Eyelid Area Research Articles

Cutaneous benign mixed tumor (chondroid syringoma) of the eyelid: clinical presentation and management.

To describe the clinical presentation of cutaneous benign mixed tumor of the eyelid and its management options. Periocular cases of cutaneous benign mixed tumor were gathered from members of an oculoplastics specialty Internet discussion group. A total of 9 patients are described in this retrospective, interventional case series. The clinical presentation, histopathology, and management of these lesions is reviewed. Patients were typically asymptomatic, presenting with a slowly enlarging, nontender nodule of 2 to 8 years' duration. The lesions ranged from 4 mm to 17 mm in greatest dimension. Four of the lesions were on the eyelid margin, three in the sub-brow area of the upper eyelid, and two in the central lids. All six cases not involving the brow were fixed to the tarsus; one brow lesion was believed to be adherent to the skin. None of the lesions was associated with significant changes of the overlying epidermis, although one lesion showed overlying pigmentation. All patients underwent excisional biopsy for diagnostic or cosmetic reasons. On histopathologic examination, the tumors were biphasic, with an epithelial component exhibiting apocrine or hair follicle differentiation and a myxoid, adipocytic, chondroid, and/or fibrous stroma. The pathologic diagnoses were all consistent with cutaneous benign mixed tumor (chondroid syringoma, pleomorphic adenoma). Follow-up ranged from 2 weeks to 12 months, although several patients failed to keep scheduled follow-up appointments. No clinical recurrences were identified. Cutaneous benign mixed tumor may occur in the eyelid, and, although uncommon, should be included in the differential diagnosis of firm, nodular eyelid tumors. The histopathologic features are similar to those seen in this tumor type arising in other areas of the body. Preoperative consideration of this diagnostic possibility may allow the surgeon to plan for complete excision, thereby reducing the possibility of recurrence or malignant transformation.

Laser Blepharoplasty and Laser Resurfacing of the Periorbital Area

Although blepharoplasty has long been the traditional method of improving the aesthetic appearance of the eyelid area, it yields little improvement in several of the major signs of periorbital aging including (1) wrinkling of the infrabrow and lower lid skin, (2) crow's foot wrinkles, (3) malar bags and wrinkles, (4) crepey changes in the periorbital skin texture, (5) pigment spots and other actinic damage, (6) elongation of the apparent vertical height of the lower lid, and (7) loss of the gentle, indistinct transition between the lower lid and cheek skin. All of these indications can be improved by the combination of laser blepharoplasty and laser resurfacing of the periorbital region. In addition to resurfacing, the author prefers to use the laser for the incisional aspects of the blepharoplasty, as it is quick, causes less sensory nerve stimulation, is less likely to damage the inferior oblique muscle, and has essentially no bleeding--and therefore, less ecchymosis--postoperatively. This technique is described and illustrated photographically. Its outcomes include a high-quality result that maintains itself well over time, improvement in the signs of periorbital aging not treated by traditional blepharoplasty, a low rate of complication, and high patient satisfaction.

Reconstruction of the Entire Upper Eyelid Area with a Subcutaneous Pedicle Flap Based on the Orbicularis Oculi Muscle

Lagophthalmos caused by trauma or inflammation may damage the cornea and, if not adequately treated, may result in loss of eyesight. Hence surgical intervention is required at the earliest possible stage. We have developed a subcutaneous pedicle flap elevated from the temporozygomatic area and rotated 180 degrees around a small pedicle base that contains the orbicularis oculi muscle. With this flap, the entire upper eyelid can be reconstructed as an aesthetic unit in one stage so that the result is satisfactory not only functionally, but also cosmetically. The operative procedure is presented along with case reports.

A Search for Lymphatic Drainage of the Monkey Orbit

• Colloid solutions of technetium Tc 99m and india ink injected into the retrobulbar space of the cynomolgus monkey outside the extraocular muscle cone were removed from the orbit by the lymphatic vessels of the conjunctiva and eyelids and were then concentrated within the lymph nodes that drained the conjunctival and eyelid areas. Colloid solutions injected into the retrobulbar space inside the extraocular muscle cone did not reach the conjunctiva and did not collect in any lymph nodes over a 24-hour period. Within the orbit, the injected colloids spread along the planes of the connective-tissue septa. No lymphatic vessels were identified within the orbits posterior to the conjunctiva. Small amounts of india ink left the posterior orbit and ultimately entered the contralateral orbit. This posterior pathway did not lead to lymphatic vessels or lymph nodes and therefore does not appear to represent a prelymphatic pathway.

A search for lymphatic drainage of the monkey orbit.

Colloid solutions of technetium Tc 99m and india ink injected into the retrobulbar space of the cynomolgus monkey outside the extraocular muscle cone were removed from the orbit by the lymphatic vessels of the conjunctiva and eyelids and were then concentrated within the lymph nodes that drained the conjunctival and eyelid areas. Colloid solutions injected into the retrobulbar space inside the extraocular muscle cone did not reach the conjunctiva and did not collect in any lymph nodes over a 24-hour period. Within the orbit, the injected colloids spread along the planes of the connective-tissue septa. No lymphatic vessels were identified within the orbits posterior to the conjunctiva. Small amounts of india ink left the posterior orbit and ultimately entered the contralateral orbit. This posterior pathway did not lead to lymphatic vessels or lymph nodes and therefore does not appear to represent a prelymphatic pathway.

Burn Injuries of the Eyelids

Burns of the eyelid and surrounding structures are relatively uncommon in spite of a high incidence of thermal injuries involving the face. The etiologic factors, circumstances that precipitated the injury, and the anatomical features unique to the eyelid and adnexal area may conceivably account for the low incidence. The basic aims in reconstructing deformities must include primarily measures of protecting corneal exposure and relieving epiphora. Early reconstruction of other deformities such as epicanthal folds, palpebral stenosis, and missing eyebrows and eyelashes should be discouraged because of frequent recurrence of deformities due to contracting scars and scar hypertrophy.

Demodex gapperi sp. n. (Acari: Demodicidae) from the Red-Backed Vole, Clethrionomys gapperi

A new species, Demodex gapperi, is described with notes on its biology and host relations. Y-shaped ova, larvae with dorsal fingers and long legs III, prominent legs in nymphal and adult stages, are noted as adaptations for survival in an unusual habitat, the ducts of the Meibomian glands. The mites consume cells of the duct epithelium. An incidence of 56.3% is reported, with a 70% incidence in male and 40% in female host animals. Population studies indicate a sex ratio in the mites of 1:2 and a maximum of 73 mites from one host animal. This new species was discovered in our laboratory in 1962; however, adequate specimens for accurate description have just recently become available. Since in many respects this is a unique demodicid, the description will be followed by some account of the biology of the mite and of its host relationships. One aspect of this last, the Y-shaped ovum, has already received some attention (Nutting et al., 1968). MATERIALS AND METHODS Eighty red-backed voles (27 females, 53 males) were examined for demodicids. Scrapings from 20 of these (10 females, 10 males) were examined, each for 6 body areas (eyelid, dorsal, ventral, genital, muzzle, and perianal). For the other voles, skin scrapings were examined for dorsal and eyelid areas or eyelid only. All scrapings were mounted in Hoyer's medium or examined in peanut oil or physiological saline. In a few cases complete eyelids were digested in 10% KOH, washed, centrifuged, and examined to obtain population counts. Sectors of skin from the 6 body areas, above, and from heavily parasitized animals were fixed in Bouin's solution, paraffin-embedded, cut at 8 to 10 Au and stained with hematoxylin and eosin or Mallory's triple stain. All measurements are in microns, and are given in Table I. Received for publication 8 September 1970. *Zoology Department, University of Massachusetts, Amherst, Mass. t Study supported in part by a National Science Foundation Grant GB-3516 to the senior author. $ University of Nigeria, Nsukku, Nigeria. ? Wisconsin Alumni Research Foundation, Madison, Wisconsin. Demodex gapperi sp. n. (Figs. 1-13) Description: with characters of the genus One of the largest members of the genus; one female measured 409.6. Striking sexual dimorphism, with males approximately two-thirds length of females-especially noticeable in opisthosomal length (avg male 164.3 vs. female 252.6). Males (Fig. 1): Gnathosoma slightly wider than long. Supracoxal spines (Fig. 8) small, peglike, directed anterolaterad. Pharyngeal bulb oval with subgnathosomal setae anterior (Fig. 9). Podosoma somewhat oval in outline, less than one-third total length, and wider than opisthosoma. Legs long, evenly spaced, and approximately one-half each visible from dorsal aspect. Opisthosoma over onehalf total length, gradually tapering posteriorly with rounded terminus. Opisthosomal annuli narrow, very faint anteriorly but well-marked posteriorly. Genital orifice (Fig. 10) directly over midline between legs I and II, ovoid with distinct operculum. Penis sheathed, 20.1 long, curving ventroposteriorly and with bulbous base. Anterior dorsal tubercles above and slightly anterior to legs I. Posterior tubercles in line with anterior tubercles, at mid-line of podosoma. Females (Fig. 2): Gnathosoma and supracoxal spines similar to male but slightly larger. Pharyngeal bulb and subgnathosomal setae as in male. Podosoma elongate-oval, approximately one-quarter total length, wider than opisthosoma. Legs shorter than male, evenly spaced. Opisthosoma similar to male but markedly longer. Annuli also similar but more pronounced. Vulva 22.4 long, irregular slit, opening on opisthosoma (Fig. 11) behind closed, fused epimeral plates. Ova (Fig. 3): Remarkably long (295.8), Yshaped, widest (29.9) at base between anterior prongs. Larvae (Fig. 4): Very slender, elongate. Legs I FIGURES 1-7. Anatomy of Demodex gapperi. 1. Dorsal view of male. Arrow indicates penis. X 270. 2. Ventral view of female. Arrow indicates vulva. X 270. 3. Ovum. X 270. 4. Dorsal view of larva. Arrow indicates dorsal finger. X 270. 5. Lateral view of larva, showing dorsal finger (left) and legs I, II, and III. X 270. 6. Ventral view of nymph. X 270. 7. Anterior prongs of ovum showing larval gnathosoma (arrow) in one prong. X 1,000.