Eyelid Injuries Research Articles

Monopolar Radiofrequency Treatment of the Eyelids

BACKGROUND Monopolar radiofrequency (RF) energy has been used to successfully accomplish noninvasive skin tightening of the face, abdomen, and extremities. Owing to concerns about injury to the eye itself, monopolar RF treatment of the eyelids has not been feasible. OBJECTIVE The objective was to evaluate the safety of a novel 0.25-cm2“shallow” treatment tip for noninvasive tightening of eyelid skin. METHODS AND MATERIALS This was a tripartite study that began with an animal model to evaluate soft tissue effects and temperature change at the ocular surface. Findings were then extrapolated to ex vivo evaluation of human eyelids and ultimately to an in vivo human eyelid safety study. RESULTS The animal studies demonstrated that the 0.25-cm2 treatment tip could be used safely on eyelids in conjunction with appropriate ocular protection. The ex vivo human eyelid studies confirmed that, at typical treatment settings, the shallow treatment tip did not produce frank eyelid injury. The in vivo human studies confirmed that, at the tested settings, the novel treatment tip did not injure the eyelids or eyes. CONCLUSION If used properly, the 0.25-cm2 treatment tip can be safely used on human eyelids.

Monopolar Radiofrequency Treatment of the Eyelids: A Safety Evaluation

Monopolar radiofrequency (RF) energy has been used to successfully accomplish noninvasive skin tightening of the face, abdomen, and extremities. Owing to concerns about injury to the eye itself, monopolar RF treatment of the eyelids has not been feasible. The objective was to evaluate the safety of a novel 0.25-cm(2)"shallow" treatment tip for noninvasive tightening of eyelid skin. This was a tripartite study that began with an animal model to evaluate soft tissue effects and temperature change at the ocular surface. Findings were then extrapolated to ex vivo evaluation of human eyelids and ultimately to an in vivo human eyelid safety study. The animal studies demonstrated that the 0.25-cm(2) treatment tip could be used safely on eyelids in conjunction with appropriate ocular protection. The ex vivo human eyelid studies confirmed that, at typical treatment settings, the shallow treatment tip did not produce frank eyelid injury. The in vivo human studies confirmed that, at the tested settings, the novel treatment tip did not injure the eyelids or eyes. If used properly, the 0.25-cm(2) treatment tip can be safely used on human eyelids.

Les traumatismes oculaires chez les enfants âgés de 0 à 15 ans: Aspects épidémiologiques et cliniques au Centre National Hospitalier Universitaire de Bangui

Ocular injuries in children are frequent and are an ophthalmological emergency. If not managed sufficiently early, these lesions may cause definitive partial loss of vision or blindness. In this survey, the authors analyze different epidemiological and clinical aspects of ocular injuries at the Bangui National Teaching Hospital in the Central African Republic to increase the awareness of children's parents, guardians, and care-takers.A prospective study was conducted on 194 cases in the ophthalmology department over a period of 3 years, and included children aged 0-15 years. A total of 197 eyes were examined by the same practitioner, comprising 191 unilateral ocular injuries and three bilateral injuries.Of the children examined, 59% were males and 41% were females, with a sex ratio of 1.3. The age group with the highest exposure (39.3%) was between 5 and 10 years. Punishments (25.9%), accidents during games (19.3%) and fights (18.8%) were the main sources of these ocular injuries. Consultation most often occurred long after the incident. Only 2.0% were seen before the 6th hour and 43.7% between 48 hours and 1 week. The clinical picture was dominated by bruises posing a therapeutic problem: 25 hyphemas (12.7%), 19 conjunctival injuries (9.6%), 19 lens dislocations with or without vitreous loss (9.6%), 18 trauma-induced cataracts (9.4%), and 15 eye lid injuries with or without lachrymal duct ruptures (7.6%). The most serious injuries were cornea injuries with or without hernia of the iris (19.8%) and nine globe dislocations (4.5%).The frequency and gravity of the lesions identified, the severity of the injuries and the delay in treating these injuries show that the public authorities, parents and child care-takers need more information in order to reduce the frequency of these accidents.

Eyelid Injuries: A Nine Year Review Of Management

BACKGROUND: Eyelid injuries are usually associated with injury to the eyeball therefore they are mostly reported along with such injuries. This report is a review of cases of eyelid injuries managed in the Jos University Teaching Hospital (JUTH), Jos Central Nigeria. PATIENT AND METHOD: This is a retrospective study of patients with eyelid injuries that were managed over 9 years. The information obtained from the patient's case notes included demographic data, cause, location and type of injury as well as the object responsible for the injury and modality of treatment. RESULT: Sixty six patients with eyelid lid injuries were managed. Fifty seven were males and 9 were females giving a male: female ratio of 6.3:1. The age ranged from one year to 62 years with a mean of 24.8 ± 13.4 years. Thirty percent of the patients were within the third decade of life. There were 36 (54.5%) cases of laceration, 20 (30.3%) cases of abrasions/bruises and 7 (10.6%) cases of avulsions. Road traffic accidents were responsible for most of the injury (27.3%) followed by fights/assault (21.2%) and sports/recreation activities (18.4%). The most frequent objects associated with the injuries were metals (41.0%), fist/feet (13.6%), stone (12.1), and wood (10.6%). There were more injuries to the upper eyelid, while eyeball trauma was the most common associated injury. Twenty three (34.9%) patients who were managed conservatively had no need for suturing or reconstruction. Flaps were used for reconstruction in three (4.5%) patients while direct closure was undertaken in forty (60.6%) patients where such closure will not impair eyelid function. CONCLUSION: Eyelid injury can occur with or without extensive trauma to the eyeball. The upper eyelid is commonly affected and complex reconstruction may be required in cases with extensive injury. KEYWORDS: Eyelid injury, causative factor, repair, reconstruction Nigerian Journal of Orthopaedics and Trauma Vol.3(2) 2004: 118-128

TYPES, CAUSES AND TREATMENT OF EYELID TRAUMA

Background. Eyelid trauma is a common cause of visit to the ophthalmologist, but there are just a few recent epidemiological studies. Purpose of our study was to analyse eyelid injuries according to the mechanism of injury, causes of eyelid injuries and different types of treatment. Methods. A retrospective review of data from patients who received surgical treatment for eyelid injuries at the Ophthalmology Department, Maribor General Hospital in 2000 and 2001 was carried out. Eyelid injuries were divided into a minor trauma with patients treated as outpatients and major trauma patients who needed hospital treatment. According to the mechanism of injury eyelid injuries were divided into a blunt trauma, sharp trauma and combination of both. They according to the localisation injuries were divided into injuries of upper lid, lower lid and both lids at the same time. We looked for causes of eyelid injuries, accompanying injuries and different types of treatment of eyelid injuries. Results. Out of 295 patients 239 were men (81%) and 56 were women (19%). 27 patients (9%) suffered major trauma and needed hospitalisation while 268 suffered minor trauma and they were treated as outpatients (91%). Blunt trauma was present in 195 cases (66%), sharp trauma was present in 40 cases (14%) and in 60 cases (20%) the injury was combination of sharp and blunt trauma. The most common causes were sudden falls in 89 cases (30%), followed by violence in 85 cases (29%). 215 patients (73%) clinically showed injury of upper lid, 46 patients (16%) showed injury of the lower lid and in 34 cases (11%) both lids were injured. Accompanying injury of the eyeball was present in 138 patients (47%) and face injuries in 17 patients (6%). 251 patients (85%) needed skin sutures, 6 patients (2%) needed skin and subcutaneous tissue suturing, lid margin was treated in 33 cases (11%) and canaliculus was treated in 5 cases (2%). Conclusions. Results of our study showed that eyelid injuries were more frequent in man and blunt trauma was the most frequent type of injury. The most common cause of injury was sudden fall. Injuries were mostly minor, and patients were treated as outpatients. Only 9% of patients suffered major trauma and needed a hospitalisation. In almost half of patients additional injury to the eye was present. According to the results of our study of eyelid trauma, which showed big diversity of injuries and high frequency of additional injuries to the eye, ophthalmologic examination and treatment should be performed in all of these cases.

Traumatic eyelid injuries.

Traumatic eyelid injuries.

Lidverletzungen

To present epidemiological data on eyelid trauma which appear rarely in the literature. Medical records of 180 patients given surgical treatment for eyelid injuries at the ophthalmology department of LMU Munich between 1997 and 1999 were evaluated. Clinical findings of eyelids and eyeballs, surgical procedures and complications during wound healing were considered. Out of 180 patients, 140 suffered blunt trauma of which 66 were due to manual work, 38 to sudden falls, 23 to violence, 7 to motor vehicle accidents and 6 to sports. From 26 cutting injuries caused by glass, 12 were caused by broken spectacles, 8 were caused by sudden falls, 4 by violence and only 2 by car accidents. Clinically 85 patients showed injuries of the upper eyelid, 55 of the lower and 40 of both lids. The lid margin was affected in 43 patients and the lacrimal drainage system in 28. Wound contamination occurred in 34 patients, 19 had foreign bodies and 13 loss of tissue. Accompanying injuries of the face was noticed in 16 patients and of the eyeball in 79 patients of which 31 were superficial, 36 were eyeball contusions of varying severity, 12 were perforations or ruptures and 4 patients additionally had orbital bone fractures. The average time from injury to surgery was 3.3 h. A total of 100 patients needed simple skin suturing, 26 sutures to the skin and subcutaneous tissue including the orbicularis and levator muscle, 43 needed readaption of the lid margin and 24 repair of the canalicular system. Post-operatively only one patient developed a necrosis and one an infection. In eyelid trauma, the lid margin is affected in 24% and the lacrimal drainage system in 16% of all injuries. Our data also showed a high association (44%) of eyelid injuries with trauma to the eyeball. This emphasises the necessity for eyelid injuries to be treated primarily by an ophthalmic surgeon, although difficult primary reconstruction and early complications in particular, are relatively rare.

Lid- und Gesichtsverletzungen nach Hundebiss1

Head und neck injuries of children are mistly due to dog bite. During the 10-year interval from 1990 to 2000 sixteen patients suffering from dog bite injuries were seen in our department. Age, gender, pattern of ocular and periocular wounds, surgical management and long-term damage were analyzed. Medial lower eyelid injuries with lacrimal duct involvement were most common. Ten victims were younger than four years. 87% of the dogs belonged to the family and friends of the patients. Two localized infections and no systemic infection were seen. Primate microsurgical wound repair leads to a satisfying functional, morphological, and esthetic long-term result.

Silent orbitocranial penetration by a pencil.

OBJECTIVE: To emphasise the value of computed tomography even in the absence of symptoms in a case of penetrating injury of the upper eyelid. METHODS: Case report. RESULTS: Although clinically...

Secondary Healing of Mohs Defects of the Forehead, Temple, and Lower Eyelid

To analyze the results of secondary healing of Mohs defects of the forehead, temple, and lower eyelid. Scars resulting from secondary healing in these 3 sites were rated by patient interviews and by analysis of postoperative photographs by 3 board-certified members of the American Academy of Facial Plastic and Reconstructive Surgery. Private facial plastic and reconstructive surgery practice in Florida. Patients with Mohs wounds of the forehead, temple, and lower eyelid that were allowed to heal by secondary intention between January 1, 1989, and December 31, 1993, who were available for follow-up. There were 10 wounds of the forehead, 6 of the temple, and 10 of the lower eyelid that were available for analysis. Wound color, contour, distortion of surrounding structures, presence of telangiectasias or paresthesias, pain or infection during healing, and overall cosmetic result. Color, contour, and overall scar cosmesis were rated using the following scale: poor (0), fair (1), good (2), and excellent (3). Telangiectasias, paresthesias, and pain or infection during healing were recorded as present or absent. The respective color and contour ratings for the 3 sites were 2.2 and 2.2 for the forehead, 2.5 and 2.7 for the temple, and 2.7 and 3 for the lower eyelid according to patient interview and 1 and 1.3 for the forehead, 1 and 1.4 for the temple, and 2.6 and 2.5 for the lower eyelid according to surgeon analysis. Pain, infection, paresthesias, and distortion of surrounding structures were rare, but 7 of 10 forehead and 4 of 6 temple wounds had telangiectasias. Many defects of the forehead and temple will heal with acceptable results. Partial-thickness or small full-thickness lower eyelid wounds heal with excellent cosmetic and functional results. Patient satisfaction is greater than might be predicted by surgeon analysis of wound healing.

Eyelid Injuries: Early and Late Repair

Eyelid Injuries: Early and Late Repair

し骨洞に達した眼か内木片異物症例

A 48-year-old man riding a motorcycle ran into a pine tree and suffered a small injury of the left medial lower eyelid. He consulted his family doctor and was told that his wound was too small to be sutured. The skin closed, but after a while a purulent discharge and fistula formation occurred at the same site. Three months after the injury he was referred to our hospital. Computed tomography revealed that an intraorbital foreign body had penetrated the ethmoid sinus. Under local anesthesia a left medial canthal incision was performed. The wooden foreign body, 4.5cm long and 4mm in diameter, was removed from the surrounding granulation tissue in the orbit. Two weeks later, a small wooden fragment was spontaneously extruded from the operative wound. In this case, the foreign body had not been found for a long time because i t penetrated the posterior ethmoid sinus without any damage of the visual organs. No matter how small an eyelid injury is, one should be aware of the possibility of deeper damage and of persistent foreign bodies. In this case computed tomography was helpful in the diagnosis of the radiolucent wooden foreign body in the orbit and in the ethmoid sinus.

Spontaneous reformation of upper eyelid.

Twenty-six patients with lesions of upper eyelids were treated with simple surgical excision under local anaesthesia as day cases. Three other patients with eyelid injuries had full-thickness margin-inclusive lacerations of upper eyelids. In all these 29 patients the upper eyelid wounds were allowed to heal solely by spontaneous repair. The cautious study began with small extramarginal skin excisions and progressed gradually via moderate sized juxtamarginal excisions of skin and orbicularis lamella to full-thickness margin-inclusive excisions. The wounds healed satisfactorily in all the 29 patients without ocular or palpebral complications. The functional results were normal. Cosmetic results were excellent in 27 patients and acceptable in 2, one of whom subsequently underwent a secondary oculoplastic repair. This study demonstrates that, for upper eyelids, full-thickness margin-inclusive excisions of up to 10 mm in horizontal extent and 5-6 mm in height, and moderate sized 13 X 10 mm juxtamarginal excisions of the skin and orbicularis lamella, yield near normal results with solely spontaneous repair. Immediate surgical reconstruction of such wounds is assumed to be mandatory by current tenets of oculoplastic surgery.

An unusual infra-orbital foreign body

A case report of a patient with a lower eyelid wound with a retained foreign body is given. The localisation, treatment and complications of orbital foreign bodies are discussed.

The significance of small wounds of the eyelids

A case of a small eyelid wound associated with a retained foreign body within the orbit is presented. The significance of small eyelid lacerations in relation to minor initial clinical signs and possible serious late complications is discussed, and suggestions are made for management of all such injuries.

The early treatment and reconstruction of eyelid burns.

Eyelid burns occurred in 67% of the 210 patients with facial burns admitted to the San Diego Regional Burn Center between 1 December 1977 and 30 June 1982. Evaluation of 48 surviving patients with significant eyelid injury demonstrated the safety and effectiveness of early excision and grafting of eyelid burns. Tarsorrhaphies were found not to be useful in preventing ectropion and resulted in deformity of the lid margins. Our technique employing early excision and grafting and reconstruction of eyelid burns is illustrated.

Techniques in Eyelid Wound Closure

While one of the most basic techniques in eyelid surgery is the repair of an eyelid defect that involves the margin, many eyelid defects are still poorly repaired; and much confusion still exists in this area. Based upon sound anatomic and surgical principles, we suggest several modifications of classically described techniques: (1) The greyline suture is replaced by a tarsal suture through the meibomian gland orifices to provide a stronger closure and better alignment. (2) All tension of closure is supported by the deep tarsal sutures rather than by the margin sutures to avoid notch formation or unsightly scars. (3) A two-layered closure where orbicularis and tarsus is closed in a single layer is technically easier and gives results comparable to the classically taught three-layered closure. Conjunctival sutures in the tarsal portion of the eyelid are unnecessary and frequently cause corneal irritation. (4) When lid resection is performed, a pentagonal excision rather than a "V" or wedge resection should be used to minimize tension on the margin when closed. We present in an illustrated step-by-step fashion our preferred technique which gives consistently good results.

Lid surgery (author's transl)

From the anatomical and physiological point of view th eyelid may be divided into three layers: a deep layer, comprising the tarsi and the canthal tendons with the levator aponeurosis and the lower lid retractors, the orbicularis muscle layer, and the skin. The surgical particularities of each of these layers are outlined. In the management of eyelid injuries the meticulous reconstruction of the medial canthal tendon and canthus is of paramount importance. Only after this are the lids closed from medially to laterally and from deep to superficial tissues.

Optic atrophy following eyelid injury.

<h3>Background</h3> Studies exploring the relationship between prenatal vitamin D exposure and childhood asthma have yielded conflicting results. Higher vitamin D intake during pregnancy has been shown to lower the risk of childhood wheeze, yet a study of maternal late-pregnancy serum 25-hydroxyvitamin D suggested higher serum concentrations may be associated with increased childhood asthma. <h3>Objective</h3> To assess the relationship between mothers9 serum 25-hydroxyvitamin D status and asthma and wheeze phenotypes in their children at age 6 years. Also to explore the relationship between maternal 25-hydroxyvitamin D status and objective measures of childhood atopy and lung function. <h3>Methods</h3> Serum 25-hydroxyvitamin D was measured at 34 weeks9 gestation in the mothers of 860 children born at term. Wheeze was classified as either transient or persistent/late using questionnaire data collated from 6, 12, 24 and 36 months and 6 years. At 6 years spirometry was performed and atopic status was determined by skin prick testing, exhaled nitric oxide was measured in 451 children and bronchial hyperresponsiveness in 216 children. <h3>Results</h3> There were no significant associations between maternal late-pregnancy 25-hydroxyvitamin D status and either asthma or wheeze at age 6 years. Maternal vitamin D status was not associated with transient or persistent/late wheeze; no significant association was found between persistent/late wheeze when subdivided according to atopic status. No associations were found with skin sensitisation or lung function. <h3>Conclusions</h3> This study provides no evidence that exposure to higher concentrations of 25-hydroxyvitamin D in maternal serum during late pregnancy increases the risk of childhood asthma, wheeze or atopy.