Horizontal Eyelid Research Articles

Anterior Lamellar Recession versus Posterior Lamellar Tarsal Rotation for Lower Lid Trachomatous Trichiasis: A Randomized Controlled Trial.

PurposeTo compare the outcomes of anterior lamellar recession (ALR) versus posterior lamellar tarsal rotation (PLTR) procedure for the repair of lower eyelid trachomatous trichiasis (TT).DesignProspective randomized comparative trial.MethodsStudy Population and Interventions: Patients with lower eyelid TT were enrolled. Patients with a history of lower lid surgery, marked horizontal lid laxity, another evident cause for the trichiasis, and those under 18 years were excluded. Participants were randomized to either PLTR or ALR. The sequence was computer-generated by an independent statistician, and the allocation sequence was concealed in sealed opaque envelops. Patients were evaluated at 1 week and 1, 3, 6, and 12 months. Main Outcome Measures: postoperative trachomatous trichiasis (PTT) and cosmetic satisfaction.ResultsA total of 60 patients were randomly assigned with 30 patients in each group. Two (3.3%) participants in PLTR group did not follow up and were excluded from the analysis. At 1, 3, and 6 months, PTT was significantly more frequent in the PLTR group than the ALR group (14.3% vs 0%; p= 0.048, 25% vs 0%; p= 0.004, 35.7% vs 10%; p= 0.019, respectively). In the ALR group, 6 patients (20%) had PTT at their 12-month follow-up visit compared with 15 patients (53.6%) in the PLTR group (P = 0.008) with absolute risk reduction of 33.6% (95% (CI= 9% −58%)). Cosmetic dissatisfaction was significantly more frequent in the ALR group at the initial follow-up visits compared to the PLTR group. However, this difference was no longer significant at 6 and 12 months follow-up.ConclusionThese data provide strong evidence that ALR is more effective in correction of lower eyelid trachomatous trichiasis with acceptable cosmesis compared with PLTR.

Modified everting sutures combined with reattachment to the inferior tarsal plate for involutional lower eyelid entropion: A new technique.

BackgroundThis study evaluated the outcomes of a new modified Wies technique for patients with involutional lower eyelid entropion without horizontal eyelid laxity.MethodsThis case series retrospectively analyzed consecutive patients with entropion who underwent surgery between January 2014 and March 2019 by the same experienced surgeon. Horizontal eyelid laxity, lower eyelid retractor function, and orbicularis muscle overriding were recorded before and after surgery. The recurrence rate and complications were also evaluated. This technique consisted of modified everting sutures combined with reattachment of the lower eyelid retractors to the inferior tarsal plate.ResultsThis new technique was performed on 28 eyes in 25 patients (mean age, 71.0±8.0 years; range, 56–87 years). Nine patients (36%) were women and 16 (64%) were men. Lower lid entropion was present in the right eye in 14 patients (56%), the left eye in eight patients (32%), and both eyes in three patients (12%). The mean follow-up period was 27.3±12.4 months (range, 6–60 months). No intraoperative complications were observed. All patients’ symptoms were alleviated. One patient (3.6%) had recurrence after 2 years (success rate, 96.4%). The remaining 27 eyes maintained a satisfactory and comfortable eyelid position. No patients had problems with scarring.ConclusionsThe approach described herein proved to be safe and feasible in eyes with involutional lower eyelid entropion without horizontal eyelid laxity. These advantages of this procedure include the lack of a conjunctival scar, punctal eversion, and lateral canthal angle deformation. A low recurrence rate and a long interval to recurrence were also observed.

A Modified Hughes Flap for Correction of Refractory Cicatricial Lower Lid Retraction With Concomitant Ectropion.

Correction of lower eyelid retraction commonly involves one or more techniques, including recession of the eyelid retractors, spacer grafts, horizontal lid tightening, and midface lifting. However, patients presenting with cicatricial lower lid retraction following prior eyelid surgery often have scarring and concomitant ectropion or entropion that cause unpredictable wound healing, recicatrization, and suboptimal outcomes. The modified Hughes tarsoconjunctival flap is typically used to repair full-thickness eyelid defects. Prior reports describe treating refractory lower lid retraction with a modified Hughes flap placed beneath the tarsus after full-thickness blepharotomy. We present our experience with a novel surgical technique for treating refractory cicatricial lower lid retraction using a modified Hughes flap above the tarsus after excision of the scarred lid margin. Three patients were treated using this technique. The upper edge of the lower eyelid and associated scar tissue are excised. A modified Hughes flap is mobilized and secured above the posterior lamellar remnant. A full-thickness skin graft is placed over the flap. The flap is divided 4-5 weeks later. This surgical technique was employed in all 3 cases. All cases were revisional, with 2 having extensive multioperative histories with multiple unsuccessful reconstructions and lid retraction repairs. All patients had improvement in cicatricial eyelid retraction, lagophthalmos, exposure keratopathy, and resolution of concomitant cicatricial ectropion. The technique of using a modified Hughes flap to reconstruct above the tarsus with excision of the scarred lid margin was effective in correcting refractory cicatricial lower lid retraction. This procedure can be considered in multioperative cases in which traditional techniques for lower lid retraction repair have failed. Reconstructing a new lid margin reduces the risk of recicatrization and suboptimal results.

The KS-Pexy: A Novel Method to Manage Horizontal Lower Eyelid Laxity.

Patients with horizontal lower lid laxity undergoing lower lid blepharoplasty are at a high risk for lid malposition. Prophylactic correction of horizontal lower lid laxity during blepharoplasty may alleviate this risk. In this article, the authors describe a novel lower lid blepharoplasty technique, the KS-pexy (named after its originators, Kuhnt and Szymanowski), for correcting horizontal lower lid laxity. All cases of KS-pexy between September of 2009 and June of 2018 from an aesthetic practice were reviewed retrospectively. All patients were diagnosed with horizontal lower lid laxity and requested lower lid blepharoplasty for aesthetic concerns. Patient demographics, clinical presentation, procedure details, and intraoperative findings were analyzed. Sixty-two patients underwent KS-pexy performed by the senior author. The average follow-up was 41.1 months, ranging from 2 to 107 months. Thirteen patients had a negative vector, 54 patients received a KS-pexy in combination with another facial procedure, and 14 patients had their KS-pexy as a secondary procedure. The overall success rate was 96.8 percent. The complication profile was as follows: chemosis (27.4 percent), new-onset dry eyes persisting longer than 8 weeks (6.5 percent), temporary lower eyelid malposition (4.8 percent), lower eyelid malposition requiring surgical intervention (3.2 percent), poor scar quality (1.6 percent), lower lid abscess (1.6 percent), transient conjunctivitis (1.6 percent), lateral fat compartment swelling (1.6 percent), canthopexy dehiscence (1.6 percent), hordeolum (1.6 percent), and temporary V2 paresthesia (1.6 percent). The KS-pexy is an effective means to treat horizontal eyelid laxity prophylactically in patients requesting lower eyelid blepharoplasty for aesthetic reasons. Therapeutic, IV.

Floppy eyelid syndrome: ocular and systemic associations.

To summarize the ocular and systemic associations of floppy eyelid syndrome (FES) as well as provide an up-to-date review on the pathogenesis and treatment strategies. Virtually all patients with FES have obstructive sleep apnea (OSA). However, a significantly lower proportion of patients with OSA have FES. Although some studies demonstrate no association between OSA and FES, almost all show at least an association with increased eyelid laxity, which may be a less severe form of FES. FES has also been associated with keratoconus (KCN) and glaucoma. Decreased corneal hysteresis has been found in FES, KCN, glaucoma, and OSA and may be related to matrix metalloproteinase (MMP) upregulation. Hypoxia-reperfusion injury, leptin resistance, and mechanical forces all may lead to increased MMP activity, contributing to elastin breakdown in the tarsus and other tissues throughout the body. Management of FES begins with investigation for OSA. Treating OSA with continuous positive airway pressure (CPAP) or surgical uvulopalatoplasty may improve FES. Surgical treatments for FES should reduce horizontal eyelid laxity while maximizing the stability of the tarsus. Collagen crosslinking may prove a helpful modality for stabilizing the tarsus in the future. FES is associated with OSA, glaucoma, and KCN. MMP upregulation and lower corneal hysteresis have been found in these conditions, pointing toward a potential common pathogenesis.

Eyelid Spontaneous Blink Analysis and Age-Related Changes Through High-Speed Imaging.

To analyze the spontaneous eyelid blink and sphincter closure activity of the orbicularis oculi by measuring the horizontal eyelid movement. Individuals 18+ years of age, any ethnicity, and gender were recruited. Participants completed a questionnaire to determine eligibility. Exclusion criteria included the following: history of facial trauma, nerve palsy, surgery, use of periorbital neuromodulators or filler within the past year, thyroid eye disease, and eyelid or ocular surface disease. Data were collected from participants by decade. Eyelid blinks were recorded using the FPS 1000HD. The motions of 3 spontaneous blinks in primary gaze were recorded. All blinks were reviewed and one chosen for most accurate analysis. Horizontal palpebral fissure width and its changes of open and closed eye measurements were taken using National Institute of Health ImageJ software version 2.0. The data were subjected to SAS version 9.4 analysis using paired t test, t test, and linear models. One hundred thirty-six patients were recruited. Fourteen patients were excluded; 122 patients were used in analysis. Ages ranged from 22 to 90 years. Participants were divided into 6 groups according to age (20-29, 30-39, 40-49, 50-59, 60-69, and 70+ years of age). The average horizontal fissure length across all ages was 24.23 mm. Average change in horizontal fissure length decreased 1.42 mm among all ages. There was a statistically significant difference comparing age 20-29 decade to age 70+ decade. Horizontal fissure length changes with eyelid blink and defines 1 component of the eyelid sphincter.

A conjunctival-sparing surgical technique for lower eyelid cicatricial entropion repair in ocular cicatricial pemphigoid

ABSTRACTPurpose: To present five cases of lower eyelid cicatricial entropion secondary to ocular cicatricial pemphigoid (OCP) successfully repaired with a conjunctival-sparing surgical technique.Methods: The records of one surgeon (SKF) were reviewed to identify patients with lower eyelid cicatricial entropion secondary to OCP who underwent repair with a conjunctival-sparing technique between September 1, 2016 and October 18, 2017. The medical records were reviewed and extracted data included: age, gender, past medical history, current medical and OCP status, clinical examination, details of entropion repair surgery, and outcome.Results: Five patients (three female, two male) were included with ages ranging from 44 to 93 years. All had biopsy proven OCP, which was in remission at the time of surgery, and all were currently receiving immunomodulatory medications. All patients were symptomatic from cicatricial entropion secondary to OCP and underwent successful lower eyelid entropion repair with a conjunctival-sparing technique described herein, involving infraciliary rotation with suture fixation of the orbicularis muscle to the tarsus. Other contributing mechanisms of eyelid malposition including horizontal eyelid laxity and orbicularis oculi override were addressed simultaneously with lateral tarsal plication or orbicularis muscle debulking, resulting in 100% anatomic success and relief of symptoms with no cases of OCP reactivation, and with good durability with an average 13.9 months follow up (range 6.5–22 months).Conclusions: Successful repair of lower eyelid cicatricial entropion in immunomodulated patients with OCP can be achieved without disease reactivation using a surgical technique that spares the conjunctiva and lower eyelid retractors.

Cicatricial ectropion surgery: a prospective study of long‐term symptom control, patient satisfaction and anatomical success

Cicatricial ectropion repair is effective and has a low complication rate. To evaluate the effectiveness and long-term functional outcomes of surgical repair of lower lid cicatricial ectropion. Prospective consecutive case series. Forty-four consecutive operations for cicatricial ectropion repair. Consecutive cases of cicatricial ectropion repair completed during 2007-2011 in Waikato Hospital and Hamilton Eye Clinic, New Zealand, were enrolled in the study following formal ethics approval. Ectropion repair was completed using inferior retractor repositioning, horizontal lid tightening and full-thickness skin grafting. Patient-reported symptoms and satisfaction, ectropion recurrence and punctal ectropion. Forty-four eyes of 40 patients (30 males and 10 female) were included in the study. The average age at surgery was 75 years. Watering and poor appearance were the most common presenting symptoms. Postoperative follow-up was 1-6 years (mean = 4 years). There were no major perioperative complications, one patient developed trichiasis postoperatively. There were five reoperations (11%) during the study period. Two patients underwent medial spindle procedures for symptomatic medial ectropion and three patients required additional horizontal lid tightening. Seventy percent of patients reported satisfaction with their long-term results despite the partial recurrence of symptoms in 45%. Ectropion recurrence in <1 year occurred in three patients. In this series, satisfactory appearance and symptom control were reported by 68% of patients at long-term follow-up. Preoperative marked ectropion with marked lid laxity is associated with early treatment failure and may be regarded as a relative contraindication to surgical correction with this technique. Punctal ectropion is an unreliable indicator of functional success.

Outcomes after surgical resection of lower eyelid tumors and reconstruction using a nasal chondromucosal graft and an upper eyelid myocutaneous flap

Surgical excision of large malignant lower eyelid tumors may cause important full-thickness eyelid defects. The reconstruction of such defects must restore the physiologic function of the eyelid and also re-establish an acceptable aesthetic result. We report the outcomes of full-thickness excision of tumors extending over half of the horizontal lid length, followed by reconstruction using a nasal chondromucosal graft (coming from the ipsilateral ala of the nose) and an upper eyelid myocutaneous flap. Histological analysis of the specimen identified the tumor type and surgical margins for each patient. A total of 25 patients were operated using this reconstruction technique between March 2009 and June 2015: 17 basal cell carcinomas, 3 spindle cell carcinomas and 5 conjunctival melanomas (out of which 2 were associated with lentigo maligna). Mean duration of follow-up after surgery was respectively 36, 41 and 17 months for each of these 3 tumor types. We found a single local tumor recurrence and this was a basal cell carcinoma in a xeroderma pigmentosum patient. After surgery, none of the patients had lagophthalmos or ocular surface complications. Only 4 patients had a 1mm scleral show postoperatively; 3 other patients developed a small retraction of the eyelid after adjuvant radiotherapy and a 1mm scleral show occurred. In malignant tumors, complete surgical excision with histological margins adapted to tumor type prevents local recurrence in most cases. Our repair strategy of nasal chondromucosal graft and skin-muscle flap for large inferior eyelid defects provides good functional and aesthetic results.

Effectiveness of modified transsection and longitudinal suture in epicanthoplasty

To introduce a modified transsection and longitudinal suture in epicanthoplasty and summarize its effectiveness. The clinical data of 119 patients underwent epicanthoplasty with modified transsection and longitudinal suture and with a follow-up time over 6 months between February 2014 and December 2016 were retrospectively analyzed. There were 8 males and 111 females with an average age of 22.7 years (range, 18-38 years). The epicanthus was as eyebrow type in 12 cases, as eyelid type in 57 cases, as tarsalis type in 39 cases, and as backward type in 11 cases. The narrow degree of epicanthus included mild (the lacrimal caruncle covered size was less than 1/3) in 42 cases, moderate (the lacrimal caruncle covered size was between 1/3 and 2/3) in 58 cases, and severe (the lacrimal caruncle covered size was over 2/3) in 19 cases. One hundred and thirteen patients were treated by blepharoplasty at the same time. The new canthus was located on the basis of the inner canthus physiological aesthetics. Through a short transverse incision, dislocated orbicularis oculi muscle near medial canthal ligament and the fiber between the medial canthal ligament and skin were completely released; then the medial canthal ligament was shortened precisely and the incision was tension-free sutured followed the Langer's line near eyes. All the incisions healed by first intention. All patients were followed up 6 months to 2 years (mean, 8.6 months). The bilateral hypertrophic scar on both bilateral medial canthal incisions happened in 3 patients at 3-6 months after operation; and the scarring gradually subsided at 10 months after the diprospan injections and the siliconegel and carbon dioxide laser treatment. Good effectiveness were obtained in the other patients, whose inner intercanthal distance significantly narrowed, both of the horizontal lid fissure length increased, the lacrimal caruncle fully exposed, and no obvious scar could be seen. The modified transsection and longitudinal suture in epicanthoplasty has the advantages of simple design, easy operation, minimally invasive, inconspicuous scar, and obvious, stable, and lasting postoperative effectiveness.

Complicated lower lid ectropions presenting to tertiary care hospital in Sub-Himalayan Region of Himachal Pradesh and their management

Introduction: Ectropions of the lower lid area are of diverse etiology. They may be involutional, mechanical, paralytic, or cicatricial. The patients have lot of discomfort due to exposure and epiphora. Some of them also develop complications like infectious keratitis that are vision threatening as well. Cicatricial ectropions, severe ectropions with tissue laxity are sometimes difficult to manage. In this study, we intend to describe techniques we have used for the management of selected complicated cases of Ectropions. Aim and Objectives: The aim of the study is to describe the complicated cases of ectropions presenting to a tertiary care hospital in Sub-Himalayan region of Himachal Pradesh, India, and the various techniques used in their management. Materials and Methods: Cases of complicated ectropions fulfilling the inclusion and exclusion criterion which presented to the department of ophthalmology were included in the study. The patients were subjected to detailed history and clinical examination according to a predesigned pro forma. They were divided into four subtypes and managed surgically. Results: Horizontal lid shortening with or without blepharoplasty was performed in the cases of involutional ectropions and showed good outcome in all cases. There was no significant lid notching postoperatively. The cicatricial ectropion cases were managed surgically using Z plasty in all but one case of generalized cicatricial ectropion where skin grafting using postauricular graft was used. Postoperatively, the patients improved symptomatically, and cosmetic outcome was also acceptable. Conclusions: Horizontal shortening with or without blepharoplasty if performed meticulously is a good procedure providing excellent results; however, the site for pentagon excision and the amount of resection required needs to be decided, along with any medial or lateral canthal tendon stabilization. Cicatricial ectropions unless are generalized or very severe managed well with Z plasty, however, it is very important to understand the dynamics of the scar before deciding the site and dimensions of the Z plasty. Full-thickness skin graft is sometimes the only option for generalized cicatricial ectropions.

Entropion and ectropion repair: a snapshot of surgical practice in the United Kingdom

ABSTRACTWe aim to provide a snapshot of the current surgical practice for correction of entropion and ectropion, the two most common oculoplastic procedures carried out in the UK, by surveying 135 consultant oculoplastic surgeons via the tool Survey Monkey. Forty-seven (35%) consultants responded. For entropion, 44% of surgeons opted for lateral tarsal strip (LTS) + everting sutures (ES). Other first-line choices included LTS + transcutaneous retractor plication (21%), Quickert’s procedure (14%), ES (7%), and Wies procedure (5%). Important patient-related factors to consider were horizontal lid laxity and retractor dehiscence.Regarding ectropion, LTS was most commonly practiced (35%), followed by LTS + transconjunctival retractor plication (28%), wedge excision (16%), and lateral canthoplasty (5%). The patient-related factors guiding choice were horizontal lid laxity, lateral canthal tendon laxity, and punctal position under traction. Responses found a wide range of preferred surgical techniques in practice. The factors guiding surgical choice were personal audit results (92% stated important/very important), familiarity with the technique (92%), and the technique being favoured by previous trainers (76%), suggesting current practice led by expert opinion, possibly due to a lack of evidence-based literature. This highlights the variety of core oculoplastic surgical techniques practiced and underlines the need for robust trials to guide surgical choice.

Comparison of Polypropylene Sling with Combined Transconjunctival Retractor Plication and Lateral Tarsal Strip for Correction of Involutional Lower Eye Lid Ectropion

Purpose:The study aims to compare the effectiveness and complications of transconjunctival retractor plication (TRP) with lateral tarsal strip (LTS) and the polypropylene sling (PS) surgery for treatment of involutional lower lid ectropion.Method:A prospective randomised pilot study was conducted on 30 eyes of 30 patients suffering from epiphora having horizontal eyelid laxity >6mm and age >50 years at a tertiary care centre from December 2014 to March 2015. They were randomly divided into two equal groups for TRP with LTS (group A) and PS (group B). Success was defined as relief in epiphora and lid laxity ≤4mm at 12 months post operatively.Result:There were 19 male and 11 female patients with age ranging from 55-80 years. The mean grade of ectropion was 2.80±1.32 in group A and 2.87±1.60 in group B. The preoperative horizontal laxity increased with the grade of ectropion (p <0.001) while medial canthal laxity was variable. The average surgical time per procedure in group A was 66 minutes and in group B was 24 minutes. Group A had a success rate of 93.33%, while group B had a success rate of 87%. Post-operative complications occurred in 2 eyes in group B only.Conclusion:Both LTS with TRP and PS are effective in the management of involutional ectropion. LTS with TRP though more invasive has higher success rates and a lower incidence of complications as compared to PS. However, PS is an easy to perform out- patient procedure that is faster and better tolerated in old patients.

Punctal Ectropion repair using the Raus–Garito clamp

ABSTRACTPurpose: To evaluate the results from the correction of ectropion of the punctum lacrimale in lower eyelids with a new surgical clamp.Design: Prospective study.Methods: Eighty eight eyelids in 55 patients with mild and moderate ectropion were included in the study. An excision of a diamond of tarso-conjunctiva with retractor reattachment and concomitant correction of horizontal lid laxity, if present, was performed.Results: Resolution of tearing was obtained in 77 eyes. In 11 eyes, persistent tearing was reported.Conclusion: Conclusion:Conclusion: Repair of early to intermediate ectropion of the lacrimal punctum using the Raus–Garito clamp is associated with a good functional and cosmetic outcome.

Surgical Microanatomy of Lower Eyelid Tarsal Ectropion Repair With a Putterman Ptosis Clamp.

To examine the changes in microscopic anatomy of the lower eyelid tarsal ectropion repair with the Putterman ptosis clamp and better understand the anatomical changes associated with the eyelid malposition correction. Ten orbits from 5 fresh frozen cadaver heads, ranging in age from 53 to 77 years, were used for the dissection. For each head, a Putterman clamp tarsal ectropion repair was performed on one side, while the contralateral unoperated orbit served as a control. After performing the procedure, both orbits were exenterated and they, along with the resected specimens, were studied microscopically using Verhoeff-Masson trichrome and hematoxylin-eosin stains. Conjunctiva, capsulopalpebral fascia, and smooth muscle were present on all tissue specimens incarcerated within the ptosis clamp. Tarsus was present in one specimen. There was a shortening of the posterior lamella of the eyelid with advancement of the capsulopalpebral fascia on all operated specimens when compared with controls. The Putterman clamp ectropion repair works by shortening the posterior lamella of the eyelid and advancing the lower eyelid retractors superiorly. This advancement tightens the lower eyelid retractors and thus stabilizes the eyelid in a more vertical position. In addition to a lateral tendon tuck as described in the original article to tighten horizontal eyelid laxity, this procedure addresses both vertical and horizontal laxity of tarsal ectropion.

Wies procedure versus Jones procedure in the surgical correction of acquired lower eyelid involutional entropion

Objective The aim of this study was to compare the effect of Wies procedure with that of Jones procedure in the primary repair of lower eyelid involutional entropion. Background Involutional entropion (senile entropion) is a general instability of the lid structures with age with inward rotation of the eyelid margin. The eyelashes rub against the inferior cornea and bulbar conjunctiva causing irritation. This finally leads to impaired optical function of the ocular surface. Different methods have been described aiming at treating one or several of the etiological factors of the involutional entropion. Patients and methods In the current comparative prospective study, 30 patients (31 eyelids) with senile lower eyelid involutional entropion without horizontal eyelid laxity were selected and divided into two groups. Group 'A' included 16 eyelids of 15 patients that were corrected using Wies procedure and group 'B' included 15 eyelids of 15 patients that were corrected using Jones procedure. Results In the group subjected to Wies procedure, during the follow-up period (6 months), 12 (85.7%) cases were successful, two cases were missed from follow-up, and two (14.3%) cases were unsuccessful (undercorrection in one case and recurrence in the other). However, in the group subjected to Jones procedure, 14 (93.3%) cases were successful and only one (6.7%) case was unsuccessful (overcorrection occurred). In the Wies group, nine (64.3%) cases showed cosmetically accepted results and five (35.7%) did not. However, in the Jones group, 12 (80%) cases showed cosmetically accepted results and three (20%) cases did not (P = 0.03). In the Wies group, eight (57.1%) patients were satisfied and six (42.9%) were not. However, in the Jones group, 13 (86.7%) patients were satisfied and two (13.3%) were not (P = 0.55). Conclusion Jones procedure is more likely successful, cosmetically acceptable, and satisfactory to the patients compared with Wies procedure.

The orbicularis oculi muscle resection technique for medial epicanthoplasty: A retrospective review of surgical outcomes in 47 Chinese patients

Epicanthal folds and single eyelids are considered characteristic East Asian traits. This study describes a new approach to medial epicanthoplasty based on an orbicularis oculi muscle resection technique and reports the surgical outcomes in Chinese patients. The study presents an uncontrolled retrospective case series review of 47 Chinese patients who underwent medial epicanthoplasty with double eyelid surgery from December 2010 to December 2014 by traditional medial epicanthoplasty (Group I, n=23) or medial epicanthoplasty using the orbicularis oculi muscle resection technique (Group II, n=24). Horizontal lid fissure length (HLFL), inner intercanthal distance (IICD), and the HLFL/IICD ratio were measured preoperatively and at 6-month follow-up. Within group and between group comparisons were performed using paired t-test, independent t-test, and Chi-square test. Pre- and postoperative photographic images were compared. In Group I, mean IICD decreased from 38.8±1.06mm preoperatively to 33.7±0.93mm postoperatively, and mean HLFL increased from 24.9±1.27 to 29.6±0.63mm (p<0.01). The HLFL/IICD ratio increased to 0.237±0.05 (p<0.0001). In Group II, mean IICD decreased from 38.7±1.30mm preoperatively to 32.2±1.13mm postoperatively, and mean HLFL increased from 24.5±1.72 to 30.6±1.08mm (p<0.01). The HLFL/IICD ratio increased to 0.315±0.047 (p<0.0001). The improvement in the HLFL/IICD ratio was significantly higher in Group II than in Group I (p<0.001). All patients obtained satisfactory results with no complications. Medial epicanthoplasty using the orbicularis oculi muscle resection technique is safe and effective for epicanthal fold correction in Chinese patients.

Pseudoexfoliation syndrome and ocular adnexa

Pseudoexfoliation syndrome (PEX) is a relatively widespread generalized age-related disease of the connective tissue. Therefore, it is reasonable to evaluate the condition of ocular adnexa in patients with PEX. The purpose of the study. To evaluate the state of ocular adnexal tissue in PEX. Methods. Both eyes of 66 patients with PEX and of 64 control individuals were examined in this prospective study. We evaluated the function of the upper eyelid levator muscles and the lower eyelid retractors, horizontal lid laxity (HLL), canthal integrity, degree of retractor disinsertion, and orbicularis muscle tone. Results. The HLL, degree of retractor disinsertion, and the laxity of the medial canthal tendon were statistically expressed in patients with PEX (p 0.05). However, the orbicularis muscle tone and the function of the lower eyelid retractors were statistically lower in these patients (p 0.05). The function of the upper eyelid levator muscles, tone of the lateral canthal tendon and degree of ptosis was found to be similar in both groups. Conclusion. Signs of atonic changes in ocular adnexa are relatively more common in patients with PEX (p 0.05).

Outcomes after surgical resection of lower eyelid tumors and reconstruction using a septal chondromucosal graft and an upper eyelid skin flap

PurposeSurgical excision of large malignant lower eyelid tumors may cause important full‐thickness eyelid defects. The reconstruction of such defects must reestablish an acceptable aesthetic result and also restore the physiologic function of the eyelid.MethodsWe report the outcomes of full‐thickness excision of tumors extending over half of the horizontal lid length, followed by reconstruction using a septal chondromucosal graft (coming from the ipsilateral nasal cavity) and an upper eyelid skin flap. Histological analysis of the specimen identified the tumor type and surgical margins for each patient.Results25 patients were operated with this technique between March 2009 and June 2015: 17 basal cell carcinomas, 3 spindle cell carcinomas and 5 conjunctival melanomas (out of which 2 were associated with lentigo malignant melanoma). Mean duration of follow‐up after surgery was respectively 36, 41 and 17 months for each of these 3 tumor types. We found a single local tumor recurrence and it was a basal cell carcinoma in a xeroderma pigmentosum patient. We describe some of the possible surgical complications and functional sequelae.ConclusionsIn the case of eyelid tumors, the need to perform complete oncologic excision with margins adapted to tumor type may result in the removal of an important part of the eyelid. Several surgical techniques are available for lower eyelid reconstruction; the choice of the technique and its results depend mainly on the surgeon's experience.In malignant tumors, complete surgical excision with margins adapted to tumor type prevents local recurrence in most cases. Our repair strategy gives good aesthetic and functional results.

Successful conjunctival socket expansion in anophthalmic patients until the age of 2 years: an outpatient procedure.

PurposeTo report the results of a simple outpatient method for soft tissue socket expansion in young children with congenital anophthalmos.MethodsSeventeen congenital anophthalmic sockets of 15 infants of a mean age of 4.2±4.4 months were fitted with specially designed serial solid acrylic shapes or hydrogel expanders using cyanoacrylate for eyelids closure when using the latter.ResultsAt the age of 2 years, the mean horizontal eyelid length increased from a mean of 11.6±4.5 to 19.4±4.6 mm and the volume of the last expander from a mean of 0.6±0.2 to 2.0±0.3 cm2. The specially designed acrylic shapes could be a substitute to the custom-made molds, which require general anesthesia.ConclusionSuccessful increase in the horizontal eyelid length as well as the conjunctival socket volume could be achieved by a simple outpatient procedure without the need for repeated hospitalization and general anesthesia in these infants.