Left Lower Eyelid Research Articles

Multicentric Mucinous Adenocarcinoma of Bilateral Eyelids.

A 59-year-old female patient presented with a purple, fluid-filled lesion on her left upper eyelid that contained a solid component. Excisional biopsy revealed a diagnosis of mucinous adenocarcinoma. Extensive oncological workup was negative for a distant primary tumor or metastasis and confirmed a diagnosis of primary mucinous adenocarcinoma. Further excision and eyelid reconstruction were required. One year later, another suspicious, fluid-filled lesion was excised from the patients' left lower eyelid. Biopsy and subsequent oncological workup confirmed a mucinous adenocarcinoma in situ, a known precursor of primary mucinous adenocarcinoma. This case contributes to the limited literature reporting multicentric primary mucinous adenocarcinoma of the eyelids and suggests that there may be underlying factors that heighten a patient's risk for developing these tumors.

Clinical outcomes of Lateral Tarsal Strip Procedure for the correction of entropion and ectropion

Purpose: Evaluating the clinical outcomes of Lateral Tarsal Strip Procedure for the correction of entropion and ectropion. Study Design: Interventional case series. Place and Duration of Study: Mayo Hospital Lahore, from January 2018 to March 2023. Methods: Lateral Tarsal Strip Procedure was performed for the correction of Lower lid malposition in 43 patients for entropion or ectropion. Complete ocular assessment was done including palpebral fissure height, amount of inward/outward turning of lids, abnormalities of lashes and pre-existing tear film abnormality. Patients with previous eye surgery were excluded. We collected data regarding surgical outcomes and satisfaction of patients. Results: Forty-three patients were included in this study. There were 30 men and 13 women in the age range of 59 to 82 years (mean 72.2±4.9 years). There were 28 right and 15 left lower eyelids. Surgical success with anatomical correction of Involutional ectropion was achieved in all patients. Distribution of type of lid abnormality is shown in Table 1. There were no perioperative or postoperative complications. After initial 100% results, only two out of forty-three eyelids (4.6%) had recurrence of involutional ectropion after 4 and 6 months. Conclusion: LateralTarsalStrip is a simple and effective approach in achieving correction for entropion/ectropion.

Hedgehog pathway inhibitors in eyelid tumors

Aims/Purpose: Basal cell carcinoma (BCC) is the most common type of tumor worldwide. Although it has a low capacity for systemic spread, it exhibits a high rate of local invasion. The most frequently affected areas are the face and neck. So far, the most widely used treatment has been surgery in its various forms: excision‐electrodesiccation‐curettage, cryotherapy, or the increasingly common Mohs micrographic surgery. In recent years, various researchers have identified molecules that can reduce or even eliminate these lesions. Among them, we highlight Vismodegib due to the good results obtained. This molecule is the first selective Hedgehog pathway inhibitor approved for the treatment of local and metastatic BCC.Methods: A 57‐year‐old female patient came to our clinic, referred by the dermatology department of our hospital, due to a basal cell carcinoma on the left lower eyelid affecting the free margin.Results: An incisional biopsy of the lesion was performed, diagnosing nodular BCC. After explaining the characteristics of the tumor and the therapeutic options to the patient, it was decided to start treatment with Vismodegib, include her in the surgical waiting list, and perform monthly follow‐up. In subsequent check‐ups, the patient reported good tolerance and adherence to the treatment, without adverse side effects. During the consultations, a clear reduction of the lesion was observed. However, due to the incomplete disappearance of the lesion, it was decided to perform a wedge resection of the tumor.Conclusions: Currently, the patient shows a good alignment of the free margin, with good tension and no signs of tumor activity.

Recurrent Solitary Neurofibroma Involving the Proximal Lacrimal Drainage System.

Solitary eyelid neurofibroma is a rare condition, and there have been no reported cases of solitary eyelid neurofibroma involving the proximal lacrimal drainage system. A 6-year-old male presented with recurrent painless swelling in the medial part of the left lower eyelid. The patient was misdiagnosed as eyelid polyp and underwent excision biopsy twice elsewhere. Subsequently, the patient presented with a recurrence of swelling and was treated with full-thickness eyelid resection and reconstruction by direct closure. Histopathology showed the presence of spindle cells with hyperchromatic nuclei in a myxoid background. These cells showed S100 and CD 34 positivity. The systemic evaluation did not show any signs of neurofibromatosis.

A delayed Tenzel flap

A 71-year-old man presented with a lentigo maligna melanoma (Breslow 0.25 mm) of the left lower eyelid. Complete excision was achieved after 3 Slow Mohs stages, resulting in a quadrangular 1.8x1.2 cm full-thickness defect. After the first stage, upper and lateral margins resulted as histologically infiltrated. Therefore, an additional lateral strip was taken after 3 days, resulting in a tumor-free result. Radicalization was completed after another 8 days on the posterior lamella and rim with immediate reconstruction.

Management Reconstruction of Eyelid Kissing Nevus

Introduction: An unusual type of congenital nevus known as "kissing nevus" develops on one eye's upper and lower lid and becomes enormous while the eyelids are closed. Reconstruction is complex since it creates both aesthetic and functional issues. Case Presentation: A 23-year-old female patient attended our ophthalmology outpatient clinic stating that she had a painless, non-progressing black nevus covering her left upper and lower eyelid since birth. The dark brown-black, 55 mm in size, with hypertrichosis that extended to the cheek and covered about two-thirds of the left upper and lower eyelid edges. A free supraclavicular skin transplant restored the complete nevus shortly after removal. We performed canthoplasty, lateral canthopexy, and full-thickness graft procedures. Three weeks following the procedures, the result was satisfactorily proved. Through histopathological examination, intradermal nevus pigmentosus was identified. Conclusions: A secure, trustworthy, and aesthetically pleasing option for head and neck deformities reconstruction involves a free supraclavicular graft.

Bilateral development of biclonal ocular adnexal marginal zone lymphoma at a 2-year interval.

Ocular adnexal marginal zone B-cell lymphoma (OAMZL) of the mucosa-associated lymphoid tissue is a distinct subtype of B-cell lymphoma. OAMZL occasionally occurs on both sides with a varied sequence in the time course. However, few case reports have described clonal analysis of bilateral OAMZ. Here we present a case of biclonal OAMZL, that developed bilaterally at a 2-year interval. A 38-year-old woman was diagnosed with OAMZL in the right lower eyelid conjunctiva and received local radiation therapy, resulting in the disappearance of the tumor. Two years later, she developed another tumor in the left lower eyelid and was diagnosed with relapse of OAMZL. She was re-treated successfully with radiation therapy. Analysis of immunoglobulin (Ig) gene rearrangement in the bilateral tumor samples showed different clonotypic VDJ recombination within the Ig heavy chain gene and different patterns of rearrangement of the Ig light chain genes. The results indicated that independent B-cell clones causing the specific subtype of lymphoma had generated in both eyes. The biclonal nature of the lymphoma that developed sequentially in the same anatomic site in this case suggests that underlying inherent or environmental factors may lead to ongoing emergence of new tumor clones.

Evaluation of the effectiveness of picosecond KTP and fractional thulium lasers on pigmented-type periorbital dark circles.

To determine the effectiveness of picosecond KTP in reducing peri-ocular dark circles caused mainly by excessive pigmentation and to compare Picosecond KTP with Thulium laser ability in reducing the intensity and extent of peri-ocular dark circles. This split-face prospective study included twelve women with periorbital dark circles (pigmented or mixed-pigmented type). The left lower eyelid was treated using the PicoHi machine (HIRONIC Ltd), a full beam Q-switched Nd-YAG provided by KTP crystal (523nm) at settings of 0.3J/cm2, 5mm, 5Hz, and 300 Ps. Whereas the right lower eyelid was treated using the Lavieen machine (WON TECH Co., Ltd), a fractional Thulium laser (1927nm) at setting 1320mJ/cm2, 30 × 15mm, 1500 microseconds. Patients received a series of 3 treatment sessions, given at 4-week intervals. The 532-nm full beam Q-switched KTP and fractional Thulium lasers were more likely to induce post-inflammatory hyperpigmentation rather than decrease the pigmentation. The risk is higher with a Q-switched KTP laser, which may be attributed to the skin tone of the participants. Nonetheless, some improvement in the pigmented type of PDCs, although not detected clinically, was documented by the VISIA software. No solid conclusion can be drawn from the results of the study. Picosecond KTP and Thulium lasers may have a role in reducing PDCs yet more studies should be performed in order to determine the exact impact these lasers have.

Histiocytic sarcoma complex in the palpebral conjunctiva of a seven-month-old dog

A seven-month-old, intact, female Anatolian Shepherd dog was referred for treatment of swelling and redness of the left eye. Ophthalmological examination revealed a pea-sized mass in the palpebral conjunctiva of the left lower eyelid. Ulcerative keratitis and blepharospasm were detected due to the irritation caused by the mass. Fluorescein staining was positive and the Schirmer tear test result was 13 mm/min. No other masses were detected in other parts of the patient’s body, and its general condition was good. The mass was removed surgically and was interpreted as histiocytic sarcoma. During a three-year, post-operative follow-up period, no recurrence of the mass was observed.

Erosive-ulcerative blepharitis in a case of herpes labialis

A 41-year-old male presented to the outpatient department with complaints of redness and pain in the left lower eyelid for 3 days. Left lower eyelid showed ulcer present laterally on the intermarginal strip with the bare mucosal surface. There was mild edema and conjunctival injection adjacent to the ulcer. He had a history of fever and perioral rashes for last 5 days. Tzanck smear from perioral lesions showed multinucleated giant cells. He was diagnosed with herpes labialis (HL) with ocular involvement. We would like to highlight the presence of erosive-ulcerative blepharitis in association with HL.

Cavernous Haemangioma Mimicking Lower Eyelid Fat Bags - An Interesting Case Report

Cavernous hemangioma is the most common primary vascular orbital tumor in adults. The usual presentation of such benign tumors is proptosis with choroidal folds due to intraconal localization. We report a case of 58-year-old male with an unusual presentation of cavernous hemangioma resulting into a picture resembling lower-lid baggy fat bags. Data including clinical picture of both eyes, magnetic resonance imaging (MRI) orbit showing mass located anteriorly, intraoperative view of transcutaneous anterior inferior orbitotomy, and histopathological examination results. A 58-year-old male patient presented with left lower eyelid swelling worsening over the past 6 months. The patient had an asymmetric lower lid fullness. A soft palpable, noncompressible mass in the left orbit beneath the lower eyelid was noticed suspicious for an orbital mass. Other ocular and systemic examinations were within normal limits. Orbital computed tomography scan with contrast revealed a well-defined, enhancing mass within the left orbit, measuring 2.5 cm × 1.5 cm, situated anterior to the eyeball and mimicking lower eyelid fat bags. MRI confirmed the presence of the mass, and angiographic sequences demonstrated marked vascularity. Histopathological examination confirmed the diagnosis of cavernous hemangioma. In conclusion, the presented case emphasizes the importance of a systematic approach to the evaluation of eyelid and orbital conditions. Awareness of uncommon orbital pathologies and the appropriate use of diagnostic imaging are essential for accurate diagnosis and tailored treatment planning. In cases like these, interdisciplinary collaboration between ophthalmologists, radiologists, and oculoplastic surgeons is critical for optimal patient care.

Effect of Regulated Type-2 Diabetes Mellitus on the Ocular Surface

The aim of this study was to see whether well-regulated Type-2 diabetes mellitus (DM) under than 10 years impacted meibography and tear film break-up time. DM (n=45) and normal subjects (n=45) were recruited. Two years’ mean glycated hemoglobin data were calculated as the regulation indicator. Eye examination followed by noninvasive tear break‑up time (NTBUT) measurement and then meibography were conducted. Regression analyses corrected for age and gender were used for comparisons between groups. Pearson correlation analysis was used to examine the linear relationship between NTBUT and meibomian gland loss to mean glycated hemoglobin. A value of p<0.05 was considered statistically significant. The meiboscale comparisons within groups did not show any statistical difference. The mean meibomian gland loss comparisons between groups for the right lower eyelid (r=0.017, p=0.69), right upper eyelid (r=0.04 p=0.24), left lower eyelid (r=0.009, p=0.68) and left upper eyelid (r=0.027, p=0.13) were all similar. NTBUT for right and left eye were similar between groups (p=0.69 and p=0.36 respectively). Pearson’s correlation did not show any significant correlation between glycated hemoglobin, NTBUT and gland loss. In conclusion, it was found that patients with less than 10-year disease duration under DM regulation had similar ocular surfaces to normal subjects.

Aesthetic Palpebral Reconstruction Following the Excision of Basal Cell Carcinoma (BCC): A Case Report

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin malignancy, and when considering its predilection for the face – it is most commonly found on the eyelids. CASE PRESENTATION: In our patient’s case, the BCC was located on the left lower eyelid exemplifying the classic macroscopic appearance of a nodular basalioma. We took into account all of the patient’s variables (particularly the lesion’s difficult location) to choose the best surgical approach for excision of the tumor, as well as the reconstructive strategy that would result in the most functional and aesthetic outcome. CONCLUSION: In this report, we present a case of our patient with BCC on the lower eyelid, our surgical method for excision and palpebral reconstruction using an autologous auricular cartilage graft, and the final outcome, which we consider was the best option for the patient in question.

MULTIPLE GIANT CHALAZIA IN HYPERIMMUNOGLOBULINEMIA E SYNDROME: A CASE REPORT

Introduction : Hyperimmunoglobulinemia E syndrome (HIES) is a rare primary immunodeficiency disorder that manifests as elevated level of serum immunoglobulin E (IgE) higher than 1.000 IU/mL and multisystem disorder characterized by recurrent skin and pulmonary abscesses caused by autosomal dominant or recessive disorder with gene mutation. We present a case of multiple giant chalazion ina patient with HIES.
 Case Illustration : A 15-year-old boy was referred to Ophthalmology Department with multiple giant lumps on the left eyelid for the last 2 weeks. He had a history of recurrent multiple lumps on the left lower eyelid in the last 1 year. He was diagnosed with HIES since 8 years ago. He had normal visual acuity of both eyes. Multiple giant chalazion were observed on the left upper and lower eyelid. The patient also presented with scalp and neck infection. Laboratory studies showed elevated total serum IgE level of 53,032 IU/mL and eosinophilia.
 Discussion : Ocular manifestations in HIES patients are not common. Some cases reported chalazia, keratoconus, and blepharitis. Surgical incision drainage was performed in our patient. Medications and surgical intervention had produced only transient improvement. The patient was treated conservatively. Riskof chalazia recurrence remains unknown as reported cases presented with diverse clinical presentation and follow-up serum IgE evaluation is not routinely performed.
 Conclusion : Recurrent multiple giant chalazia may occur as an ophthalmic feature of HIES. HIES should be considered and investigated in patients presenting with recurrent giant chalazia.

MULTIPLE GIANT CHALAZIA IN HYPERIMMUNOGLOBULINEMIA E SYNDROME: A CASE REPORT

Abstract
 Introduction : Hyperimmunoglobulinemia E syndrome (HIES) is a rare primary immunodeficiency disorder that manifests as elevated level of serum immunoglobulin E (IgE) higher than 1.000 IU/mL and multisystem disorder characterized by recurrent skin and pulmonary abscesses caused by autosomal dominant or recessive disorder with gene mutation. We present a case of multiple giant chalazion ina patient with HIES.
 Case Illustration : A 15-year-old boy was referred to Ophthalmology Department with multiple giant lumps on the left eyelid for the last 2 weeks. He had a history of recurrent multiple lumps on the left lower eyelid in the last 1 year. He was diagnosed with HIES since 8 years ago. He had normal visual acuity of both eyes. Multiple giant chalazion were observed on the left upper and lower eyelid. The patient also presented with scalp and neck infection. Laboratory studies showed elevated total serum IgE level of 53,032 IU/mL and eosinophilia.
 Discussion : Ocular manifestations in HIES patients are not common. Some cases reported chalazia, keratoconus, and blepharitis. Surgical incision drainage was performed in our patient. Medications and surgical intervention had produced only transient improvement. The patient was treated conservatively. Riskof chalazia recurrence remains unknown as reported cases presented with diverse clinical presentation and follow-up serum IgE evaluation is not routinely performed.
 Conclusion : Recurrent multiple giant chalazia may occur as an ophthalmic feature of HIES. HIES should be considered and investigated in patients presenting with recurrent giant chalazia.

Management of Full-Thickness Lower Eyelid Defect After MOHS Procedure and Mustard Flap

Introduction : Large full-thickness eyelid defects are considered a challenging case. This study reports how to manage the reconstruction of eyelid defect in a case with a history of carcinoma cell basal of the eyelid, which is removed with MOHS procedure and mustard flap reconstruction but full-thickness of more than 50% defect of the lower eyelid remains.
 Case Illustration : A 67 years old woman was referred from the dermatology and venereology clinic with a history of eyelid cancer operation, 13 days prior. The patient's chief complaint was the left lower eyelid felt pulled down. Examination revealed a left lower eyelid full-thickness defect of more than 50% and ectropion at the lateral side. An 8 mm lagophthalmos without corneal exposure was present. The reconstruction was done with a lips mucosa graft to form posterior lamella, at the medial side anterior lamella was formed by the glabellar flap, and at the lateral side was formed by a skin graft due to lack of the anterior lamella from the mustard flap previously.
 Discussion : Eyelid reconstruction aims to provide adequate globe protection. The principle management of reconstruction in full-thickness eyelid defects horizontally of more than 50% can’t be done by an anterior flap (mustard) only because it's unstable and the eyelid can be retracted. The reconstruction must consist of the anterior and posterior lamella which have to be tight to the periosteum.
 Conclusion : One step procedure for large defects of the lower eyelid after cancer removal can be done with considering the proper plan of reconstruction technique.

Prospective Study on the Surgical Outcome of Eyelid Carcinoma

Abstract
 Introduction & Objectives : Introduction Resection of eyelid carcinoma may lead to a risk of recurrences which might increase if excision was incomplete. Risk factors of incomplete surgical removal and recurrences are deep infiltration, spreading outside the macroscopic border, eye socket penetration, and histological type of the eyelid carcinoma. Objective To evaluate the surgical outcomes of eyelid carcinomas.
 Methods : This is a hospital based prospective observational study involving 16 patients. Prior to the surgery patients were evaluated for visual acuity, intra ocular pressure, extra ocular motility, fundus examination, and local clinical examinations. The eyelid carcinomas were histological detected concerning carcinoma type and margin involvement. Local anesthesia was applied. Patients were evaluated 1 month, 3 months and 6 months after surgery for local complications, patients satisfaction on surgical results, and recurrences. The surgical technic applied in this study were also observed.
 Results : Dominant tumor type were basal cell carcinoma and squamous cell carcinoma (87, 44%). The locations were at right and left lower eyelid with percentage of 68. 7 % and 31. 3 % respectively. All patients satisfied on surgery outcomes (100%). Three patients (6. 25 %) with complications were found within 6 months after the surgery. There were no recurrences during follow up period. Surgery procedures applied were modified hughe’s procedure (56. 25%) and mass excision and reconstruction (43. 75%).
 Conclusion : There was less complications and no recurrences within 6 months after surgery. All patients satisfied with the surgical outcomes.

Challenges in Diagnosing and Initial Treatment of Advanced Eyelid Basal Cell Carcinoma in Rural Area: A Case Report

Introduction : Basal cell carcinoma (BCC) is the most common non-melanoma eyelid cancer with a high risk of recurrence. This case report discusses the management of extensive BCC in a rural setting with limited resources.
 Case Illustration : A 62-year-old Timorese female, presented to the hospital with a mass on the left periocular region. It appeared as a mole in the lower left eyelid and extended to the surrounding tissues over nine years. As a farmer, she was frequently sun-exposed. A blackish mass was found at the left orbit, buccal, and entire nose (8 x 7.5 cm) with an ulcerated surface and attached firmly. The right eye had bedside visual acuity >6/60, with palpebral edema, free eye movement, hyperemia nasal conjunctiva, and transparent cornea. The left eye is difficult to examine. Two submandibular lymphadenopathies were palpated. A Head CT scan showed a suspected malignant soft tissue mass with irregular thickening of soft tissue with ill-defined borders. Histopathology examination revealed a nodulocystic type of basal cell carcinoma.
 Discussion : Locally advanced BCC cases need a multidisciplinary approach. In a limited resources setting, the treatment highlights are histological diagnosis, complete surgical excision, and exenteration with margin control. From a broader perspective, the role of primary health care in educating and revering for early treatment is paramount.
 Conclusion : Prevention and early treatment are the most important factors in managing locally advanced BCC.

KISSING NEVUS RECONSTRUCTION WITH A SUPRACLAVICULAR GRAFT: A RARE CASE REPORT

Introduction : Kissing nevus is a rare form of congenital nevus that occurs on upper and lower eyelid of one eye, forming a large nevus when the eyelids are closed. This condition causes functional and aesthetic problems thus the reconstruction is essential.
 Case Illustration : A 23-years old female presented to our ophthalmology outpatient clinic with complain of having painless, black colored, non-progressive nevus over left upper and lower eyelids since birth that cosmetically unpleasing. The dark brown-black colored was sized 55x30 mm with hypertrichosis covering approximately two third of both left upper and lower eyelid margins and extending to cheek. The entire nevus was excised and reconstructed by supraclavicular full thickness skin graft, lateral canthopexy and canthoplasty. Three weeks after operation showed satisfactory results. Histological examination revealed intradermal nevus pigmentosus.
 Discussion : The reconstruction of eyelid after excision remains a challenge because of its specialized function and cosmetic significance. Ideally, the reconstruction should provide a stable eyelid margin, protect the ocular surface, and sustain mobility. Free skin grafts harvested from the control lateral eyelid, postauricular, supraclavicular, and upper arm region have been the most common reconstructive approach. The supraclavicular area is a reliable donor option to cover large head and neck defects due to its similarity in colour, thickness, and flexibility.
 Conclusion : Free supraclavicular graft is safe, reliable and cosmetically acceptable choice for reconstruction head and neck defects.

CICATRICIAL ECTROPION REPAIR DUE TO TRAUMA : A CASE REPORT

Introduction : Cicatricial ectropion is a complication that can occur after trauma. Scar tissue formation causes anterior lamellae shortening (skin and orbicularis muscle), resulting in outward lid margins rotation.
 Case Illustration : A 16 y.o male patient came with complaints of the left upper and lower eyelids folding outwards since 3 months ago after trauma, watery eye. Examination VOD 20/20, VOS 20/50. Scar on the superior and inferior lids, the inferior lid margin is folded out, inferior tarsal conjunctiva is visible, lagophthalmus 4 mm, fissure palpebral vertical (FPV) 12 mm, margin reflex distance (MRD) 1 = 4 mm, MRD2 = 8 mm, fissure palpebral horizontal (FPH) 30 mm, conjunctival injection. Corneal (macular) scars central-peripherally at 3-6 o'clock. Patient was diagnosed with cicatrical ectropion with left eye corneal scar and ectropion repair was performed with full-thickness skin graft from retroarticular. One week and six weeks after surgery, FPV improved to 10 mm, MRD1 = 4, MRD2 = 6 mm, FPH 30 mm, and lagophthalmos 2 mm became 1 mm.
 Discussion : Cicatricial ectropion is usually treated in 3 procedures: release vertical scar traction, horizontal lid tightening, repair anterior lamella can be done with full-thickness skin graft. horizontal lid tightening in this case not carried out because of no laxity.
 Conclusion : Scar traction release and repair anterior lamella with full-thickness skin graft from retroauricular was choice in this case because extensive defect and ectropion grade 3. After surgery anatomical structure of the lids and looks better aesthetically.