively; and 0.917, 0.3636 cm2, 6.5%, 0.3354 cm2, and 6.0% for intramethod reliability, respectively. Unsatisfactory results were found for the volumetric measurement of the upper eyelid: the ICC, MAD, REM, TEM, and %TEM estimates for intrarater reliability were 0.992, 0.2299 mL, 10.3%, 0.2414 mL, and 10.8%, respectively; for interrater reliability, these values were 0.985, 0.2749 mL, 12.3%, 0.3253 mL, and 14.6%, respectively; and for intramethod reliability, these values were 0.433, 1.6716 mL, 77.9%, 2.0615 mL, and 96.1%, respectively. This is the first study to propose a standardized upper eyelid region selection strategy and simultaneously validate its reliability for 3D areal and volumetric measurements. This study confirmed the high-level reliability of areal measurement and poor reliability of volumetric measurement based on direct measurements using a single image, which may provide better results when this method is combined with the image overlapping and registration procedure. However, this is subject to further validation. Nonetheless, this method could provide quantitative areal and volumetric data on the upper eyelids and might have widespread application potential in the future.

Early laser treatment of local complications after surgical blepharoplasty

Purpose of the study: to evaluate the effectiveness of early laser treatment of various types of local complications after surgical blepharoplasty based on the dynamics of the clinical picture and outcome, as well as patient satisfaction indicators according to FACE-Q.Material and methods. The study involved 24 patients with various types of local postoperative complications: scars with a tendency to hypertrophic growth (5 cases), inversion of the lower eyelid (4), seroma with undetected ligature fragments (2), aseptic inflammation of soft tissues of unknown genesis (2), neoangiogenesis in the eyelid area (3), extensive hemorrhages in the surgical intervention area (8 cases). Treatment was started on the day of the patient's treatment when the fact of the complication was established. The treatment was performed using the MultilineTM laser multiplatform using the Nd:YAP/KTP vascular laser with a combination of two wavelengths of 540 and 1079 nm and/or the Er:YAG, 2940 nm laser with SMA technology. The choice of the type of laser radiation and the interval between sessions were determined by the nature of the complication. Patients' satisfaction with the results of treatment was determined by the FACE-Q questionnaire.Results. The results of treatment by evaluators were determined as excellent in 19 patients (79.2%) and good in 5 patients (20.8%). The outcome of the resolution of complications in all patients was a thin, flat, inconspicuous scar, persistent defects requiring additional correction were not observed. During 6 months of follow-up, the dynamics of FACE-Q indicators after laser treatment of complications showed a statistically significant improvement on all assessed scales: the general appearance of the eye, the outcome of the operation performed, the severity of side effects, psychological stress, social adaptation.Conclusion. Laser treatment of postoperative complications of blepharoplasty allows improving the aesthetic result of the operation and restoring the psychoemotional state of the patient.

Short-term qualitative and quantitative analyses of preseptal injection of hyaluronic acid on the treatment of acquired lower eyelid cicatricial ectropion

Purpose: Recently, hyaluronic acid (HA) was proposed as a promising option for the treatment of acquired lower eyelid cicatricial ectropion. However, this effect was not confirmed by quantitative assessments. This study aimed to assess the effect of hyaluronic acid on the treatment of acquired lower eyelid cicatricial ectropion. Methods: Eight patients with acquired lower eyelid cicatricial ectropion (13 eyelids) were treated with a single 1 mL injection of hyaluronic acid in the preseptal area of the lower eyelid. Evaluation of symptoms and biomicroscopic exam was performed before and 30 days after hyaluronic acid injection. Quantitative analysis of the lower eyelid position (with and without lid traction) was determined before and 30 days after hyaluronic acid injection through standard photographs analyzed using the ImageJ. Results: All patients experienced partial improvement of symptoms. The lower eyelid position was significantly lifted after hyaluronic acid injection with a significant reduction of medial and lateral angles, reduction of the margin reflex distance, and total and medial ocular fissure area. However, signs of lid margin inflammation and corneal punctate keratitis persisted. Conclusion: Hyaluronic acid injected in the pre-septal area of the lower eyelid improved acquired lower eyelid cicatricial ectropion symptoms and significantly lifted the position of the lower eyelid. Further studies, with a large number of participants and a long-term follow-up period, are needed to better determine the permanency of the effects of hyaluronic acid injections on the treatment of acquired lower eyelid cicatricial ectropion.

Periorbital Skin Rejuvenation of Asian Skin Using Microneedle Fractional Radiofrequency.

The periorbital area plays an important role cosmetically. Periorbital wrinkles are attributed to long-term, repeated use of orbicularis oris muscles and UV-induced dermal collagen degeneration. Fractional microneedle radiofrequency (RF) treats scars and laxity by creating vertical channels of injury in the dermis, triggering a scarless healing cascade and neocollagenesis. To evaluate the effect and safety of a novel fractional microneedle RF device on periorbital wrinkles based on several objective indicators. Eleven healthy Korean patients aged 30 to 75 years with periorbital wrinkles were included in this study. Wrinkle grades were evaluated using the Fitzpatrick wrinkle assessment scale (WAS). The melanin and erythema index, transepidermal water loss (TEWL), and three parameters for elasticity were recorded. Skin biopsies were obtained in patients who consented. All patients exhibited wrinkle improvement in the lateral periorbital area, and two patients also showed efficacy in the lower eyelid area. There was a statistically significant decrease in WAS and a significant improvement in the melanin index of V4 and V5. TEWL also showed a considerable decline on V4 and V5, suggesting that the water content of the skin increased with repeated laser sessions. A peak increase in viscoelasticity and a decrease in retraction time following the first laser application were observed. In the histopathologic examination, the dermis had a denser collagen and elastin content. Microneedle fractional RF resulted in statistically significant long-term clinical improvement of periorbital wrinkles and enhanced pigmentation and skin hydration.

Endolift® the “lunch-time” laser lifting for the lower eyelids

Lasers and others energy-based devices have reached very high levels of results. Although the area of the lower eyelids is one of the most difficult to treat without surgery, Endolift® represents one of the safest and effective techniques that we can offer. Endolift® procedure was performed with a 200 microns second-generation bare fiber connected to an Italian 1470nm semiconductor laser to treat the lower eyelids of a 43-year-old patient with wrinkles and skin laxity. No anesthesia was required. The fiber was easily inserted through the skin, without any incisions, directly between the orbicularis oculi muscle and the septum. The total laser energy delivered was 80 J for each side. Post-procedure the patient immediately resumed her daily activities. Snap Back test was performed before (T0) and 6 months (T1) after the procedure; Fitzpatrick “wrinkle score” and “degree of elastosis” were assessed at T0 and T1; investigator Global Aesthetic Improvement scale (iGAIS), external investigator Global Aesthetic Improvement scale (eiGAIS) and participant Global Aesthetic Improvement scale (pGAIS) were also recorded at T1. The treatment has been completed with a session of a vascular 532nm diode laser for treating the fine telangiectasias, immediately before the Endolift® procedure. The lower eyelids have benefited from the possibility that the Endolift® has to remodel and retract the tissues, activate the collagen production, and stimulate the neo-angiogenesis. Results are evaluated at T1, when the skin laxity is reduced and superficial wrinkles are smoothed, resulting in an overall compacting of the skin which is visible and continues to progress over the following months. The only adverse events recorded were redness for 3 hours and a light swelling for 2 days. Snap Back test at T0 was severe and negative at T1; at T0 wrinkle score” was II and Fitzpatrick “degree of elastosis” was 7-9 but at T1 Fitzpatrick “wrinkle score” was I and Fitzpatrick “degree of elastosis” was 1-3; iGAIS, eiGAIS and pGAIS at T1 were all +3. Endolift® can currently be considered one of the leading non-surgical treatments for the laxity of lower eyelids.

Is histogram manipulation always beneficial when trying to improve model performance across devices? Experiments using a Meibomian gland segmentation model.

Meibomian gland dysfunction (MGD) is caused by abnormalities of the meibomian glands (MG) and is one of the causes of evaporative dry eye (DED). Precise MG segmentation is crucial for MGD-related DED diagnosis because the morphological parameters of MG are of importance. Deep learning has achieved state-of-the-art performance in medical image segmentation tasks, especially when training and test data come from the same distribution. But in practice, MG images can be acquired from different devices or hospitals. When testing image data from different distributions, deep learning models that have been trained on a specific distribution are prone to poor performance. Histogram specification (HS) has been reported as an effective method for contrast enhancement and improving model performance on images of different modalities. Additionally, contrast limited adaptive histogram equalization (CLAHE) will be used as a preprocessing method to enhance the contrast of MG images. In this study, we developed and evaluated the automatic segmentation method of the eyelid area and the MG area based on CNN and automatically calculated MG loss rate. This method is evaluated in the internal and external testing sets from two meibography devices. In addition, to assess whether HS and CLAHE improve segmentation results, we trained the network model using images from one device (internal testing set) and tested on images from another device (external testing set). High DSC (0.84 for MG region, 0.92 for eyelid region) for the internal test set was obtained, while for the external testing set, lower DSC (0.69-0.71 for MG region, 0.89-0.91 for eyelid region) was obtained. Also, HS and CLAHE were reported to have no statistical improvement in the segmentation results of MG in this experiment.

The effect of thermo-mechanical device (Tixel) treatment on evaporative dry eye disease – A pilot prospective clinical trial

PurposeTo examine the effects of treatment with a thermomechanical skin device to the eyelid area on the clinical signs and symptoms of patients who suffer from dry eye disease (DED) secondary to meibomian gland dysfunction (MGD). MethodsForty patients aged 45 years or older with DED due to MGD were recruited. Both eyes (n = 80) of each patient received three treatments with the Tixel device (Novoxel®, Israel), with each treatment separated by a 2-week period. Treatment was applied across the upper and lower eyelids, with the same intensity, tip protrusion distance, and contact duration. Two additional follow-up visits were performed at 2-week intervals after treatment cessation. DED status was evaluated during each visit via SPEED II questionnaire, tear break-up time (TBUT), corneal staining score (CSS), MGD score, and frequency of lubricant use. Visual acuity (VA) was recorded during first and last visits. ResultsMean age was 64.3 ± 12.4 years and 72.5 % (n = 29) were female. 45 % (n = 18) had a history of blepharitis, 12.5 % (n = 5) had chalazia, and 17.5 % (n = 7) suffered from allergic conjunctivitis. Mean follow-up time was 2.1 ± 0.6 months. Comparing the first and last visits, all parameters showed significant improvement after Tixel treatment: mean SPEED II scores (16.5 ± 5.9 to 11.8 ± 6.7, p < 0.001), CSS (2.0 ± 1.3 to 0.5 ± 0.9, p < 0.001), TBUT (2.7 ± 0.8 s to 6.5 ± 2.2 s, p < 0.001), MGD score (2.7 ± 0.5 to 1.2 ± 0.4, p < 0.001), and rate of lubricant use (3.4 ± 2.4 per day to 1.9 ± 2.0, p < 0.001). VA also improved (0.10 ± 0.11 logMAR to 0.08 ± 0.10 logMAR, p < 0.05). No major side effects were observed. ConclusionsIn this pilot study Tixel treatment induced significant improvement of signs and symptoms among patients with DED due to MGD. Benefits persisted for at least one month. Further randomized controlled double-blinded studies are needed.

Refined Concept of Motor Supply to the Medial Periorbital Area Relevant to Periorbital Surgery.

Mimetic muscles in the medial periorbital area have been thought to be innervated solely by the angular nerve. Recently, however, the upper medial palpebral branch and lower palpebral branch were reported as additional motor suppliers in this area. This study aimed to define all the motor nerve systems passing through the medial canthal area. Motor nerve branches that passed through the medial canthal region were identified and traced thoroughly from the parotid gland to their destinations under a surgical microscopic field in 74 hemifaces. The courses, anatomical positions of, and anatomical relationships between the angular nerve and the upper medial palpebral branch were observed. The upper medial palpebral branch and the angular nerve were found in all samples within a 3-mm to 6-mm area lateral to the intersecting point of the medial orbital rim and medial canthal ligament. The upper medial palpebral branch supplied the upper eyelid, whereas the angular nerve supplied the extraorbicularis muscles in the medial periorbital area. The medial pretarsal area of the upper eyelid was supplied solely by the pretarsal branches of the upper medial palpebral branch, which was formed by uniting three or four minor branches that traveled throughout the anterior cheek. Two separate motor nerve systems, the upper medial palpebral branch and the angular nerve, exist in the medial canthal area. The upper medial palpebral branch course along the medial orbital rim is considered as a facial nerve danger zone.

Vertical V-Y Advancement Lifting Based on Fat Compartments: A New Approach for Lower Eyelid and Midcheek Rejuvenation.

Lower blepharoplasty techniques continue to improve over time. With discovery of the numerous fat compartments of the face, surgeons noticed that the appearance of the lower eyelid area through aging could be improved through midface lifting. This article introduces a vertical V-Y advancement lifting technique using the concept of fat compartments for lower lid and midcheek rejuvenation. Eighty female patients were categorized into four age groups at 20 patients each from 20 to 59 years old. The average measurement for the lower lid length in each group was recorded. An additional 318 patients who underwent lower eyelid blepharoplasty combined with fat compartments advancement lifting for lid-cheek junction rejuvenation from April of 2015 to May of 2018 were included in this study. The postoperative effect was evaluated based on preoperative and postoperative photographs, lower lid length measurements, and three-dimensional facial analyses. Lower lid lengths gradually increased with age, with the greatest increase occurring in the 30- to 39-year-old group. A total of 318 Asian female patients (age range, 35 to 58 years) underwent the surgical procedure. Measurements of lower lid length showed an average reduction of 0.31 cm 6 months after surgery. Three-dimensional facial analysis indicated that midcheek volume increased at varying degrees after surgery. Lower eyelid blepharoplasty combined with vertical V-Y advancement lifting makes it possible to restore facial fat compartments. This procedure improves projection in the midcheek without fillers, thus achieving a more youthful appearance of the lower lid and lid-cheek contour in middle-aged women. Therapeutic, IV.