Eyelid Morphology Research Articles

Anatomical Study and Clinical Observation of Retro-orbicularis Oculi Fat (ROOF).

To study the anatomical location of retro-orbicularis oculi fat (ROOF) in the upper eyelid and to investigate how ROOF affects the appearance of the upper eyelid. Twenty-eight Chinese hemifacial cadaver specimens were used (14 male cadavers; age range 52-82years). In 28 hemifaces, the eyelids were dissected from the superficial to deep layers, and the appearance, location, extent, and surrounding tissue of ROOF were observed. Additionally, we observed the relationship between the upper eyelid morphology and ROOF of the upper eyelid in surgical patients who were treated in the plastic surgery department of Tongji Hospital affiliated with Huazhong University of Science and Technology in 2018. ROOF is a type of fascia adipose tissue that is located in a fat compartment between the muscles (the orbicularis oculi and frontalis muscles) and the orbital septum/frontalis fascia. In patients with hypertrophic ROOF, the upper eyelid appears as a heavy eyelid and as a drooping eyelid. And in patients with atrophic ROOF, the upper eyelid appears as a sunken eyelid. ROOF is located in the fat compartment between the orbicularis muscle and the orbital septum/frontalis fascia. ROOF covers the entire upper eyelid and appears thinner medially and thicker laterally. It is continuous with the fat under the frontalis muscle and affects the appearance of the upper eyelid. It represents an important factor in upper eyelid surgery. 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.

Evaluating Dry Eye and Meibomian Gland Dysfunction With Meibography in Patients With Stevens-Johnson Syndrome.

To investigate ocular surface and meibomian gland characteristics using infrared meibography in patients with Stevens-Johnson syndrome (SJS). This is a single-center, prospective, noncontrolled, observational study. Thirty-two Thai patients (64 eyes) with SJS for 1 year or longer (1-44 years) were enrolled in the study. All participants underwent a comprehensive ophthalmic examination including slit-lamp biomicroscopy, tear meniscus height, fluorescein tear breakup time, ocular surface fluorescein staining, eyelid morphology, Schirmer 1 test, meibomian gland expressibility, and upper and lower eyelid meibography using a noncontact infrared meibograph mounted on a slit-lamp biomicroscope. The mean age was 42.2 ± 17.7 years (range, 4-68 years). Twenty-nine patients (90.6%) had a history of severe ocular complications in the acute stage of the disease. Medications were the most common cause of SJS (93.8%). Meibum quality could not be assessed in 23 patients (71.9%) due to no glands expressible. Partial or complete loss of the meibomian glands in either the upper or lower eyelid was found in all patients. The degree of meibomian gland dropout significantly correlated with tear breakup time (P < 0.001), meibum quality (P < 0.001), meibum expressibility (P < 0.001), ocular surface staining (P < 0.001), and presence of long-term ocular sequelae including symblepharon (P = 0.027) and limbal stem cell deficiency (P = 0.003). SJS is associated with obstructive meibomian gland dysfunction. The severity of meibomian gland dropout has a relationship with abnormal dry eye tests, subjective meibomian gland evaluation, and other ocular sequelae of SJS.

A Novel Plastic Surgical Technique for Treating Congenital Entropion in Asians.

Summary:Congenital entropion is an ocular condition involving malpositioning of the eyelid, which can result in ocular pain, conjunctival epiphora, or photophobia. Noninvasive treatment is effective in some cases; however, surgical treatment is indicated when keratitis and ocular irritating symptoms occur. There is no consensus regarding the most appropriate surgical technique. Moreover, some patients complain of changes in their appearance or unwanted incision scars after surgery. In particular, individuals with certain types of Asian heritage exhibit a lower eyelid morphology that differs from that of white individuals, caused by orbital fat locational difference. Subciliary muscle bulges cause swelling in the lower eyelid called Namidabuluro and are considered to create a youthful and beautiful appearance in Asians. Accordingly, some Asian individuals tend to be sensitive about changes to the appearance of the lower eyelid. To our knowledge, no report has yet described changes to Namidabukuro during congenital entropion repair in Asians. We describe a novel surgical technique for congenital entropion repair with the creation of cosmetically natural Namidabuluro in an East Asian cohort. The study included 8 lower eyelids of 4 Japanese female patients. Scarring was not noticeable in any of the 4 cases. Eversion of the cilia and the creation of cosmetically natural Namidabuluro were accomplished in all cases. There has been no case of recurrence yet. The novel surgical technique we developed enables not only the treatment of congenital entropion but also the creation of cosmetically acceptable Namidabuluro, resulting in increased patient satisfaction.

Adjustable V-Flap Epicanthoplasty Based on Desired Eyelid Morphology.

Eyelid shape is one key distinctive feature of the Asian eye. The presence of epicanthal folds is a common eyelid defect of Asians. Different surgical techniques have been developed to correct epicanthal folds. However, potential problems with these techniques are emerging, such as difficulty in design, recurrence and/or prominent scarring after surgery, and restricted application together with double eyelidplasty. An improved epicanthoplasty technique with high simplicity and flexibility is imperative. From October 2000 to March 2017, we performed V-flap epicanthoplasty procedures on 423 Asian patients. The whole procedure, including V-shaped skin incision, myotomy and pilication of the medial canthal ligament was performed layer by layer. A similar palpebral fissure distance and inner canthal distance were acquired with this surgical operation. Besides, this surgical technique will not cause limitations on double eyelid morphology when a double blepharoplasty is performed at the same period. The V-flap epicanthoplasty we described here is able to fully correct the epicanthal folds with a simple and flexible design, and the surgery can be adjusted according to patient needs for desired double eyelid shape. Satisfactory results were ideally achieved with no recurrence and finer scar.Level of evidence V 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 .

Exploring the Asian ethnic predisposition to dry eye disease in a pediatric population

PurposeTo investigate the differences in ocular surface characteristics, tear film parameters, and dry eye symptomology between co-located pediatric populations of Asian and Caucasian ethnicity. MethodsSeventy New Zealand-born pediatric participants, aged between 5 and 18 years, were recruited in an age and environmentally controlled cross-sectional study. Participants were classified into three groups according to ethnicity and eyelid morphology: Asian single lid (ASL), Asian double lid (ADL), and Caucasian double lid (CDL). Ocular biometry, tear film parameters, ocular surface characteristics, and dry eye symptomology were evaluated in a single clinical session. ResultsOverall, no significant intergroup differences were observed in tear film quality, dry eye symptomology, and meibomian gland dropout. A higher proportion of ASL and ADL participants exhibited incomplete blinking than the Caucasian group (both p < 0.001). Meibomian gland shortening was more frequently observed among the two Asian groups (both p < 0.05), while gland tortuosity was more common in the Caucasian group (both p < 0.001). ASL participants exhibited greater inferior lid wiper epitheliopathy grades than ADL participants (p = 0.01), and corneal astigmatism was more pronounced in the ASL than CDL group (p = 0.02). ConclusionsEthnic differences in meibomian gland morphological patterns were observed in the current pediatric cohort, although overall meibomian gland dropout did not differ between groups. Asian participants exhibited a higher degree of incomplete blinking, and more marked inferior lid wiper epitheliopathy and corneal astigmatism were observed in the ASL group. These findings would suggest that eyelid anatomy and tension may potentially be implicated in the development of ethnic differences in dry eye disease later in life.

Diagnosis and management of blepharitis: an optometrist's perspective.

Blepharitis is a condition characterized by inflammation of the eyelid margin and is a common cause of discomfort and irritation among people of all ages, ethnicity, and sex. In general, blepharitis is not a sight-threatening condition, but if left untreated has the potential to cause keratopathy, corneal neovascularization and ulceration, and permanent alterations in eyelid morphology. Historically, blepharitis has been categorized according to multiple structural classifications, including anatomic location, duration, and etiology. The substantial overlap of symptoms and signs from the differing structural classifications has led to initial misdiagnoses, clinical underreporting, and variability in treatment of blepharitis. The multifactorial nature is still not fully appreciated but infection and inflammation have been identified as the primary contributors. Ongoing clinical research continues the pursuit for a treatment panacea; however, long-term management of the underlying causes of blepharitis remains the best clinical approach. Here, we will attempt to review the existing literature as it pertains to clinical management of blepharitis and address a stepwise approach to diagnosis, treatment, and management.

The Asian Eyelid: Relevant Anatomy.

The eyelid of Asians has its own unique characteristics. If the surgeon does not acknowledge this, aesthetically pleasing results will seldom be achieved. Here the authors review and summarize important up-to-date anatomical and relevant clinical studies of the Asian upper eyelid, aiming to help surgeons thoroughly understand its unique features, including Asian eyelid morphology, anatomical details, and the mechanisms of upper eyelid crease formation. Hopefully, an in-depth understanding of the Asian eyelid will aid surgeons to accomplish their work and lead to novel new techniques in this field.

Ultrasonographic visualization of lower eyelid structures and dynamic motion analysis.

To define the ultrasonographic structure of normal lower eyelid anatomic compartments and their spacial relationship in dynamic motion. High resolution ultrasound (15MHz) was performed on the lower eyelids of 7 normal subjects. Movements of the lower eyelid and its compartments were visualized with ultrasound. In addition, the maximal excursion area of the lower eyelid fat compartments and retractor motions was measured before and after motion. The orbicularis muscle could be seen as an echolucent structure between the dermis and the echodence fat pads. Lower eyelid fat pad seems to be divided into 2 compartments as range of motion and direction of movement of each of them varies. It seems that these compartments have also different behavior. The measured profile area of the visible normal lower eyelid fat pads during movement of globe from up-gaze to down-gaze decreased by 50%. Order of movement of lower eyelid structures seems to be as follows: after globe movement fist we see retractor movement, anterior orbital fat pad, then skin and septum, and finally movement of inferior fat pad. Ultrasound represents a noninvasive tool for the visualization of lower eyelid morphology. Expanding its application could help us understand the compartmental changes in physiological eyelid movement, in aging and diseased study populations, as well as assess operative outcomes.

Mechanical analysis of eyelid morphology

From a mechanical instability perspective a double eyelid is a double-folded thin film structure on a curved substrate, caused by compression as the film “slides” on the substrate. The underlying mechanics issues, in particular the requirements for forming a double folded structure, are studied using a modeling/simulation framework. A minimalist model is employed to explore the wrinkle to fold transition. Refined and enriched models are further developed based on anatomical structures, which demonstrate three critical factors for the formation of double layer folding of the eyelid. First, a crease line in the eyelid is essential where the local bending rigidity is relatively weak. Second, the skin above the crease line should be thin and wide enough. Third, the skin below the crease line should have a relatively large effective stiffness so it can be lifted as a whole when the eyes open. When the eye is opened beyond about 40% of its initial wrinkle wavelength, the double-folded structure emerges. Various types of eyelid morphologies are discussed based on the mechanistic model. The study provides useful insights for surgery, cosmetics, and morphogenesis, as well as microfabrication.

Morphological Changes of the Eyelid According to Age

Purpose: The morphological changes of the eyelids according to gender among different age groups in Korea were analyzed. Methods: Six-hundred adults without any ocular disease were selected, and sorted by age (ranging from 20 to 79 years), and gender. Each group consisted of 50 adults. Interpalpebral fissure (IPF), marginal reflex distance 1 (MRD1), amount of the upper lid, degree of browptosis, lateral hood width of the eyelid, and protrusion of the eyelid fat were measured. The measured values were analyzed to determine changes related to the aging process. Other age groups were analyzed and compared with the subjects between 20 and 30 years old, using the Student’s t-test with SPSS. Results: MRD 1 and IPF slightly decreased with age, but there was no statistical significance. The upper lid amount showed a statistically significant increase at the 7th and 8th decade. The degree of browptosis showed a statistically significant increase from the 7th decade of age in men, and from the 6th decade in women. In particular, the lateral browptosis was more drooped than the center browptosis. The lateral hood width of the eyelid showed a statistically significant increase from the 7th decade of age in men, and from the 6th decade in women. Eyelid fat was most protruded at the central lower part, but there was no statistical significance. Conclusions: It is important to understand the change related to aging in the study of eyelid morphology and eyelid operation. The results from present study may be used to determine standard for the safe amount of skin resection in Korean eyelid operations.

The Influence of Eyelid Morphology on Normal Corneal Shape

To investigate associations between the topography of the cornea and the morphology of the eyelids in a population of young adult subjects with a range of refractive errors. Corneal topography data and digital images of the anterior eye were acquired for 100 young adult subjects. The corneal topography data and palpebral fissure images were analyzed to determine a range of parameters describing the shape of the cornea and the morphology of the palpebral fissure. Correlation analysis was carried out to investigate for significant associations between the parameters describing the topography of the cornea and the parameters describing the morphology of the palpebral fissure. A number of highly significant correlations were found between the best-fitting corneal spherocylinder and the eyelid morphology parameters. The corneal best-fit sphere (M) was significantly correlated with the horizontal palpebral fissure width (r = -0.428; P < 0.001). Corneal astigmatism power vector J45 was significantly correlated with the angle of the palpebral fissure (r = 0.392; P < 0.001). The axis of corneal astigmatism was also found to be significantly correlated with the angle of the palpebral fissure (r = 0.317; P = 0.005). A number of significant associations exist between the corneal spherocylinder and the morphology of the eyelids in a normal adult population.