Eyelid Research Articles

Globe Subluxation in the Specialty Contact Lens Practice

Purpose. This report documented the occurrence of globe subluxation (GSL) during the insertion of a scleral contact lens (SL) and described the management of two keratoconus patients, in need of a gas permeable contact lens prescription and experiencing GSL. Furthermore, an anatomical explanation for the occurrence of spontaneous GSL is attempted. Material and Methods. Two separate case reports of GSL were evaluated and described. In case 1, the patient experienced GSL secondary to insertion of a trial SL and in case 2 the patient had experienced multiple GSLs secondary to Grave’s disease. Different management strategies were taken to help to provide functional vision for these patients. In case 1, the patient was fitted with a smaller corneal gas permeable lens to minimize lid manipulation needed to insert a lens and provide effective correction. In case 2, the patient’s existing Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) SL was designed to increase vertical lens steepness to tighten the lens fit and minimize the chance of losing the lens during wear. Results. With the help of the individually fitted contact lenses, it was possible to achieve visual rehabilitation in accordance with the patient’s specific needs. Conclusion. SL are fitted with increasing frequency and tend to require excessive lid manipulation, which may lead to GSL. This small case series demonstrated different lens design and selection maybe utilized to minimize the occurrence of GSL. The superior septum orbitale is perforated several times across the width of the upper lid by the aponeurosis of the levator. This structural arrangement weakens the superior septum orbitale and, postulated here, predisposes the eye to GSL by a herniation primarily of the superior septum orbitale.

Vision preserving role of radiotherapy in orbital plasmablastic lymphoma

An uncommon but aggressive variant of diffuse large B-cell lymphoma is plasmablastic lymphoma (PBL). Although they primarily involve the gastrointestinal tract, lymph nodes, and oral mucosa of immunocompromised males, orbital presentation is rare. In this article, we report a case of an elderly, immunocompetent gentleman presenting with progressive proptosis, ptosis, and diminished vision of the right eye with a palpable mass in the right upper eyelid. Imaging and biopsy confirmed the rare diagnosis of orbital PBL. After obtaining institutional tumor board concurrence, the patient was delivered 45 Gy external beam radiation therapy followed by six cycles of chemotherapy. Post-therapy, he is in remission with improvement in vision and is currently on maintenance chemotherapy.

The effect of type 2 diabetes mellitus on lid wiper epitheliopathy and ocular surface parameters

IntroductionThis cross-sectional study was conducted to investigate the impact of type 2 diabetes mellitus(DM) and its duration on indicators such as lid wiper epitheliopathy(LWE), and to assess the significance of LWE for early diagnosis of dry eye disease(DED) in DM patients. MethodsA total of 137 subjects with ocular surface disease index(OSDI) score ≥13 were divided into the non-DM group, the short-term DM group (duration <5 years), and the mid-to-long-term DM group(duration ≥5 years). Evaluations were conducted for LWE, OSDI, lipid layer thickness (LLT), partial blinking rate (PBR), fluorescein tear breakup time (FTBUT), corneal fluorescein staining score (CFS), eyelid margin score, and meibomian gland dropout (MGd). ResultsThe upper-LWE score and total LWE score in the mid-to-long-term group were higher than those in the non-DM group (p = 0.008 and p = 0.031, respectively). The lower-LWE scores were more severe than upper-LWE scores in the non-DM and short-term groups (p = 0.001 and p = 0.045, respectively).The confirmed diagnosis rate of DEWSII dry eye with LWE as the primary diagnostic indicator was significantly higher than that which utilize FTBUT<5s as the primary diagnostic indicator(p < 0.05). Compared to the non-DM group, the LLT was thinner and the MGd was more severe in the mid-to long-term group. The upper-LWE score was moderately positively correlated with the MGd, and the lower LWE score was moderately negatively correlated with LLT. ConclusionLWE, LLT, and MGd worsen with the progression of diabetes. Additionally, changes in LWE may precede the FTBUT, indicating that LWE could be considered as an important indicator for early diagnosis of DED in diabetic patients.

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.

Modern Approach to Diabetic Retinopathy Diagnostics.

This article reviews innovative diagnostic approaches for diabetic retinopathy as the prevalence of diabetes mellitus and its complications continue to escalate. Novel techniques focus on early disease detection. Technological innovations, such as teleophthalmology, smartphone-based photography, artificial intelligence with deep learning, or widefield photography, can enhance diagnostic accuracy and accelerate the treatment. The review highlights teleophthalmology and handheld photography as promising solutions for remote eye care. These methods revolutionize diabetic retinopathy screening, offering cost-effective and accessible solutions. However, the use of these techniques may be limited by insurance coverage in certain world regions. Ultra-widefield photography offers a comprehensive view of up to 80.0% of the retina in a single image, compared to the 34.0% coverage of the traditional seven-field imaging protocol. It allows retinal imaging without pupil dilation, especially for individuals with compromised mydriasis. However, they also have drawbacks, including high costs, artifacts from eyelashes, eyelid margins, and peripheral distortion. Recent advances in artificial intelligence and machine learning, particularly through convolutional neural networks, are revolutionizing diabetic retinopathy diagnostics, enhancing screening efficiency and accuracy. FDA-approved Artificial Intelligence-powered devices such as LumineticsCore™, EyeArt, and AEYE Diagnostic Screening demonstrate high sensitivity and specificity in diabetic retinopathy detection. While Artificial Intelligence offers the potential to improve patient outcomes and reduce treatment costs, challenges such as dataset biases, high initial costs, and cybersecurity risks must be considered to ensure safety and efficiency. Nanotechnology advancements further enhance diagnosis, offering highly branched polyethyleneimine particles with fluorescein sodium (PEI-NHAc-FS) for better fluorescein angiography or vanadium oxide-based metabolic fingerprinting for early detection.

Single-stage Differential Template Technique for the Repair of Palpebral Neurofibromatosis With Severe Blepharoptosis in Adults.

To report the surgical outcomes of single-stage differential template technique for the correction of palpebral neurofibromatosis associated with severe blepharoptosis in adults. This is a retrospective interventional case series. Adult patients with severe unilateral palpebral neurofibromatosis, severe blepharoptosis, and lateral canthal dystopia underwent a single-stage repair. The excess anterior and posterior lamellae of the eyelid tissue were excised in a differential manner, using the other eyelid as a template (differential template technique). The levator muscle was resected and reattached to the tarsus during the reconstruction. The surgical outcomes and complications were evaluated. A total of 5 patients underwent the differential template technique. The median age at presentation was 24 years, and 4 were males. All had severe blepharoptosis, with excess upper eyelid and temporal plexiform neurofibroma. All underwent a single-stage procedure with an average follow-up of 17.8 months. The average palpebral fissure height improved from 0 mm preoperatively to 8.25 mm postoperatively, with a well-formed eyelid crease and an average lagophthalmos of 2 mm. Good functional and cosmetic outcome was noted in all patients, with no exposure keratopathy. Two patients had a lateral canthal "stand-off," and 1 patient developed mild upper eyelid retraction, which was managed conservatively. A single-stage differential template technique can correct palpebral neurofibromatosis with severe blepharoptosis providing good cosmetic and functional outcomes.

A case of adnexal cutaneous leishmaniasis in Washington DC

PurposeTo report a rare non-endemic case of Leishmania aethiopica in Washington DC.Case reportA 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms.ConclusionThis case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment.

Effectiveness of an Acupuncture Steam-Warming Eye Mask on Dry Eye Disease in Visual Display Terminal Users: A Prospective Randomized Controlled Trial.

We aim to evaluate the effectiveness of an acupuncture steam-warming eye mask (ASEM) on dry eye disease (DED) in visual display terminal (VDT) users. This prospective randomized clinical trial included VDT users with DED-related features who were randomly assigned to the ASEM group (ASEM for 2 weeks, 20 participants) or the steam-warming eye mask (SEM) group (SEM for 2 weeks, 20 participants). The tear film break-up time (TBUT), Schirmer test, tear meniscus height, ocular surface staining scores, eyelid and meibomian gland exam, subjective symptoms, and quality of life (QoL) scores before and after treatment were collected. A generalized linear mixed model was applied to compare the improvement of symptoms and signs between the two groups. After the 2-week treatment, all the subjective symptoms and questionnaire scores in the ASEM group improved significantly (all p < 0.05), whereas the feelings of relaxation, comfortable, and refreshment did not change in the SEM group (both p > 0.05). The TBUT, tear meniscus height, and meibum quality in the lower eyelid were significantly better in the ASEM group than the SEM group (all p < 0.05), whereas no significant changes were observed in the Schirmer test and ocular surface staining scores. Compared with the SEM group, the ASEM group experienced a stronger feeling of refreshment (p = 0.013), lower sensation of ocular discharge (p = 0.031), higher TBUT (p = 0.045), better meibomian gland expressibility of both eyelids (both p < 0.05), and better meibum quality of both eyelids (both p < 0.05), even after adjustments for age and sex. In conclusion, comparing with SEM, ASEM can improve some subjective DED symptoms, tear film stability, and meibum status in VDT users.

The Use of Oxymetazoline 0.1% Ophthalmic Solution for Acquired Blepharoptosis: A Systematic Review.

Oxymetazoline hydrochloride has been shown to be effective in some studies for acquired blepharoptosis and for aesthetic upper eyelid elevation. This study aims to systematically review the literature on the use of topical oxymetazoline for treating acquired blepharoptosis. PubMed (U.S. National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and Cochrane. A systematic review of studies published between 2013 and 2024 following PRISMA guidelines was performed using the PubMed, Scopus, and Cochrane databases. Primary outcomes included pre- to posttreatment change in marginal reflex distance (MRD1) after treatment with topical oxymetazoline, and mean difference (pre-to-posttreatment) in MRD1 versus control. Five articles included data from 458 patients for analysis. Meta-analysis demonstrated significant improvement in MRD1 measurements posttreatment with oxymetazoline (1.40 mm; 95% confidence interval, CI [0.41 mm, 2.40 mm]). In addition, when compared to controls, patients treated with oxymetazoline demonstrated greater increase in MRD1 values (0.83 mm; 95% CI [0.10 mm, 1.55 mmm]). Heterogeneity, measured by I2 statistic, was high in all studies (85%-95%). The use of oxymetazoline 0.1% ophthalmic solution significantly improves MRD1 in patients with acquired blepharoptosis. Further studies comparing this treatment in other etiologies of acquired blepharoptosis should be conducted. Laryngoscope, 2024.

Quantitative and Aesthetic Analysis of Changes in Eyebrow Position After Subbrow Blepharoplasty.

Narrowing of the distance between the eyes and eyebrows is commonly observed after subbrow blepharoplasty. The purpose of this study was to quantify the changes in brow-lid distance after subbrow blepharoplasty in Asian women. We observed and standardized the pre- and postoperative photographs of 63 patients who underwent subbrow blepharoplasty from January 2020 to October 2022. We measured the distances from the medial and lateral eyebrow to the lower lid margin on the right side of the face and then analyzed the changes in postoperative brow-lid distance using the standard iris diameter for Asian women of 11.5mm as a reference. Photographs of 63 patients were included in the study. All 63 patients were females. The average postoperative distance of the lateral eyebrow to the lower lid margin was 30.08 ± 2.74mm, a significant decrease in comparison to the preoperative distance (31.84 ± 2.65mm) (P < 0.001). The mean postoperative distance of the medial eyebrow to the lower lid margin was 25.84 ± 2.87mm, compared with that of the preoperative distance (27.59 ± 2.94mm), which was a significant decrease (P<0.001). All 63 patients (100%) had a decrease in the lateral eyebrow distance, while 59 (93.65%) had a decreased medial eyebrow distance. There was a statistically significant change in brow position, consistent with our observations. Subbrow blepharoplasty can cause a decrease in the distance between the eyebrows and eyes. 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 .

The effect of intense pulsed light combined with topical 0.05% Cyclosporin A eyedrops in the treatment of Sjögren’s syndrome related dry eye

ABSTRACT Objectives This study aimed to assess the effectiveness and safety of intense pulsed light (IPL) therapy plus topical 0.05% cyclosporine A (CsA) eye drops to treat Sjögren’s Syndrome-related dry eyes (SS-DE). Research design and methods In this prospective, randomized trial included, 60 individuals with SS-DE symptoms were randomized to receive topical eye drops containing either 0.1% sodium hyaluronate (Group S) or 0.05% CsA (Group C) plus IPL therapy. Before the first treatment (baseline), and at 12, 16, and 20 weeks after treatment commencement, we assessed the best corrected visual acuity (BCVA), the Ocular Surface Disease Index (OSDI) score, the Schirmer I test (SIT), noninvasive tear breakup time (NBUT), corneal fluorescein staining (CFS), meibomian gland (MG) dropout, lid margin abnormality, MG expressibility, and meibum quality. Results Both groups showed significant improvements in the OSDI, NBUT, CFS, MG expressibility, and meibum quality (all p < 0.05). Group C showed a greater increase in OSDI, NBUT, MG expressibility, and meibum quality (all p < 0.05). Moreover, SIT and lid margin abnormalities significantly improved in Group C (both p < 0.05), but not in Group S. Conclusion Treatment with 0.05% CsA eyedrops plus IPL therapy could significantly reduce the issues and physical discomfort of patients with SS-DE. Clinical Trial Registered on 20 July 2021, with the registration number ChiCTR2100049059.

Clinical characterization and long-term postoperative outcomes of retinoblastoma patients receiving enucleation and primary orbital implantation in early infancy: an observational study

ObjectivesTo retrospectively investigate clinical characterization and the long-term postoperative outcomes of retinoblastoma (RB) patients receiving enucleation with primary orbital implantation in early infancy (0–6 months old).MethodsThe clinical and follow-up data of 42 RB patients receiving enucleation with primary orbital implantation in early infancy at Beijing Tongren Hospital from December 2009 to January 2020 were analysed. The average follow-up time was 83 months. The patient group included 24 males and 18 females, 30 unilateral and 12 bilateral cases. A total of 44 eyes with 10 in stage D and 34 in stage E underwent 40 unilateral and 2 bilateral surgeries. 17 RB eyes received hydrogel and 27 RB eyes received hydroxyapatite implants. This study was performed by following the guideline of STROBE.ResultsEnucleation combined with primary orbital implantation promoted survival and was safe with few and minor complications such as increased secretion, upper eyelid ptosis, and sunken eye sockets which were not affected by stages, lateralities, or implant materials. 55-80% RB patients exhibited satisfactory appearance and obvious or moderate motility of orbital implants according to the evaluation by doctors and family members. Family members were likely more optimistic about the appearance and more pessimistic about motility of the orbital implantation than doctors did.The quality of life was high as indicated by PedsQL3.0 or PedsQL4.0 scores ( ≧ 90 for > 75% patients). It was not affected by the stages, laterality, and implant materials, nor affected by the appearance and motility of the implants.ConclusionsThe outcomes of the combination of enucleation and primary orbital implantation for pertinent RB patients in early infancy are generally satisfactory with few and minor complications, high safety, appearance, and overall quality of life. Enucleation combined with primary orbital implantation in early infancy benefits pertinent RB patients in appearance, survival, and quality of life.

Three-dimensional computer navigation in the reconstruction of complex unilateral orbital fractures: evaluation and review of applications.

The eyes are the central aesthetic unit of the face. Maxillofacial trauma can alter facial proportions and affect visual function with varying degrees of severity. Conventional approaches to reconstruction have numerous limitations, making the process challenging. The primary objective of this study was to evaluate the application of three-dimensional (3D) navigation in complex unilateral orbital reconstruction. A prospective cohort study was conducted over 19 months (January 2020 to July 2021), with consecutive enrollment of 12 patients who met the inclusion criteria. Each patient was followed for a minimum period of 6 months. The principal investigator carried out a comparative analysis of several factors, including fracture morphology, orbital volume, globe projection, diplopia, facial morphic changes, lid retraction, and infraorbital nerve hypoesthesia. Nine patients had impure orbital fractures, while the remainder had pure fractures. The median orbital volume on the normal side (30.12 cm3; interquartile range [IQR], 28.45-30.64) was comparable to that of the reconstructed orbit (29.67 cm3; IQR, 27.92-31.52). Diplopia improved significantly (T(10) = 2.667, p = 0.02), although there was no statistically significant improvement in globe projection. Gross symmetry of facial landmarks was achieved, with comparable facial width-to-height ratio and palpebral fissure lengths. Two patients reported infraorbital hypoesthesia at presentation, which persisted at the 6-month follow-up. Additionally, five patients developed lower lid retraction (1-2 mm), and one experienced implant impingement at the infraorbital border. Our study provides level II evidence supporting the use of 3D navigation to improve surgical outcomes in complex orbital reconstruction.

Use of oxymetazoline hydrochloride ophthalmic solution, 0.1% for improved lid symmetry in Graves’ disease

ABSTRACT Purpose The purpose of this study is to evaluate the usage of oxymetazoline hydrochloride ophthalmic solution, 0.1% in the treatment of Graves’ disease to improve lid symmetry. Methods Fourteen patients were identified with unilateral upper eyelid retraction, secondary to Graves’ disease. A phenylephrine test was performed to evaluate whether treating the unaffected (non-retracted) side would result in improved symmetry using Hering’s law. Patients were prescribed oxymetazoline hydrochloride ophthalmic solution, 0.1% to instill into the unaffected eye. Marginal reflex distance 1 (MRD1) measurements were taken pre- and post-treatment and patient satisfaction surveys were completed. Results The average pre-treatment MRD1 difference between the right eye (OD) and the left eye (OS) was 2.46 [range 1.50–4.00]. The average post-treatment MRD1 difference between OD and OS was 0.39 [range 0.00–1.00]. One hundred percent of patients were satisfied or very satisfied with the improvement in symmetry. Conclusions Oxymetazoline hydrochloride ophthalmic solution, 0.1% is a potential method to improve symmetry in patients with Graves’ disease and unilateral upper eyelid retraction via Hering’s law, especially for non-surgical candidates or those who prefer non-surgical treatment. Our results indicate improved MRD1 differences between fellow eyes and patient satisfaction regarding the symmetry of the upper eyelids.

The Utility of Preoperative Phenylephrine Testing in Müller Muscle Conjunctival Resection Surgery for Involutional Ptosis.

Phenylephrine testing prior to Müller muscle conjunctival resection has traditionally been used to predict postoperative outcomes. The purpose of this study is to determine if preoperative phenylephrine testing impacts postoperative changes in eyelid position. In this multicenter cross-sectional cohort study, 270 eyelids of participants with involutional ptosis and levator function >12 mm who underwent Müller muscle conjunctival resection were divided into 2 comparison groups. Participants who had preoperative phenylephrine testing served as the control group and those who did not were the study group. The primary outcome measure was postoperative marginal reflex distance from the upper eyelid margin (marginal reflex distance 1 [MRD1]) at the latest follow-up visit. Secondary outcomes included change in MRD1, reoperation rate, and predictive capacity of preoperative phenylephrine testing. Of the 270 eyelids that underwent Müller muscle conjunctival resection, 116 eyelids served as controls and 154 were in the study group. Mean age of participants was 62.6 years. Levator function, resection length, preoperative MRD1, change in MRD1, and latest postoperative MRD1 measures when compared in the control and study groups demonstrated no significance (p > 0.05) via 2-tailed t-test. Postoperative MRD1 was correctly predicted within 1 mm for 60.2% of eyelids that underwent preoperative phenylephrine testing. Preoperative phenylephrine testing does not significantly predict postoperative eyelid elevation following Müller muscle conjunctival resection. Surgeons may thereby reassess the utility of preoperative phenylephrine testing given the lack of influence on surgical outcomes.

Superior rectus/levator complex in acquired anophthalmic socket repaired with spheric implant-a computed tomography scan and topographic study.

To determine whether the levator palpebrae superioris (LPS)/superior rectus (SR) muscle complex, can influence the position of the upper lid and fornix in acquired anophthalmic sockets. This comparative non-randomized and non-interventional study included retrospective data of 21 patients with unilateral acquired anophthalmic sockets repaired with spheric implants. High-resolution computed tomography (CT) measurements of the LPM/SR muscle complex and clinical topographic position of the upper lid, superior and inferior fornix depth in primary gaze position were evaluated. Demographic data were presented as frequency and percentage proportions and quantitative variables comparing the socket measurements with the normal contralateral orbit was statistically analyzed using non-parametric tests considering P<0.05. The anophthalmic orbits had a significantly shorter LPS length (P=0.01) and significantly thicker SR (P=0.02) than the normal orbit. Lagophthalmos was present in anophthalmic sockets but not in normal orbits (P=0.002), while levator function was normal in both (P>0.05, all comparisons). The superior fornix depth was similar in the anophthalmic socket and the contralateral normal orbit (P=0.192) as well the inferior fornix depth (P=0.351). Acquired anophthalmic sockets repaired with spheric implants have shorter LPS, thicker SR, and more lagophthalmos than normal orbits. The relationship of the LPS and SR with other orbital structures, associated with passive or active forces acting in the final position of the lids and external ocular prosthesis should be further investigated.

Ocular and Systemic Pharmacokinetics of Lotilaner Ophthalmic Solution, 0.25%, Following a Single Dose or Repeated Doses in Dutch-Belted Rabbits.

Purpose: To evaluate the ocular and systemic pharmacokinetics of lotilaner ophthalmic solution, 0.25%, following bilateral topical ocular administration of single and repeated doses in rabbits. Methods: Dutch-belted rabbits (n = 34) were administered lotilaner ophthalmic solution, 0.25%, eye drops, either in a single bilateral dose (Group 1) or twice a day bilaterally for 7 days and once on Day 8 (Group 2). The pharmacokinetics and tissue distribution levels of lotilaner were assessed following the single dose in Group 1 and the last dose in Group 2. The drug levels were examined in various ocular tissues and whole blood. The maximal concentration of the drug (Cmax), time to maximal concentration, the terminal phase elimination half-life, the area under the concentration-time curve (AUC), and total clearance of the drug were determined. Results: In the eyelid margins, lotilaner exhibited the highest observed concentrations at 0.25 hour (h), presenting a mean Cmax of 14,600 ng/mL in Group 1 and 20,100 ng/mL in Group 2. The highest AUC was in the eyelid margin at 242,000 h×ng/mL in Group 1 and 535,000 h×ng/mL in Group 2. In the eyelid margin, the observed clearance rate (0.634 mL/h in single dose, 0.288 mL/h in repeat dose) was the slowest among all ocular tissues in both groups, with the longest half-life of 152 h (∼6.3 days) observed in the repeat dose group. Conclusions: Lotilaner ophthalmic solution, 0.25%, demonstrated rapid ocular tissue absorption into the eyelid margin tissue with a long half-life of almost a week. No adverse effects were observed following topical ocular administration in Dutch-belted rabbits.

Comparison of Two Doses of Botulinum Toxin A for Dry Eye Treatment by Injection into the Medial Lower Eyelid: A Randomized, Comparative Pilot Study

Comparison of Two Doses of Botulinum Toxin A for Dry Eye Treatment by Injection into the Medial Lower Eyelid: A Randomized, Comparative Pilot Study

A jugular venous compression adjunct for surgical excision of distensible orbital venous malformations

ABSTRACT Purpose Orbital venous malformations (VM) pose challenges in complete resection due to indistinct borders and bleeding proclivity. Current methods for aiding surgical excision of distensible orbital venous malformations are inadequate. We investigated whether external neck compression could facilitate intraoperative distension of venous orbital lesions during surgical excision in patients diagnosed with VM. Methods Eighteen patients (8 males and 10 females) diagnosed with distensible venous anomalies were enrolled. Neck compression technology, was employed to distend the lesions before puncture embolization using n-butyl-2-cyanoacrylate glue under general anesthesia. The surgical process, along with preoperative to postoperative changes in ocular symptoms, were recorded. Results The average surgical duration was 95 min. A mean of 3.41 ml surgical glue was used for embolization. The compression belt maintained pressure at 35–40 mmHg. Total lesion resection was achieved in 12 patients, with 6 patients undergoing subtotal removal not requiring supplementary surgery. Symptoms were entirely alleviated in 17 patients, and signs of distensible lesions during the Valsalva maneuver were absent. One patient underwent secondary surgery for residual eyelid lesions. Minor complications included mild ocular movement restriction, residual subcutaneous induration, transiently increased orbital pressure, and lower lid ectropion in four, three, four, and one patient, respectively. Three patients experienced a mild post-operative visual acuity decrease, although none experienced vision loss. Conclusions Direct orbital embolization aided by a jugular vein compression device is safe and demonstrates satisfactory outcomes in orbital varicose vein treatment.

Effects of Upper Eyelid Blepharoplasty on Perceived Attractiveness, Success, and Health.

This study aims to evaluate the impact of upper eyelid blepharoplasty on perceived age, attractiveness, success, and overall health as rated by observers. A web-based survey was conducted with 203 observers who were unaware of the study's purpose. They assessed pre- and post-operative images of 12 female patients using the Delphi method to ensure appropriate image selection and unbiased ratings. Observers rated the images on a visual analog scale from 0 to 10, where higher scores indicated more favorable perceptions. The observer group consisted of 108 females (53.2%) and 95 males (46.8%), with an age range of 18 to 61 years. The mean age perceived by observers decreased from 51.75 before surgery to 42.10 after surgery, indicating a significant reduction in perceived age (p=0.01). Additionally, post-surgical assessments showed significant increases in perceived attractiveness, success, and overall health. Upper eyelid blepharoplasty significantly enhances how patients are perceived in terms of youthfulness, attractiveness, and success. These findings underscore the positive impact of cosmetic eyelid surgery on public perception.