Eyelid Pathology Research Articles

Preferred practice patterns for safe cataract surgery in the presence of lacrimal and eyelid pathologies

Preferred practice patterns for safe cataract surgery in the presence of lacrimal and eyelid pathologies

Ptosis: why is it important and what can it tell you?

Ptosis is a droop of the upper lid. It is an important observation for facial practitioners to recognise, as it can have implications in the decisions made regarding treatment. There are several causes of ptosis and not all of them stem from eyelid pathology. In this article, the author discusses the different types of ptosis; how to identify ptosis; how to examine; and when to refer or refuse aesthetic treatment.

Guidelines for the application of artificial intelligence in the diagnosis of anterior segment diseases (2023).

The landscape of ophthalmology has observed monumental shifts with the advent of artificial intelligence (AI) technologies. This article is devoted to elaborating on the nuanced application of AI in the diagnostic realm of anterior segment eye diseases, an area ripe with potential yet complex in its imaging characteristics. Historically, AI's entrenchment in ophthalmology was predominantly rooted in the posterior segment. However, the evolution of machine learning paradigms, particularly with the advent of deep learning methodologies, has reframed the focus. When combined with the exponential surge in available electronic image data pertaining to the anterior segment, AI's role in diagnosing corneal, conjunctival, lens, and eyelid pathologies has been solidified and has emerged from the realm of theoretical to practical. In light of this transformative potential, collaborations between the Ophthalmic Imaging and Intelligent Medicine Subcommittee of the China Medical Education Association and the Ophthalmology Committee of the International Translational Medicine Association have been instrumental. These eminent bodies mobilized a consortium of experts to dissect and assimilate advancements from both national and international quarters. Their mandate was not limited to AI's application in anterior segment pathologies like the cornea, conjunctiva, lens, and eyelids, but also ventured into deciphering the existing impediments and envisioning future trajectories. After iterative deliberations, the consensus synthesized herein serves as a touchstone, assisting ophthalmologists in optimally integrating AI into their diagnostic decisions and bolstering clinical research. Through this guideline, we aspire to offer a comprehensive framework, ensuring that clinical decisions are not merely informed but transformed by AI. By building upon existing literature yet maintaining the highest standards of originality, this document stands as a testament to both innovation and academic integrity, in line with the ethos of renowned journals such as Ophthalmology.

Accuracy of trained technicians in screening orbital and adnexal diseases at rural vision centers in South India.

To assess the agreement between the diagnosis made by trained technicians at vision centers (VC) and oculoplasty specialists at the base hospital, in patients referred from VC to the orbit and oculoplasty clinic of a tertiary eye care hospital in south India. This was a retrospective study that compared the findings of VC technicians and the specialists of the orbit and oculoplasty services in a base hospital. A total of 384 patients referred from 17 VCs between May 2021 and May 2022 were included. The diseases were categorized according to the site of involvement as diseases of the eyelids (43%), diseases of the lacrimal system (37.3%), orbital diseases (15.6), and others (4.1%). The mean age of the patients was 35.9 years and 50.6% were females. Medical records of all referred patients who attended the orbit clinic were analyzed. Of the 384 patients, 378 (98.67%) were confirmed to have o. bital and adnexal diseases. There was an overall 80% agreement between the diagnosis made by trained VC technicians and oculoplasty specialists; the kappa coefficient was 0.78 (95% confidence interval [CI]: 0.76 to 0.80), with a P value < 0.001. The agreement was the highest for diseases of the lacrimal system (90.9%, kappa coefficient 0.87), followed by eyelid pathologies (80%, kappa coefficient: 0.77). Of these, 54.8% of patients were managed with surgical procedures. There is good agreement between the findings of VC technicians and oculoplasty specialists. Trained technicians can help in the early detection and referral to higher centers. They also help to make sure adherence to treatment and periodic evaluation, especially in resource-constraint settings.

The gamut of artificial intelligence in oculoplasty

Artificial intelligence (AI) is taking its grasp over health-care system and ophthalmology as one of the most dynamic streams is largely influenced by AI. AI over the past few decades has made a huge impact in the bailiwick of oculoplasty. AI-based imaging softwares have made easier the diagnosis and management of several orbital and eyelid pathologies by its accuracy and reproducibility. AI also has made possible real-time tracking of deep orbital structures through navigation-guided technologies which have made orbital surgeries safer and easier. This article is a meta-analysis of several articles which have discussed applications and impact of AI-based software in diagnosis and management planning of periorbital and eyelid pathologies and also articles on navigation-guided orbital surgeries.

Levator palpebrae superioris function and corneal astigmatism in university students with normal eyelid morphology

Background: Eyelids have been shown to influence corneal shape. The effects of eyelid pathologies on corneal astigmatism have been widely investigated. This study aimed to determine the correlation between levator palpebrae superioris (LPS) muscle function and with-the-rule (WTR) corneal astigmatism in university students with normal eyelid morphology.Methods: This was a cross-sectional study with a sample of 58 university students of Chinese origin selected by simple random sampling at the University College Sedaya International (UCSI) University Optometry Clinic, Kuala Lumpur, Malaysia. We included participants aged 18 to 30 years, regardless of sex, with normal eyelid morphology, normal LPS function, and WTR corneal astigmatism. For LPS muscle function, the distance of the upper eyelid margin from the maximal downgaze to the upgaze was measured, while the frontalis function was negated by the thumb of the examiner. Corneal astigmatism was measured using a manual Keratometry (Topcon OM-4; Topcon Corporation, Tokyo, Japan). Results: Of the 58 participants, 23 (39.7%) were men and 35 (60.3%) were women. The mean ± standard deviation (SD) age was 23.22 ± 1.77 years. For all participants, the means ± SDs for LPS muscle function and corneal astigmatism were 14.72 ± 1.74 mm and - 1.16 ± 0.47 D, respectively. Of the 58 participants, 25 and 33 had low and moderate WTR corneal astigmatism, respectively. The mean LPS muscle functions were not significantly different between the low and moderate WTR corneal astigmatism groups (P &gt; 0.05). A positive but statistically insignificant correlation (r = + 0.14; P &gt; 0.05) was found between LPS muscle function and WTR corneal astigmatism. Conclusions: We found no significant difference in the mean LPS muscle function between low and moderate WTR corneal astigmatism groups in young university students of Chinese origin with normal eyelid morphology. Furthermore, no significant correlation was found between LPS muscle function and low-to-moderate WTR corneal astigmatism.

Descriptive study of a telemedicine program in palpebral pathology for primary care (tele-eyelid).

In 2013 we implemented an asynchronous telemedicine circuit for the diagnosis of eyelid diseases (tele-eyelid), connecting the outpatient primary healthcare with the hospital's specialists. The purpose of this study is to assess the use of telemedicine in the diagnosis of eyelid diseases by primary care teams, to evaluate its usefulness and to analyse the epidemiology of the pathological conditions referred to the tertiary level hospital, as well as the need for surgery. This study was carried out in the Spanish public health system, in a mainly rural area assisted by the Institut Català de la Salut (ICS) and Althaia Xarxa Assistencial Universitària de Manresa. This is a retrospective, descriptive analysis of the telematic consultations undertaken between 2013 and 2019. The consultations between 2018 and 2019 underwent a further descriptive retrospective-prospective analysis to assess the conditions referred to the hospital. Unnecessary referrals were avoided in 72% of telematic consultations. More than 50% of primary care practitioners used tele-eyelid. Up to 68% of the referrals were due to eyelid tumours, 50% needed surgery and 18%, a biopsy. Moreover, we found a high reliability between telematic and face-to-face diagnosis. Teleophthalmology applied to eyelid pathology is a useful tool to improve access to specialized care and helps solving pathological conditions. It avoids unnecessary consultations and increases efficiency, both in primary and hospital care.

Estudio descriptivo de un programa de telemedicina en patología palpebral para atención primaria (telepárpados)

Background and objectiveIn 2013 we implemented an asynchronous telemedicine circuit for the diagnosis of eyelid diseases (tele-eyelid), connecting the outpatient primary healthcare with the hospital's specialists. The purpose of this study is to assess the use of telemedicine in the diagnosis of eyelid diseases by primary care teams, to evaluate its usefulness and to analyse the epidemiology of the pathological conditions referred to the tertiary level hospital, as well as the need for surgery. Materials and methodsThis study was carried out in the Spanish public health system, in a mainly rural area assisted by the Institut Català de la Salut (ICS) and Althaia Xarxa Assistencial Universitària de Manresa. This is a retrospective, descriptive analysis of the telematic consultations undertaken between 2013 and 2019. The consultations between 2018 and 2019 underwent a further descriptive retrospective-prospective analysis to assess the conditions referred to the hospital. ResultsUnnecessary referrals were avoided in 72% of telematic consultations. More than 50% of primary care practitioners used tele-eyelid. Up to 68% of the referrals were due to eyelid tumours, 50% needed surgery and 18%, a biopsy. Moreover, we found a high reliability between telematic and face-to-face diagnosis. ConclusionsTeleophthalmology applied to eyelid pathology is a useful tool to improve access to specialized care and helps solving pathological conditions. It avoids unnecessary consultations and increases efficiency, both in primary and hospital care.

Tear Trough and Lid-Cheek Junction Anatomy: Current Understanding and Nonsurgical Treatment.

The tear trough and lower eyelid are sentinel sites of facial aging and are increasingly the target of nonsurgical aesthetic procedures. This article will review the advances that have led to our current understanding of tear trough anatomy. We propose a new functional classification of the lid-cheek junction for soft tissue filler treatment, and suggest simpler stratification of patients seeking lower eyelid treatment based on the etiology of their tear trough depression. We aim to describe a stepwise approach to management, with specific technical considerations targeting the underlying causes of lower eyelid pathology. The common complications and pitfalls of nonsurgical tear trough management will be discussed.

Limbal Stem Cell Deficiency: Demographics and Clinical Characteristics of a Large Retrospective Series at a Single Tertiary Referral Center.

The aim of this study was to characterize a large cohort of patients presenting to a single referral center for limbal stem cell deficiency (LSCD). A retrospective chart review of all patients with a clinical diagnosis of LSCD from 2002 to 2015 was performed. Demographics, etiology, previous ocular surgeries, visual acuity, and treatment were assessed. Seven hundred thirty-eight eyes of 434 patients (51.4% male subjects) were diagnosed with LSCD. The mean presenting age was 42.9 years, 70% presented with bilateral disease, and overall vision was poor. The most common etiologies were congenital aniridia (30.9%), chemical or thermal injuries (20.6%), contact lens (16.8%), Stevens-Johnson syndrome (SJS, 10.4%), and iatrogenic (7.3%). Congenital aniridia had a significantly increased association with glaucoma or ocular hypertension (P < 0.0001). Chemical or thermal injuries (P = 0.0007), SJS (P < 0.0001), and mucous membrane pemphigoid (P < 0.0001) had a significantly increased association with eyelid pathology. The mean logMAR best corrected visual acuity (analysis excluded eyes with light perception and no light perception) at presentation was 1.145 (∼20/280). Keratoplasty performed (before presentation at our center) without first addressing the LSCD was seen in 80 eyes; all keratoplasties failed due to recurrence of the LSCD. Patients presenting with LSCD were on average middle aged without sex predominance. LSCD was most commonly bilateral, comprised a wide range of etiologies, and decreased vision substantially. Ocular comorbidities may need to be treated before treating the LSCD surgically. Finally, not addressing the LSCD (primary issue) first can result in keratoplasty failure.

Perioküler Yaşlanma İçin Yapilan Kombine Cerrahinin Kozmetik Ve Fonksiyonel Sonuçlari; Görme Alani Ve Kornea Topografisindeki Değişiklikler

Purpose: To evaluate the visual field and corneal topographic findings which occur with combined surgeries in patients who have other involutional periocular changes in association with dermatochalasis. &#x0D; Material and Method: Eighty eyelids of 40 patients were included in the study and the subjects were divided into 2 groups as additional eyelid pathology (Group 1) and additional eyebrow ptosis (Group 2). In the preoperative and postoperative 3rd month, Margin Reflex Distance-1 (MRD-1), corneal parameters obtained by high base topography device and visual field findings obtained by a visual field device were recorded and detailed ophtalmologic examination was performed. &#x0D; Results: A mean elevation of 0.5 mm was observed in the MRD-1 values in both groups. Postoperatively, a marked reduction was observed in the rate of observing scotoma in the visual field and in MD and PSD values (p

Study of histomorphological spectrum of eyelid lesions

Background: Eyelid pathologies are the most common surgical specimens encountered among all of the ophthalmic lesions and constitute a wide range of diseases by their unique histologic features. This study aims to find out the histopathological spectrum of eyelid lesions, their demographic distribution, and preferential location prevalent in our community.Materials and Methods: This is an observational study in which we retrospectively evaluated the data of 692 patients retrieved from the histopathology department of National Reference Laboratory, Kathmandu, from May 2016 to April 2019.Results: A total of 701 histologic diagnoses comprised of benign, precursor, and malignant lesions and accounted for 86.6%, 2.6%, and 10.8% respectively with preponderance in females. The common benign lesions included melanocytic nevus (17.7%), epidermal cyst (11%), hemangioma (8.9%), dermoid cyst (8.2%), chalazion (6.7%), and squamous papilloma (6.4%). Tumour of epidermal origin was the most common neoplastic lesion accounting for 31.2%. Basal cell carcinoma (50%) followed by sebaceous carcinoma (27.6%) and squamous cell carcinoma (14.5%) constituted the majority of malignant lesions prevalent above the age of 60 years with the preferential site of the upper eyelid for basal cell carcinoma and squamous cell carcinoma; and lower eyelid for sebaceous carcinoma.Conclusions: Benign eyelid lesions are more prevalent than malignant ones with overall female preponderance. Epidermal tumours are common among neoplasms. A malignant tumour, a disease of an elderly individual, is predominated by basal cell carcinoma followed by sebaceous carcinoma, an aggressive tumour with a high recurrence rate in our population.

Screening of pediatric eye disease at home by using camera of mobile phone

The simplest method of screening eye pathology in infant is red reflex examination. Present, absence or change of red reflex is key point in early detection of eye pathology. Objective – establish possibility using of mobile phone camera for eye pathology screening at home.Materials and methods. 750 children were included in research. Patient parents allowed photo their child before ophthalmology exam. First step was taking photo on parent’s mobile telephone in playing room from different distance and lighting. Second step was photo in exam room in mesopic condition in 1, 2 and 4 m distance with using maximum zoom and then ophthalmologic exam. After that, all photos was analysed by next signs: present or absence of red reflex, intensive of red reflex, present or absence pathology shadow, in case of red reflex changing, distance where changing is best viewed, comparison photo with result of ophthalmology exam. Results. After analysing photos all children was divided in three groups depending on red reflex chan-ging. In the first group red reflex was even without additional shadow, same in both eye. In this group after ophthalmology exam ametropy low level and eyelid pathology was diagnosed. In the second group red reflex was irregular by colour with additional light shadow or different intensity of red reflex in both eye. Ametropy high level was diagnosed in this group. In the third group we observed absence or colour change of red reflex. Cataract, congenital glaucoma, retinoblastoma, retinal and choroidal coloboma, Coats retinitis was diagnosed. Changing of red reflex possible to find on all photos from different distance, but the most informative was photo that was done from 1 m in mesopic condition. Conclusion. By equability and colour changing of red reflex on photo, all children may divided in three groups: 1 – children require only prophylactic ophthalmology exam, 2 – children require additional ophthalmology exam, 3 – children require immediate ophthalmology exam.

Tratamiento de las afecciones palpebrales en la obra de Escribonio Largo

Tratamiento de las afecciones palpebrales en la obra de Escribonio Largo

Lower Eyelid Distraction Test: New Insights on the Reference Value.

The evaluation of palpebral laxity can be performed by the distraction test (DT). Although widely used in ophthalmologic practice, there is no consensus about the results considered normal by the test. The objectives of this study are to obtain the value of DT in a group of individuals with healthy eyelids and to compare with the measurements in subjects with senile ectropion. Lower eyelid DT was performed in 200 individuals without any eyelid pathology and in 30 individuals with lower lid ectropion. The results were analyzed by age and sex in the control group and compared with the results of the ectropion group. The mean value of DT in the control group was 6.96 mm, lower than in the ectropion group (9.48 mm) (p < 0.001). In the control group, the mean female DT was 6.70 mm, while the male was 7.22 mm. There were differences in the DT values in the subgroups of 20-39 and 40-59-year old according to gender, with men presenting higher measurements than women. In the other age subgroups, both genders presented similar DT values. Even when considering only individuals in the control group with the same range of age as in the ectropion group, the DT value was higher in individuals with ectropion (7.23 and 9.48 mm, respectively, p < 0.001). The mean DT value is 6.96 mm; however, the measurement varies according to age and sex in people without palpebral pathology. Individuals with senile eyelid ectropion present higher measurements than healthy ones.In this study, the authors performed the eyelid distraction test in 200 healthy individuals, bringing to the literature the new information that there is a variability of the normal test's value regarding age and gender.

Objective Measurement of Eyelid Force in Ptosis Versus Controls.

Thorough evaluation of the upper eyelid is essential for diagnosis and management planning in blepharoptosis. In a previous study, our group described a novel force gauge for direct assessment of upper lid force in healthy subjects. In this study, the authors apply the same technique for measuring muscle forces in ptotic eyelids.Patients scheduled to undergo surgical repair of aponeurotic blepharoptosis or dermatochalasis, from July 2017 to August 2018, in a tertiary care medical center, were enrolled in this prospective case series. When the eyelid disorder was unilateral, the normal eye was designated as control. The upward force generated by the eyelid was measured directly using a handheld dynamometer noninvasively attached to the upper eyelid. Measurements were conducted with and without fixation of the frontalis muscle, to differentiate between total lid force, levator force, and frontalis contribution.A total of 56 eyes was included in the study: 34 in the ptosis group, 11 in the dermatochalasis group, and 11 as controls. Both the ptosis group and the dermatochalasis group had significantly lower total muscle force and levator force measurements when compared with control (P <0.05). Calculated frontalis force contribution to upgaze did not differ significantly between groups. In the control group, calculated frontalis force contribution to upgaze strongly correlated to marginal reflex distance1 (r = 0.75, P = 0.05)In conclusion, the authors present a simple, inexpensive, new portable force gauge for direct eyelid force measurements in eyelid pathologies. Distinct differences between ptotic and healthy eyelids are demonstrated, suggesting potential applications in patient evaluation and management.

Primary Lash Ptosis.

Lash ptosis is often an overlooked sign that may coexist with congenital and acquired blepharoptosis. This is a report of case series of patients presented in an oculoplastic clinic with visual field loss associated with lash ptosis. On examination, the primary pathology was attributed to lash ptosis dehiscence. All patients underwent anterior lamellar repositioning and were followed for an average of 15 (10-24) months. All patients had resolution of visual field loss and heaviness of eyelids. Lash ptosis is associated with abnormalities such as floppy eyelid syndrome. However it may be a primary condition, with no background eyelid pathology and no external explanation for the eyelash ptosis. The condition might result from anatomical changes in the orbicularis oculi, Riolan's muscle, and tarsal plate. Patients in this series complained of upper lid visual field restriction. Anterior lamellar repositioning resulted in complete resolution of complaints. Additional studies are needed to learn about the pathophysiology of this entity.

Epiblepharon correction in Korean children based on the epicanthal pathology.

This study aims to investigate the surgical outcomes of a novel epiblepharon correction method based on the pathologic features of epicanthal tissue. The correlation between the pathology and clinical presentations was also studied. This retrospective study included 72 eyelids of 36 children with epiblepharon and epicanthal folds. From July 2013 to March 2016, epicanthal tension-releasing procedure of subdermal fibrinolysis with orbicularis oculi ring myotomy were performed in 36 children. Photographs before and after operation were analyzed with Image J program. A clinical severity of the epiblepharon was scored based on the lower eyelid skin fold height (mild to severe). Subdermal fibrosis index was defined as the portion of fibrosis in low power field (× 40) and eyelid contour was assessed with custom software (MATLAB). Eighty eyelids without eyelid pathology were analyzed to establish the normal eyelid contour. The epicanthal tissues were classified into three categories: mild, moderate, and severe fibrosis. The mean age of the patients was 5.5years. Intercanthal distance (ICD) ratio was defined as Inner ICD (IICD)/outer ICD (OICD). The IICD/OICD was 0.41 in the severe epiblepharon group that is significantly longer compared to that of the mild epiblepharon group (0.38). Subdermal fibrosis index was higher in severe epiblepharon group. Eyelid contour was normalized and the cilia touch was resolved after the epicanthal tension-releasing procedure. Epicanthal tension-releasing procedure with orbicularis oculi ring myotomy achieved favorable surgical outcomes. Clinical correlations with pathologic findings and satisfactory results of the procedure suggest that medial epicanthal fibrosis is the main pathologic feature causing epiblepharon and epicanthal folds.

A Novel Technique for Measuring Eyelid Force.

We present a novel technique to directly measure the eyelid upward force generation. This technique can be used during routine clinical examination using an inexpensive, portable force gauge. This prospective case series was conducted January to June 2015 in an ophthalmology clinic affiliated with a tertiary care medical center. A convenience sample of 42 patients (40-90 years of age) without known eyelid pathology participated. The eyelid upward net force generated was measured directly using a handheld dynamometer noninvasively attached to the upper eyelid. Comparison of the eyelid-brow upward force generated with eyelid upward net force generated allowed us to assess the contribution of levator and frontalis muscles to the force generated during upgaze. Data were evaluated with relation to gender and age. Upper eyelid force generated was 53.3 g OD and 53.9 g OS; the generated force during frontalis muscle fixation was 38.4 g OD and 41.1 g OS. The levator and frontalis muscles showed a 3:1 ratio respectively in their contribution to the force generated during upgaze. Although no statistically significant differences were seen between eyes, gender, or within age groups, younger patients showed increased generating force which is attributed to the levator muscle. Interclass correlation coefficient showed virtually no correlation between clinical eyelid assessments and direct muscle force measurement. Reliability for repeated direct force measurements by the same physician was strong, with interclass correlation coefficient 0.951 to 0.969. No adverse events occurred. We describe a simple, reliable, inexpensive, new method for assessing upper eyelid upward force generation. Because the levator muscle serves as the primary contributor to eyelid elevation, this directly measurable eyelid assessment may help to increase understanding of its functional contribution and assessment when assessing eyelid pathologies.

Measurement of the Strength of Human Musculus Orbicularis Oculi Using Video Analysis

Introduction Current methods to measure the of strength of the musculus orbicularis oculi are limited by high proneness to examiner error or by their complex and impracticable set-ups. Our aim was to develop a simple and practicable method to measure eye lid power via video analysis. Methods 50 healthy subjects were included. A deformable single use lid speculum was used. Forced maximum lid closure was recorded via a video slit lamp. Analysis of the video data was performed with open source tracking software. The maximum and minimum distances of the inserted lid speculum were detected. The rigidity and mechanical characteristics of the lid speculum were tested separately. In this way, lid power could be determined by analysis of the maximum compression of the lid speculum. To explore the impact of age and sex on eye lid power, Pearson's correlation coefficient was evaluated. ICC (intra class correlation) was analysed as a measure of reliability. Results In three repeated measurements in 9 subjects, an ICC of α = 0.91 was detected. With 50 healthy subjects, the range of lid power was 0.62 - 4.72 N. No correlation was found between the age of the subjects and eyelid power (Pearson's correlation coefficient = 0.054). A weak correlation was found between the sex of the subjects and eyelid power. For female subjects, the mean power was 1.82 N and for male subjects 2.58 N (Pearson's correlation coefficient = 0.428). Discussion A test series of 50 healthy subjects exhibited a wide range of lid power. The wide range makes it difficult to distinguish between pathological and normal eyelid power. The major application field of the method may therefore be in inner-individual measurements of known eyelid pathologies, such as paresis of the facial nerve or ocular myasthenia.