Eyelid Closure Research Articles

Functional reconstruction of lower eyelid using paramedian forehead flap combined with frontalis muscle and periosteum

Both cosmetic and functional aspects are important in the reconstruction of lower eyelid tissue defects. In this case report, we describe a two-stage reconstruction of a skin defect, including the orbicularis oculi muscle, after resection of a basal cell carcinoma using a paramedian forehead flap combined with the frontalis muscle and periosteum. In the first stage, the paramedian forehead flap, including the frontalis muscle and periosteum, was elevated, the periosteal flap was fixed to the outer orbital periosteum to lift the lower eyelid, and the skin flap, including the frontalis muscle, was sutured to the defect. In the second stage, the flap was divided and the frontalis muscle flap was sutured to the medial palpebral ligament. Electromyography at 1 year postoperatively confirmed neurotization of the transferred muscle, and at 6 months, voluntary contraction of the transferred muscle was observed during eyelid closure. These results suggest that a paramedian flap combined with the frontalis muscle and periosteum is a useful option for reconstructing horizontal skin defects involving the orbicularis oculi muscle.

Sex differences in photophobic behaviors following cortical spreading depression in rats.

Photophobia is a common and debilitating symptom associated with migraine. Women are disproportionately affected by migraines, with a higher prevalence and more severe symptoms compared to men. This study investigated the effects of cortical spreading depression on light-aversive and dark-seeking behaviors in a rat model, with an emphasis on sex differences. Experiments were conducted on seven to eight-week-old male and female Sprague Dawley rats. cortical spreading depression was modeled by injections of potassium chloride or artificial cerebrospinal fluid into the occipital cortex through a guide cannula. Key behavioral assessments included light-aversive and dark-seeking behaviors measured using a three-chamber box, pupil to iris ratio, periorbital tightening, periorbital allodynia and facial withdrawal thresholds. Our results demonstrated that cortical potassium chloride injections significantly increased photophobic behaviors, particularly in female rats. Specifically, potassium chloride-injected females demonstrated a significant reduction in the time spent in the light chamber (p = 0.001) and increased time in the dark chamber compared to control rats (p = 0.01), indicating heightened light-aversion. Females exhibited more substantial pupil constriction and eyelid closure at 180 min after potassium chloride injection compared to artificial cerebrospinal fluid injection, suggesting a stronger physiological response to light. Similarly, a greater percent of female rats displayed periorbital allodynia (withdrawal threshold <6 g) over a post injection time course compared to male rats. Among rats that exhibited periorbital allodynia at least two consecutive time points, females had significantly lower facial withdrawal thresholds than males at 60-, 90-, 120-, and 180-min post injection (p < 0.05), suggesting a difference in magnitude and duration. Furthermore, the area under the curve for the time course experiment indicated development of tactile allodynia in periorbital region among female rats (p < 0.0001). Altogether these findings highlight the importance of considering sex-specific differences in developing therapeutic strategies for the treatment of migraine. We report for the first time a complete time course analysis of migraine-related responses, providing a comprehensive overview of the dynamics involved. The results suggest that potassium chloride-induced cortical spreading depression may offer a valuable model for studying the underlying mechanisms and sex differences of photophobia in migraine, aiding in the development of targeted treatments.

The FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial: Study Design

ABSTRACT Purpose To report the design of FLuorometholone as Adjunctive MEdical therapy for TT surgery (FLAME) trial. Design Parallel design, double-masked, placebo-controlled clinical trial with 1:1 randomization to fluorometholone 0.1% eye drops twice daily or placebo twice daily for 4 weeks in eyes undergoing trachomatous trichiasis (TT) surgery for assessing the efficacy, safety, and cost-effectiveness of fluorometholone 0.1% in preventing recurrent postoperative trichiasis (PTT). Methods Up to 2500 eligible persons with trachomatous trichiasis undergoing lid rotation surgery were enrolled in the Jimma zone, Ethiopia. Participants, surgeons, study field staff, and study supervisors leading operational aspects of the trial are masked to treatment assignment. Randomization is stratified by the surgeon and is simultaneously stratified by the district. Study visits (in addition to programmatic follow-ups) are at the baseline/enrollment, at four-week post-enrollment, and after 6 months and 1 year. The primary outcome is cumulative one-year PTT incidence, defined as: ≥1 lashes touching the globe, evidence of epilation, and/or repeat TT surgery. Secondary postoperative outcomes include the number of trichiatic lashes, location (touching the cornea or not), evidence of post-operative epilation, entropion, changes in corneal opacity, IOP elevation, need for cataract surgery, visual acuity change from the baseline, eyelid contour abnormality, granuloma, eyelid closure defect, and the occurrence of adverse events. Health economic analyses center on calculating the incremental cost per case of PTT avoided by fluorometholone treatment. Conclusion The FLAME Trial is designed to provide evidence of the efficacy, safety, and cost-effectiveness of adjunctive topical peri-/postoperative fluorometholone 0.1% therapy with trichiasis surgery, which is hypothesized to reduce the risk of recurrent trichiasis while being acceptably safe. Clinical Trial Registration https://www.clinicaltrials.gov/study/NCT04149210.

Voluntary blinks and eye-widenings, but not spontaneous blinks, facilitate perceptual alternation during continuous flash suppression.

The fact that blinks occur more often than necessary for ocular lubrication has led to the proposal that blinks are involved in altering some aspects of visual cognition. Previous studies have suggested that blinking can modulate the alternation of different visual interpretations of the same stimulus, that is, perceptual alternation in multistable perception. This study investigated whether and how different types of blinks, spontaneous and voluntary, interact with perceptual alternation in a multistable perception paradigm called continuous flash suppression. The results showed that voluntary blinking facilitated perceptual alternation, whereas spontaneous blinking did not. Moreover, voluntary eye-widening, as well as eyelid closing, facilitated perceptual alternation. Physical blackouts, which had timing and duration comparable to those of voluntary blinks, did not produce facilitatory effects. These findings suggest that the effects of voluntary eyelid movements are mediated by extraretinal processes and are consistent with previous findings that different types of blinks are at least partially mediated by different neurophysiological processes. Furthermore, perceptual alternation was also found to facilitate spontaneous blinking. These results indicate that eyelid movements and perceptual alternation interact reciprocally with each other.

Surgical Treatment of Synkinetic Eyelid Closure in Marin-amat Syndrome Complicated by Facial Palsy After COVID-19 Vaccination

Background: Marin-Amat syndrome is a rare, irreversible, and hard-to-treat neurological sequalae that has recently been associated with COVID-19 vaccination. Given the rarity of this condition and the absence of curative treatment to date, the authors herein review the literature to date and report the first ever successful surgical treatment of 2 patients who developed Marin-Amat syndrome after ChAdOx1 nCoV-19 vaccination. Materials and Methods: In this case study, the authors treated Marin-Amat syndrome in a 45-year-old woman and a 75-year-old woman with facial palsy that developed 24 days and 4 months after receiving COVID-19 vaccination, respectively. The patients’ clinical histories and physical examination results were reviewed. A literature review was performed using PUBMED for the years 1990 to the present. Results: It is noteworthy that these are the first reported cases of Marin-Amat Syndrome to be successfully treated by surgery. The patient’s neurological symptoms improved after surgical intervention in contrast with the lack of response after botulinum toxin injection and intensive rehabilitation. Conclusion: This study is the first to demonstrate the successful treatment of the extremely rare Marin-Amat syndrome after ChAdOx1 nCoV-19 vaccination through surgery. Selective myectomy and myotomy in situ in combination with levator plication proves to be highly effective and favorable in treating this condition as the surgery overtakes the limited effectiveness of and directly obviates the need for botulinum toxin injections, thereby improving patient satisfaction and quality of life.

Fatigue Detection Based on Blood Volume Pulse Signal and Multi‐Physical Features

ABSTRACTFatigue detection holds paramount importance in the timely identification of safety hazards. Nonetheless, prevailing fatigue detection methodologies often overlook the diverse spectrum of fatigue features or temporal cues. To address this lacuna, we introduce fatigue detection based on blood volume pulse signal and multi‐physical features (FDBVPS‐MF). Initially, a non‐invasive technique is employed to extract the blood volume pulse signal (BVPS) from the forehead region, which is subsequently fed into a one‐dimensional convolutional neural network (1D CNN) to formulate a fatigue detection model based on BVPS. Concurrently, features such as percentage of eyelid closure (PERCLOS), blink frequency (BF), and maximum closing time (MCT) are computed from eye images, and amalgamated with yawning frequency (YF) derived from mouth images to generate multi‐physical features (MF). MF is then input into the 1D CNN network to construct a fatigue detection model based on MF. Subsequently, employing weights, derived through Adaboosting, a fusion approach is executed to integrate the outputs of the two fatigue detection models, thus facilitating multi‐modal fatigue detection. On the UTA‐RLDD dataset, the proposed FDBVPS‐MF exhibits an accuracy and precision of 88.9% and 88.2%, respectively. Experimental findings substantiate the superior efficacy of FDBVPS‐MF over conventional methodologies.

Simultaneous Reconstruction of Voluntary and Spontaneous Smiles and Eyelid Closure With Triple Latissimus Dorsi Muscle Flaps.

Using the free latissimus dorsi muscle flap for dynamic reconstruction for established facial paralysis helps reconstruct various facial dysfunctions, depending on nerve and muscle arrangements. The authors divided the latissimus dorsi muscle into 3 flaps, 2 placed in the cheek area to reconstruct a "voluntary and spontaneous smile" and 1 fixed to the fascia implanted in the eyelid to treat lagophthalmos in a 1-stage procedure in a 61-year-old woman who underwent tumor resection for a left facial nerve schwannoma and developed complete facial paralysis. Fascia lata and free latissimus dorsi muscle grafting were performed. Spontaneous smile was reconstructed using the contralateral facial nerve as a motor source. Voluntary smile and eyelid closure were reconstructed using the ipsilateral masseter nerve, dividing the latissimus dorsi muscle flap into 3 muscle bodies. This procedure restored her smile and eyelid closure ability, with a nearly normal overall facial impression, making it a valuable technique for 1-term reconstruction of smiles and eyelid closure.

"Folding Fan Flap": A Novel and Dependable Surgical Technique for Crow's Feet Correction by Z-Plasty of Orbicularis Oculi Muscle.

The challenge of crow's feet surgical correction is to minimize the complication caused by orbicularis oculi muscle (OOM) resection while ensuring the operative effect. This study aims to propose a novel technique to solve this problem and evaluate its efficacy. From January 2022 to April 2024, all patients who received "Folding fan flap" in our institution were included. The outer third of the OOM below the lateral canthus was dissected and received Z-plasty to exchange width for length and reconstruct the muscle dynamics in a non-circular direction. Preoperative and postoperative smiling crow's feet were assessed by two independent physicians using the Lemperle wrinkle scale. At least six months after surgery, patient satisfaction with wrinkle correction, naturalness of facial expression, and local flattening was subjectively evaluated on a five-point scale. Complications including hematomas, incomplete eyelid closure, facial stiffness, and forehead numbness were recorded. A total of 32 patients (63 sides) were included with a mean follow-up of 13.9 ± 5.2 months. Postoperative assessments showed a significant reduction in Lemperle's score from 4.8 ± 0.4 to 1.5 ± 0.5 (P=0.000). Regarding the satisfaction of surgical outcomes and the naturalness of facial expressions, thirty patients (93.8%) were very satisfied. There were no severe complications such as hematomas and incomplete eyelid closure. Preliminary clinical studies demonstrated the efficacy of this technique in ensuring outcomes while preserving normal dynamic expressions. By Z-plasty of the outer circle of OOM, the muscle dynamic was successfully modified rather than eradicated. 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 .

Evaluation of the efficacy of upper eyelid gold implant surgery in the treatment of lagophthalmos

Material and method: The study included 12 eyes of 12 patients, comprising 5 men and 7 women, with an average age of 55 years. Surgeries were performed on 6 right upper eyelids and 6 left upper eyelids affected by lagophthalmos due to various causes. The average duration of symptoms before surgery was 3 years and 6 months. Patients were eligible for surgery at least 6 months after the onset of paralysis. During the qualification examination, the weight of the implant was estimated using steel trial weights attached to the skin of the upper eyelid, and 0.2 g was added to this measured weight to determine the final implant weight. All patients underwent gold implant insertion into the upper eyelid, with the implants fixed to the tarsal plate using absorbable sutures to prevent prosthesis migration. Special attention was paid to precise layered tissue suturing. Subsequent ophthalmological examinations were conducted at various intervals post-surgery to evaluate the outcomes. Results: Complete eyelid closure was achieved in 50% of the cases, while 100% of the patients reported subjective satisfaction with the surgical outcomes. The patients’ quality of life improved by an average of 85%. The average frequency of using moisturizing eye drops decreased from 7 times daily to 2 times daily. Improvement in the ocular surface condition was noted in all patients. Conclusions: Gold implant insertion into the upper eyelid facilitates improvement in eyelid function and ocular surface condition, significantly enhancing the quality of life for patients with paralytic lagophthalmos.

Clinical Outcomes and Prognostic Factors in Eyelid Malignancy: A 17-Year Retrospective Analysis of Surgical Management and Reconstruction Techniques.

To assess clinical outcomes in patients undergoing surgical excision and eyelid reconstruction for malignancies. This 17-year retrospective study (2004-2021) analyzed patients with malignant eyelid tumors who underwent excision and reconstruction. Data on tumor type, size, location, surgical techniques, complications, and prognostic factors for recurrence were evaluated. A total of 152 patients underwent surgical excision and reconstruction for eyelid malignancies. Basal cell carcinoma (52.6%) was the most common, followed by sebaceous cell carcinoma (32.2%). Direct lid closure was the most frequent reconstructive method. Postoperative complications, including ectropion, entropion, and canalicular obstruction, were minimal but required additional surgery in some cases. Recurrence occurred in 13 patients. Lymph node involvement (OR 21.291, p = 0.004) and positive intraoperative frozen margins (OR 7.083, p = 0.018) were significant risk factors for local recurrence. Surgical excision and reconstruction are effective treatments for eyelid malignancies, with techniques tailored to tumor size, location, and extension to ensure proper lid function. Lymph node involvement and positive intraoperative frozen margins are key predictors of local recurrence.

Electro-Stimulation System with Artificial-Intelligence-Based Auricular-Triggered Algorithm to Support Facial Movements in Peripheral Facial Palsy: A Simulation Pilot Study.

Facial palsy causes severe functional disorders and impairs quality of life. Disturbing challenges for patients with acute facial palsy, but also with those with chronic facial palsy with synkinesis, are the loss of the ability to smile and insufficient eyelid closure. A potential treatment for these conditions could be a closed-loop electro-stimulation system that stimulates the facial muscles on the paretic side as needed to elicit eye closure, eye blink and smile in a manner similar to the healthy side. This study focuses on the development and evaluation of such a system. An artificial intelligence (AI)-based auricular-triggered algorithm is used to classify the intended facial movements. This classification is based on surface electromyography (EMG) recordings of the extrinsic auricular muscles, specifically the anterior, superior, and posterior auricular muscle on the paretic side. The system then delivers targeted surface electrical stimulation to contract the appropriate facial muscles. The evaluation of the system was conducted with 17 patients with facial synkinesis, who performed various facial movements according to a paradigm video. The system's performance was evaluated through a simulation, using previously captured data as the inputs. The performance was evaluated by means of the median macro F1-score, which was calculated based on the stimulation signal (output of the system) and the actual movements the patients performed. This study showed that such a system, using an AI-based auricular-triggered algorithm, can support with a median macro F1-score of 0.602 for the facial movements on the synkinetic side in patients with unilateral chronic facial palsy with synkinesis.

Formed Visual Hallucinations Precipitated by Eyelid Closure After Stroke.

Formed Visual Hallucinations Precipitated by Eyelid Closure After Stroke.

Combined 0.05% Mitomycin-C and 1% 5-Fluorouracil-Mediated Cornea Resolution in Well-Differentiated Ocular Surface Squamous Cell Carcinoma of a Human Immunodeficiency Virus Positive Patient: A Case Report

This is a report of a conservatively treated case of well-differentiated ocular surface squamous cell carcinoma (OSSCC) in a human immunodeficiency virus-positive patient. She was a 60-year-old woman who presented with a 4-month history of progressive swelling in her right eye. There was an associated history of pain, redness, and bloody discharge from the eye. Examination revealed a hard craggy, hemorrhagic, necrotic, fungating, friable, pedunculated, pyramidal-shaped mass over the right eye that prevented closure of eyelids. There was no view of any healthy cornea or conjunctiva tissue, nor the anterior and posterior segments of the right eye. A clinical diagnosis of OSSCC was made and confirmed on histology. Because of the challenge of performing globe-preserving tumor resection, she received eight courses of a combination of topical 0.05% mitomycin-C and 1% 5-fluorouracil drops over 6 months with complete resolution and restoration of corneal transparency, function, and anatomy. This case report highlights the possibility of complete corneal healing in patients with combined immunodeficiency and well-differentiated squamous cell carcinoma. Conservative nondestructive chemotherapy is a viable alternative in cases where tumor resection is a challenge.

β-Catenin gain of function mutant in mouse periocular neural crest-derived mesenchymal cells impairs embryonic eyelid morphogenesis and leads to blepharophimosis syndrome in mice

PurposeThe aberrant canonical Wnt-β-catenin signaling can cause devastating outcomes of tissue morphogenesis and tumor formation. In this study, we examined the impact of overexpression of constitutive active β-catenin in mouse periocular neural crest-derived mesenchymal cells during embryonic eyelid morphogenesis. MethodsWe expressed a stabilized β-catenin in which the exon 3 of the Ctnnb1 gene was deleted in periocular neural crest (PONC)-derived eyelid stromal cells (Ctnnb1Δex3-PONC). Histopathological examinations were performed to examine the eyelid morphogenetic alterations in Ctnnb1Δex3-PONC mice. Immunohistochemical investigations for cell proliferation, apoptosis, and differentiation were also assessed. ResultsWe discovered that nuclear accumulation of β-catenin resulted in a reduction of nuclear Ki-67 and phospho-Erk1/2 expression levels and elevation of apoptosis in PONC cells during embryonic eyelid closure morphogenesis. Interestingly, however, the eyelid epithelial migration was not affected, which resulted in only eyelid epidermal closure but lacked underneath dermal formation at embryonic (E) day 16.5. The sequelae of Ctnnb1Δex3-PONC revealed the malformation of the eyelid margin and Meibomian gland and deficiency of Muller's smooth muscle fibers formation. Consequently, Ctnnb1Δex3-PONC mice manifested blepharophimosis syndrome at P21. ConclusionOur data suggested that aberrant expression of β-catenin gain of function in PONC interrupts the interplay between epithelium and stroma for the morphogenesis of eyelid closure during embryonic development.

The central and peripheral corneal response to short-term hypoxia.

To quantify the magnitude and recovery of central and limbal corneal oedema induced by short-term unilateral eyelid closure without contact lens wear. The left eye of 10 adults with healthy corneas was patched using a folded eye pad for 30 min. High-resolution optical coherence tomography images (which captured the limbal and central corneal regions simultaneously) were obtained before patching, immediately after eye opening and again at 1, 2, 5, 6, 9, 10, 14 and 15 mins after eyelid opening. Oedema was measured from the limbus (scleral spur) to the central cornea (thinnest corneal location) along the horizontal meridian. A greater amount of limbal oedema was noted (mean [SD] 3.84 [1.79] %) compared to the central cornea (2.48 [0.61] %; p = 0.04) after 30 mins of unilateral eyelid closure. Both central and limbal corneal oedema recovered rapidly following eyelid opening, with no significant differences in the rate of corneal recovery between corneal locations (p = 0.90). Short-term unilateral eyelid closure resulted in ~55% more relative oedema in the limbal region compared to the central cornea. Rapid recovery of oedema and corneal overshoot (thinning beyond the baseline corneal thickness) was observed within 1-2 min of eyelid opening for both central and peripheral regions.

Through their eyes: Navigating life with limited eyelid closure in patients with Moebius syndrome

Moebius syndrome (MoS), a rare congenital condition caused by the underdevelopment of the sixth and seventh cranial nerves, presents with uni- or bilateral facial paralysis and lateral gaze palsy. Those with MoS often have incomplete eyelid closure (lagophthalmos). This study aimed to investigate the experiences of individuals living with incomplete eyelid closure due to MoS. Participants shared their experiences in semi-structured open-ended focus groups during the 2023 MoS Foundation Conference. Data were analyzed thematically using Nvivo. The Terzis and Bruno scoring system was used to grade participant eyelid closure (range: 1 being no eyelid closure with full scleral show to 5 being complete eyelid closure with no scleral show) and blink (from 1 being no blink to 5 being synchronous and complete blink present). Marginal reflex distances 1 and 2 (MRD1 and MRD2) were measured to grade for ptosis and lid retraction, respectively. Fifteen participants participated in two focus groups, comprising adults (n=12) and adolescents (n=3). All participants had lagophthalmos with some scleral show, ptosis, and lid retraction. The median eyelid closure score was 3 (incomplete eye closure with 1/3 scleral showing). Five key themes were identified: social stigma and misunderstanding, daily life impacts, seasonal exacerbations, different attitudes toward surgical intervention between adults and adolescents, and a prevailing sense of self-acceptance regarding their condition. Incomplete eyelid closure poses significant social challenges for individuals with MoS, especially around social encounters. Our findings show the importance of developing tailored communication tools to support those living with this facial difference.

Impact of nursing interventions on the prevention of ocular surface disorders in critical care patients: A systematic review.

Intensive care unit (ICU) patients are at an increased risk of ocular surface injuries because of various factors such as reduced tear production and impaired protective mechanisms. Despite the significance of ocular care in ICU settings, there is a lack of consensus on effective interventions, leading to inadequate prevention of ocular surface disease (OSD). This systematic review aimed to assess the effectiveness of nursing eye care in preventing OSD in ICU patients. Secondary objectives included identifying primary risk factors for ocular injuries and examining the most effective preventive methods. A systematic review following PRISMA guidelines was conducted, encompassing a literature search, article selection, quality assessment and data synthesis. Studies meeting inclusion criteria were observational studies and clinical trials, focusing on adults admitted to ICUs under sedation and receiving mechanical ventilation. Of 3545 initially identified articles, 12 studies met inclusion criteria. These studies involved a total of 1853 participants. Various interventions were assessed, including saline rinsing, lubricating drops, gel lubricants, occlusion with polyethylene dressing, passive blinking and eyelid closure with tape. Moist chamber occlusion every 6 h combined with gel lubrication emerged as the most effective method in preventing OSD. Gel lubrication along with moist chamber occlusion proved to be the most effective strategy in preventing ocular injuries in ICU patients. Conversely, the routine use of physiological saline was associated with increased severity of corneal lesions. Properly defined protocols and well-trained nursing teams are crucial for reducing ocular injuries in ICU settings. The findings underscore the importance of implementing evidence-based eye care protocols in ICUs, emphasizing the use of gel lubrication and ocular surface protection to mitigate the risk of OSD. This highlights the need for comprehensive training programmes for ICU nursing staff to ensure optimal ocular care delivery.

19F NMR Reveals the Dynamics of Substrate Binding and Lid Closure for Iodotyrosine Deiodinase as a Complement to Steady-State Kinetics and Crystallography.

Active site lids are common features of enzymes and typically undergo conformational changes upon substrate binding to promote catalysis. Iodotyrosine deiodinase is no exception and contains a lid segment in all of its homologues from human to bacteria. The solution-state dynamics of the lid have now been characterized using 19F NMR spectroscopy with a CF3-labeled enzyme and CF3O-labeled ligands. From two-dimensional 19F-19F NMR exchange spectroscopy, interconversion rates between the free and bound states of a CF3O-substituted tyrosine (45 ± 10 s-1) and the protein label (40 ± 3 s-1) are very similar and suggest a correlation between ligand binding and conformational reorganization of the lid. Both occur at rates that are ∼100-fold faster than turnover, and therefore these steps do not limit catalysis. A simple CF3O-labeled phenol also binds to the active site and induces a conformational change in the lid segment that was not previously detectable by crystallography. Exchange rates of the ligand (130 ± 20 s-1) and protein (98 ± 8 s-1) in this example are faster than those above but remain self-consistent to affirm a correlation between ordering of the lid and binding of the ligand. Both ligands also protect the protein from limited proteolysis, as expected from their ability to stabilize a compact lid structure. However, the minimal turnover of simple phenol substrates indicates that such stabilization may be necessary but is not sufficient for efficient catalysis.

Enhancing Lower Eyelid Suspension Outcomes Through Pre-surgical Facial Nerve Reanimation: A Comparative Study.

Lower eyelid suspension, a common therapeutic procedure for facial paralysis-induced eyelid retraction, faces challenges due to high recurrence in patients lacking facial muscle function and impedes wider adoption. This research aims to explore the potential effects of restoring orbicularis oculi muscle tension through facial nerve reanimation prior to lower eyelid suspension and to define the indications for lower eyelid suspension. The study encompassed 32 individuals with complete facial paralysis, segmented into group A (reanimation group) and group B (non-reanimation group), based on whether the orbicularis oculi muscle's tension was restored through facial nerve reconstruction prior to lower eyelid suspension. Subjective assessments of eyelid closure (the inter-eyelid gap upon gentle closure) and objective methods measures of scleral show (the distance from the pupil's center to the lower eyelid margin, MRD2) were used to provide a comprehensive analysis of long-term effectiveness. The group A exhibited significantly greater long-term improvement in lagophthalmos and lower eyelid ectropion. The alterations in MRD2 measured 2.66 ± 0.27mm in the group A versus 2.08 ± 0.53 mm in the group B, denoting a statistically significant variance (p < 0.001). Moreover, while the ratio of MRD2 preoperative 6 months postoperative revealed no significant difference between groups, a significant difference emerged in 12 months postoperative (group A: 1.02 ± 0.21; group B: 1.18 ± 0.24; p < 0.05), with the values in group A closer to 1, indicative of enhanced symmetry. Restoring the tension in the orbicularis oculi muscle through facial nerve reconstruction prior to palmaris longus tendon sling could effectively sustain long-term outcomes of lower eyelid retraction correction and reduce the recurrence rate. 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 .

Dynamic Eye Closure Restoration in Facial Palsy with Neurotized Platysma Muscle Graft in Rats.

One of the most devastating deficits of facial paralysis is eyelid dysfunction, which is controlled by the orbicularis oculi muscle (OOM), as it leads to loss of the protective mechanism of the eye. This study used a rat model to assess the functional outcomes of neurotized platysma muscle grafts (PMGs) for OOM replacement. Forty male Sprague-Dawley rats with iatrogenic right eyelid dysfunction were divided into five groups: one control group and four groups utilizing PMG with different sources of nerve innervation. Eyelid function recovery was assessed at 2, 4, 6, and 8 weeks. The PMGs were harvested for pathological examination at the end of the study. All rats except those in the control group and one from the group using ipsilateral frontal and upper zygomatic frontal nerve branches directly neurotized to the PMG (nerve-to-muscle) recovered eyelid closure function within 8 weeks of the study period. The mean recovery time was 3.87 ± 1.28 weeks. A total of 87.5% of rats that had the contralateral zygomatic branch as the donor nerve regained the consensual corneal reflex (p-value < 0.001). Replacement of neurotized PMG for OOM function is successful in a rat model. Using the upper zygomatic branch as the donor nerve, it was possible to restore the consensual corneal reflex. This method shows promise for further human studies.