Reconstruction of large full-thickness medial lower eyelid margin defects often requires centrally based tarsoconjunctival pedicle flaps from the ipsilateral upper eyelid in combination with anterior lamellar grafting. However, centrally based flaps may result in temporary obstruction of the visual axis in the affected eye. The authors present a novel modified surgical technique using a medially based tarsoconjunctival pedicle flap from the upper eyelid for the reconstruction of large full-thickness medial lower eyelid defects. A tarsoconjunctival flap was mobilized and hinged medially by the conjunctiva from the upper eyelid with rotation into the lower eyelid defect. This surgical technique was used in 4 cases of medial lower eyelid defects involving 60% to 65% of the eyelid after basal cell carcinoma excision. Successful reconstruction of the defect was achieved in all 4 cases without graft failure, wound dehiscence, or lagophthalmos. Medially hinged tarsoconjunctival pedicle flaps are an effective technique for the reconstruction of large full-thickness medial lower eyelid defects. This procedure may be considered especially in patients with similar defects who cannot tolerate ocular occlusion.

Meibomian glands are responsible for the production and secretion of lipids into the precorneal tear film, which limits its evaporation. This study aimed to evaluate the percentage of Meibomian gland loss rate (MGLR) in the upper eyelid of cats of different ages assessed by infrared meibography. Additionally, possible correlations between MGLR and age, body weight and tear tests were assessed. Three groups were formed according to age: from 6 months to 2 years (Group A, n = 14), from 2 to 3 years (Group B, n = 15), and from 3 to 6 years (Group C, n = 13). Schirmer tear test (STT-1), tear film break-up time (TFBT) and MGLR were performed in 79 eyes of 42 cats (21 males and 21 females). STT-1 was higher in Group C, with statistical significance only when compared with Group B (p = 0.02). TFBT did not differ significantly among groups (p = 0.90). MGLR did not differ between males and females (p = 0.99). MGLR was 25.08% ± 4.16% in Group A, 28.27% ± 4.45% in Group B and 27.72% ± 3.80% in Group C (p = 0.10), and did not correlate with any of the evaluated parameters. This study demonstrated that MGLR is not influenced by sex and did not differ between young and adult cats. Additionally, this parameter did not correlate with age, body weight or tear parameters.

Lower eyelid blepharoplasty is one of the most demanding techniques of aesthetic and functional oculoplasty. The past two decades have witnessed a paradigm shift from resective procedures toward tissue-preserving, volume-maintaining approaches. The transconjunctival technique offers ascarless approach with very low rates of eyelid malposition, whereas the transcutaneous approach enables simultaneous correction of skin, muscle, and septal pathologies. Midface lifting remains an important adjunct in patients with malar descent, negative vector, or midfacial volume deficiency. This review discusses anatomy, indications, surgical techniques, postoperative care, complication management, and current trends.

Lateral hooding of the upper eyelid is a common yet frequently undertreated aspect of periorbital aging in East Asians. This study aimed to investigate the roles of the orbicularis oculi muscle (OOM), retro-orbicularis oculi fat (ROOF), orbicularis retaining ligament (ORL), and lateral orbital thickening (LOT) in the pathogenesis and to evaluate the novel OOM-ORL-ROOF composite suspension (ORRCS) technique. Anatomical analyses were conducted on 6 cadaveric heads and 18 plastinated specimens. Clinical outcomes of the ORRCS procedure were retrospectively reviewed in 85 East Asian patients with lateral dermatochalasis (LDC grade ≥1). Assessments included LDC grade, lateral canthal tilt, brow position, complications, and patient satisfaction preoperatively and at 6 and 12 months postoperatively. Anatomically, the age-related descent of the continuous OOM-ORL-ROOF composite is primarily due to the attenuation of its deep retaining structures, the ORL-LOT retaining complex. Clinically, ORRCS significantly improved the mean LDC grade from 2.24±0.77 to 0.40±0.49 (p<0.001) and increased lateral canthal tilt by ~5° (from 3.0° ± 1.13° to 8.0° ± 1.25°). Brow position remained stable ( p >0.05). Scars were inconspicuous, with no major complications and high patient satisfaction (4.7/5). Lateral hooding primarily results from the descent of the OOM-ORL-ROOF composite unit due to the attenuation of the deep ORL-LOT retaining complex. The ORRCS technique corrects this deformity by re-suspending the complex to the robust LOT, providing a promising anatomy-guided deep-plane approach with favorable early outcomes in this cohort while restoring a natural contour and preserving brow dynamics. 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 .

Idiopathic dacryoadenitis is a diagnosis of exclusion and may present with unilateral or bilateral eyelid swelling, erythema, pain, and characteristic S-shaped ptosis of the upper eyelid. Glucocorticoids remain the mainstay of treatment when symptoms are functionally limiting or clinically significant. Although local triamcinolone acetonide (TA) injection provides targeted anti-inflammatory effects with fewer systemic adverse effects, it carries a rare but potentially catastrophic risk of iatrogenic vascular embolization and acute vision loss. We searched the PubMed database for relevant reports and herein describe the case of a 36-year-old woman with idiopathic dacryoadenitis who developed acute vision loss during lacrimal gland TA injection. She received immediate comprehensive treatment, including high-dose intravenous corticosteroid pulse therapy, vasodilators, neuroprotective agents, intraocular pressure-lowering medications, ocular massage, and supplemental oxygen. Her best-corrected visual acuity gradually recovered to 1.0 (20/20) at follow-up. Previous reports have described isolated cases of ophthalmic artery branch embolism after lacrimal gland TA injection, with most patients experiencing poor visual outcomes. Here, we report a case of complete visual recovery after such an injection. We compare this case with prior reports and discuss the possible pathogenic mechanisms, the therapeutic rationale, mechanisms of recovery, study limitations, and directions for future research. Intraglandular triamcinolone administration for dacryoadenitis can cause severe vision loss. Although prompt multimodal management may restore vision, prognosis depends on treatment timing, embolic site, therapeutic choices, and individual patient factors. Reinforcing preventive precautions is essential to minimize this rare but potentially catastrophic risk. 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 .

Long-term and comfortable sleep monitoring is a core requirement for daily health management. However, existing sleep monitoring technologies fail to simultaneously achieve accurate sleep stage classification, wearing comfort, and direct monitoring of characteristic physiological signals. Here, we report a wearable sleep monitoring system (SMS) based on piezoelectric sensing and convolutional neural network (CNN) analysis. The system assesses sleep structure and quality by capturing characteristic eye movement signals and provides actionable recommendations for long-term sleep health management. The sensor employs a highly stereoregular polyacrylonitrile (PAN) composite fiber film modified with PDA@ZnO as the sensing unit, providing high sensitivity, excellent wearing comfort, and long-term durability. It conforms closely to the upper eyelid, enabling effective acquisition of direct physiological signals associated with sleep. Furthermore, we developed a CNN model for five-state sleep classification and validated it using original-recording-level 5-fold validation and a 1000-sample processed held-out test set, achieving an accuracy of 95.90% with a Cohen's Kappa coefficient of 0.949. The system efficiently presents sleep quality information through a simple and user-friendly human-computer interaction interface. The proposed system introduces a novel approach to convenient health monitoring and provides a feasible technical solution for accurate and long-term sleep health assessment in daily life.

Scrub typhus is a mite-borne zoonosis endemic to the Asia-Pacific region. Although ocular complications are occasionally reported during later stages of infection, direct mechanical ocular injury related to mite exposure has rarely been reported. Recognition of early ocular manifestations may facilitate timely diagnosis and treatment of this potentially serious infection. We describe a rare case of a 9-year-old Taiwanese boy who developed acute ocular and systemic symptoms after exposure to mites during a visit to Alishan Forest, Taiwan. Live mites were identified attached to the lower eyelid margins and ocular surface. The left eye showed multiple linear corneal epithelial abrasions with stromal edema, causing severe photophobia, tearing, and reduced visual acuity. The following day, the patient developed fever, headache, myalgia, and a necrotic eschar at the bite site, clinically suggestive of scrub typhus. The diagnosis was primarily based on clinical presentation and endemic exposure history because confirmatory serologic or PCR testing was not performed. Early administration of topical antibiotics, corticosteroids, and systemic doxycycline led to complete resolution of both ocular and systemic symptoms within 10days without residual deficits. To our knowledge, few reports have described concurrent corneal injury and clinically suspected scrub typhus following direct mite exposure at the initial stage of contact. This case highlights the importance of considering mite-related ocular injury and scrub typhus in the differential diagnosis of acute ocular trauma and febrile illness following outdoor activities in endemic areas. Early recognition and prompt initiation of appropriate therapy may help prevent complications and improve clinical outcomes.

To characterize age-related variations in symptomatic meibomian gland dysfunction (MGD) clinical manifestations. This cross-sectional, hospital-based study included 100 symptomatic Asian MGD individuals (age 20-89 years). Clinical assessments included the Standard Patient Evaluation of Eye Dryness questionnaire, fluorescein tear film break-up time, corneal staining, Schirmer I test without anesthesia, lid margin examination, meibum expressibility, and quality. Interferometry was used to measure lipid layer thickness (LLT), capture blinking patterns, and obtain meibography images, which were analyzed using ImageJ software. Age was analyzed as a continuous variable using linear regression and decade-based comparisons. In symptomatic MGD, younger individuals correlated with more incomplete blinking, reduced LLT, and greater gland distortion (all P < 0.05). Increasing age was positively associated with LLT, meibomian gland (MG) plugging, anterior displacement of the mucocutaneous junction, telangiectasia, MG dropout area, and gland shortening and dropout (all P < 0.05). Multivariate analysis confirmed younger age and absence of MG plugging as independent predictors of reduced LLT. Decade-based analysis confirmed a significant monotonic increase in LLT with advancing age (Jonckheere-Terpstra P < 0.001). Symptomatic MGD presentations differ with age. Younger patients exhibit incomplete blinking and gland tortuosity with reduced LLT; older patients show lid margin changes with MG dropout and shortening. The paradoxical increase in LLT with age reflects obstructive and compensatory mechanisms rather than improved tear film function, underscoring the need for a multidimensional diagnostic approach incorporating age, MG morphology, and clinical context.

Standardized Reattachment of the Lateral Canthal Tendon in the Swinging Lower Eyelid Approach: A Step-by-Step Technique.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune disorders that cause inflammation and necrosis of small- to medium-sized blood vessels. It most commonly affects the kidneys and lungs, leading to complications such as rapidly progressive glomerulonephritis and pulmonary hemorrhage. (1) Ocular involvement occurs in up to 50% of patients with AAV, most commonly presenting as scleritis, episcleritis, or orbital inflammatory disease (also known as orbital pseudotumor). Other ocular findings may include keratitis, uveitis, or retinal vasculitis. (2)(3) Eyelid necrosis with destructive orbital inflammation, however, is extremely rare and poses a significant diagnostic challenge because its presentation can mimic infections, malignancies, or other inflammatory orbital conditions. Prompt recognition is critical to prevent irreversible tissue damage and vision loss. (4) We report the case of a 74-year-old Hispanic woman with multiple vascular risk factors who presented with recurrent pustules of the right upper eyelid that progressed to full-thickness eyelid necrosis, medial orbital mass effect, and corneal compromise. Initial management was directed toward presumed orbital cellulitis; however, orbital imaging revealed a destructive extraconal mass with mass effect and associated venous stasis. Sequential biopsies demonstrated extensive necrosis with histiocytoid granulomatous inflammation and focal features of chronic vasculitis. Negative stains and cultures excluded infectious and neoplastic causes. After thorough evaluation and exclusion of alternative etiologies, the findings were most consistent with ANCA-negative ANCA-associated vasculitis (AAV). The patient was treated with high-dose intravenous corticosteroids and rituximab induction, resulting in stabilization of orbital disease and preservation of vision. This case highlights the potential for destructive orbital vasculitis to masquerade as infection or malignancy and underscores the importance of considering AAV in atypical orbital presentations. Prompt recognition and initiation of immunosuppressive therapy are critical to prevent irreversible morbidity.

Repair of a Large Multi-subunit Lower Eyelid and Cheek Defect.

The Dendropsophus ruschii species group currently comprises two species with disjunct distributions between the Atlantic Forest and the Amazon. Based on an integrative approach combining morphological, acoustic, and molecular data (mtDNA barcoding), we describe a new species from the Serra da Mantiqueira, Minas Gerais, Brazil. Dendropsophus liliae sp. nov. is diagnosed by its small size, rounded digital discs, presence of a calcar appendage, dark red iris, and a distinct white stripe from the snout to the upper eyelid. This discovery expands the known diversity of the group and represents its most inland record within the Atlantic Forest.

Blepharoptosis, or drooping of the upper eyelid, is commonly encountered by dermatologic surgeons due to aging, medical conditions, periocular procedures, and/or inadvertent neurotoxin administration. Proper recognition and management are critical for both functional and cosmetic outcomes. To review clinically relevant anatomy, diagnostic evaluation, and nonsurgical treatments for acquired ptosis, emphasizing considerations specific to dermatologic practice. A literature review of PubMed and Embase identified English-language studies and clinical trials addressing the diagnosis and management of blepharoptosis, with emphasis on nonsurgical and dermatologic applications. Key diagnostic tools include the marginal reflex distance 1, levator function testing, and standardized preprocedure and postprocedure photography. Oxymetazoline 0.1% demonstrates modest but statistically significant improvement in marginal reflex distance 1 and superior visual field improvement in randomized trials. Off-label adrenergic agents and targeted pretarsal botulinum toxin injections may offer adjunctive benefits, although supporting evidence is limited. Dermatologic surgeons are positioned to identify and manage mild acquired ptosis using validated metrics and nonsurgical options. Selective botulinum toxin placement can be considered in selected cases; supporting evidence remains limited. Appropriately identifying cases that need referral for surgical repair will also benefit patient care by improving vision, daily function, and cosmesis.

Superior orbital sulcus hollowness is a common aesthetic concern that may result from structural changes, trauma, or excessive fat removal during upper blepharoplasty, and it can be further exacerbated by age-related orbital remodeling. Traditional corrective approaches such as fat redistribution and autologous fat grafting carry limitations, including graft atrophy and the risk of embolic complications. This study evaluated the safety and outcomes of superior orbital sulcus correction using a medial-pedicled preseptal orbicularis oculi muscle flap. This retrospective study analyzed 481 patients who underwent upper blepharoplasty between January 2017 and June 2024, of whom 45 received additional correction of superior orbital sulcus hollowness with a medial-pedicled preseptal orbicularis oculi muscle flap. Exclusion criteria included male sex, previous upper eyelid surgery, levator dehiscence, less than six months of follow-up, and refusal to complete the FACE-Q Adverse Effects questionnaire. The mean follow-up duration was 8 months, and the mean patient age was 51.4 years. Postoperative complications and patient-reported outcomes were evaluated and compared with those of patients undergoing conventional upper blepharoplasty. Early postoperative complications, including transient lagophthalmos and edema, were self-limiting. In the conventional blepharoplasty group, 16 patients developed medial canthal scarring, with four requiring revision. In the flap group, transient supraorbital hypoesthesia occurred in 71% of patients and resolved within a few months, and no cases of flap necrosis were observed. Statistical analysis using the Mann-Whitney U test demonstrated no significant difference in FACE-Q scores between the two groups (U = 8828.0, p = 0.251). The medial-pedicled preseptal orbicularis oculi muscle flap appears to be a safe, reproducible, and anatomically sound technique for selected patients with superior orbital sulcus hollowness. Although the relatively uniform flap volume may not fully correct the deformity in all cases and patient numbers were limited, this method provides a promising alternative to fat grafting without adding long-term complications, with the potential to enhance aesthetic outcomes and patient satisfaction. Level of Evidence IV 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 .

This study aimed to perform a retrospective analysis of clinical data from 94 patients with sunken upper eyelid, investigating the etiologies, types, and surgical approaches for this condition, so as to provide a theoretical basis for the clinical prevention and treatment of sunken upper eyelid. Clinical data of 94 patients who underwent sunken upper eyelid correction in our hospital from June 2024 to May 2025 were retrospectively summarized and analyzed. The collected data included general patient information (age and gender), history of previous upper eyelid surgery, presence of comorbidities (e.g., multiple eyelids, wide double eyelids, and blepharoptosis), as well as the surgical method employed, surgical outcomes, and occurrence of surgical complications. All patients were followed up for 6-9 months postoperatively. Patient satisfaction was evaluated based on indicators such as bilateral upper eyelid morphology, fullness, and symmetry. Among the 94 included patients with sunken upper eyelid, there were 84 females and 10 males, with a mean age of 34 years. According to the presence of a previous upper eyelid surgery history, the patients were categorized into two groups: 16 cases (17.0%) of primary sunken upper eyelid (without a history of upper eyelid surgery) and 78 cases (83.0%) of secondary sunken upper eyelid (with a history of upper eyelid surgery). Analysis of surgical records showed that 12 patients underwent autologous granular fat injection transplantation, while 82 patients received open surgical correction for sunken upper eyelid. The causes of sunken upper eyelid in this study mainly included two types: absolute deficiency of orbital septal fat content (58 cases, 70.7%) and relative deficiency of orbital septal fat content (24 cases, 29.3%). The mean preoperative depth of sunken upper eyelid was 8.2mm, and this value significantly decreased to 2.7mm at the last postoperative follow-up (p < 0.05). The mean Global Aesthetic Improvement Scale score at the last follow-up was 2.34. Clinically, sunken upper eyelid is mostly caused by excessive removal of orbital septal fat during previous upper blepharoplasty. A comprehensive repair strategy is recommended, which prioritizes the restoration of orbital septal fat volume via orbital septal fat release or transposition and flake fat grafting, supplemented by autologous granular fat injection transplantation. For patients with comorbidities such as multiple eyelids, wide double eyelids, or blepharoptosis, simultaneous correction of these comorbidities while addressing the sunken upper eyelid is advisable to achieve optimal clinical outcomes. 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 .

Background:Full-thickness eyelid margin defects resulting from tumor resection present a significant reconstructive challenge, necessitating techniques that balance functional restoration with aesthetic outcomes. This study evaluates the efficacy of the eyelid composite tissue flap advancement technique in addressing these challenges.Methods:In this retrospective case series, 85 patients with eyelid margin tumors underwent reconstruction using the described technique. Following tumor excision, which was tailored based on the pathological diagnosis (75 pigmented nevi, 8 basal cell carcinomas, 2 squamous cell carcinomas), bilateral full-thickness eyelid flaps were created parallel to the defect. Key surgical steps included the precise incorporation of the marginal arterial arcade to ensure vascularity and layered anatomical closure. The primary outcomes assessed were flap survival, eyelid function, aesthetic results, and patient satisfaction.Results:All 85 flaps survived completely, with primary healing achieved in all cases. The functional integrity of the repaired eyelids was maintained, and the aesthetic appearance was rated as natural or satisfactory. No major complications, such as significant notching, ectropion, or lagophthalmos, were observed during the follow-up period.Conclusions:The eyelid composite tissue flap advancement technique is a reliable and effective single-stage procedure for reconstructing full-thickness defects involving up to two-thirds of the eyelid length. Its robust blood supply and ability to restore the natural anatomical layers make it an ideal choice for this indication, yielding high survival rates and satisfactory functional and cosmetic outcomes.

Clinicopathological analysis of actinic keratosis affecting the eyelid.

Revisional upper eyelid blepharoplasty is often associated with scar-related hyperalgesia and poor tolerance to local anesthesia, which may compromise intraoperative stability and patient experience. This study evaluated whether a multimodal intravenous conscious analgesia protocol based on oliceridine and alfentanil combined with local anesthesia improves perioperative comfort compared with local anesthesia alone. In this prospective randomized clinical trial conducted between January 2023 and January 2025, 132 patients undergoing revisional upper blepharoplasty were assigned to receive either multimodal conscious analgesia (oliceridine plus low-dose alfentanil with local anesthesia, n=72) or local anesthesia alone (n=60). Primary outcomes included intraoperative pain scores and reflex tearing. Secondary outcomes included operative stability, postoperative tissue reactions, patient-reported outcomes, and safety. Patients receiving combined anesthesia reported significantly lower pain scores at all perioperative time points (P < 0.05) and a markedly reduced incidence of reflex tearing compared with controls (6.9% vs 75.0%, P < 0.001). Excessive body movements were also less frequent (14.6% vs 80.0%, P < 0.001). Postoperatively, periorbital swelling and ecchymosis were significantly improved at day 7 (P < 0.05), and FACE-Q intraoperative comfort scores at 3 months were higher in the combined group (88.6 ± 6.2 vs 76.4 ± 9.7, P < 0.001). No severe adverse events occurred in either group. Multimodal opioid-based conscious analgesia combined with local anesthesia provides improved intraoperative comfort and early recovery in revisional blepharoplasty while preserving patient cooperation. Further studies are required to delineate the independent contribution of individual agents and to compare this strategy with established sedation protocols. 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 .

Pleomorphic adenoma of the lacrimal gland is a benign epithelial neoplasm and can rarely undergo cystic degeneration, mimicking other conditions with similar radiological findings. It commonly presents as a slow growing, painless mass in the outer upper eyelid, characterised by exophthalmos, ptosis, diplopia and reduced ocular movements. Here, we present one such case of a male in his mid-30s presenting with a painless, progressive fullness in the left upper eyelid with mild proptosis and restricted ocular movements which was initially suspected to be due to an underlying dermoid cyst owing to the cystic nature of the lesion on imaging. Surgical intervention involving complete excision was preferred, rendering no recurrence on follow-up. Histopathological examination however revealed microscopic features suggestive of a pleomorphic adenoma with cystic changes contrary to the initial diagnosis of a dermoid cyst. This case highlights the challenges faced in arriving at the right diagnosis with successful treatment outcomes.

Cost Analysis of Outpatient Ophthalmic Procedures.