Eyelid Research Articles

Application of Facial Expression Analysis Technology in Violence Risk Assessment of Individuals with Mental Disorders in Supervised Settings.

To explore the association between violent behaviors and emotions in individuals with mental disorders, to evaluate the application value of facial expression analysis technology in violence risk assessment of individuals with mental disorders in supervised settings, and to provide a reference for violence risk assessment. Thirty-nine male individuals with mental disorders in supervised settings were selected, the participant risk of violence, cognitive function, psychiatric symptoms and severity were assessed using the Modified Overt Aggression Scale (MOAS), the Historical, Clinical, Risk Management-Chinese version(HCR-CV), the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). An emotional arousal was performed on the participants and the intensity of their emotions and facial expression action units was recorded before, during and after the arousal. One-way analysis of variance (ANOVA) was used to compare the differences in the intensity of emotions and facial expression action units before, during and after the arousal. Pearson correlation analysis was used to calculate the correlations between the intensity of the seven basic emotional facial expressions and the scores of the assessment scales. The intensity difference of sadness, surprise and fear in different time periods was statistically significant (P<0.05). The intensity of the left medial eyebrow lift action unit was found significantly different before and after the emotional arousal (P<0.05). The intensity of anger was positively correlated with the Modified Overt Aggression Scale score throughout the experiment (P<0.05). Eye action units such as eyebrow lifting, eyelid tightening and upper eyelid lifting can be used as effective action units to identify sadness, anger and other negative emotions associated with violent behaviors. Facial expression analysis technology can be used as an auxiliary tool to assess the potential risk of violence in individuals with mental disorders in supervised settings.

The current alternative for ocular surface and anophthalmic socket reconstruction, cryopreserved umbilical amniotic membrane (cUAM).

This report presents the results of using cryopreserved umbilical amniotic membrane (cUAM) as an alternative mucosal graft for ocular surface reconstruction in cases of anophthalmic socket contracture (ASC), cicatricial entropion (CE), and conjunctival-scleral defects. The study included patients who underwent non-commercial implantation of cUAM grafts (prepared by corneal banking methods) for ASC, CE, conjunctival defect, and scleral melting. The main success criteria for this study were the comfortable fitting of the ocular prosthesis in ASC patients, the natural eyelid position in CE patients, and the degree of conjunctivalisation in melting patients. cUAM transplantation was performed in 2 patients who could not use a prosthetic eye due to conjunctival contracture, 2 patients with CE, and 1 patient with conjunctival defect and 1 patient with conjunctival-scleral melting. The primary outcome was achieved in 83.3% (5/6) of patients. In one patient with CE, partial healing was achieved due to the persistence of CE in the medial upper eyelid. cUAM is a viable alternative to mucosal grafting for reconstructing the bulbar and palpebral conjunctival surface, fornix, and orbit, with reduced donor morbidity and shorter surgical time. Its regenerative ability allows for tissue defect healing and improves cosmetic appearance through epithelialization within weeks.

Upper and Lower Eyelid Malignancies: Differences in Clinical Presentation, Metastasis, and Treatment.

Approximately 5-15% of all dermatologic malignancies manifest in the upper and lower eyelids. The primary types include basal cell carcinoma, squamous cell carcinoma, and sebaceous cell carcinoma, with Merkel cell carcinoma and melanoma following closely behind. Basal cell carcinoma predominantly affects the lower eyelid, yet various other carcinomas, melanomas, metastases, and neoplasms of diverse origins can arise on both upper and lower eyelids. Risk factors such as advanced age, smoking, and notably, exposure to UV light significantly contribute to the development of these eyelid lesions. Despite the increasing incidence, research on dermatologic eyelid malignancies remains limited. However, such study is imperative given that many systemic oncologic malignancies initially present as metastatic eyelid lesions. This paper provides an in-depth exploration of eyelid anatomy, clinical presentation, diagnosis, and treatment management.Key Points: Eyelid metastases represent less than one percent of all eyelid cancers, yet they often serve as the initial indication of an underlying systemic malignancy. Early detection and treatment is crucial in improving prognosis and quality of life for patients. Treatment options encompass a range of modalities, with Mohs surgery as the gold standard for the removal of ocular tumors. Additional treatment options include local excision as well as non-surgical interventions such as radiotherapy, cryotherapy, immunotherapy, and topical medications.

Upper Eyelid Blepharoplasty: An Aesthetic and Functional Repair

Upper blepharoplasty is a popular cosmetic surgery technique, with a yearly demand growth of 6%. It is primarily performed on women, aged between 50 and 70, to rejuvenate the look, enhance the supratarsal crease, and rectify contour abnormalities. The procedure also has functional advantages, such as enhancing the upper field of vision and reducing ptosis. In a clinical scenario, patients with eyelid scars experienced eyelid retraction, lagophthalmos, and ulcerative keratitis. Initially, supportive care was performed, followed by surgical treatment, including scar band release, full-thickness skin graft, eyelid closure, and tarsorrhaphy. Positive results included an expanded visual field, improved quality of life, reduced headaches, and enhanced eyesight. However, further investigation is needed due to contradictory findings and lack of scientific data. We present an interesting case of a patient in whom reconstruction was performed for aesthetic-functional purposes.

Impact of refresher training on the outcomes of trachomatous trichiasis surgery

Background/aimsTrachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher...

Comparison of Intense Pulsed Light Treatments including Upper Lid or Lateral Canthus in Patients of Meibomian Gland Dysfunction.

Background: To determine the differences in the effects of intense pulsed light (IPL) treatment when including the upper and lower lid or lateral canthus area in patients with meibomian gland dysfunction (MGD). Methods: Patients who underwent three IPL treatment sessions at 3-week intervals were divided into three groups according to the treatment sites: group A, lower lid; group B, upper and lower lids; and group C, lower lid and lateral canthal area. Before and after the IPL treatment sessions, we obtained the lid abnormality score (LAS), meibum expressibility (ME), meibum quality (MQ), lipid layer thickness (LLT), type I Schirmer test (ST), tear break-up time (TBUT) test, corneal fluorescein staining scores (CFSs), and Ocular Surface Disease Index (OSDI). Results: IPL treatment significantly improved LASs, ME, MQ, TBUT, CFS, and OSDI values in all groups. Differences in LAS values before and after IPL treatment were significantly greater in groups B and C than those in group A. Conclusions: IPL treatment encompassing the upper lid and lateral canthus together with the lower lid elicited additional improvement in patients with MGD. The additional effect on treating the lateral canthus was similar to the effect observed on the additional treatment of the upper lid.

Giant conjunctival melanoma with rich vascularization causing persistent bleeding.

The present study reported a rare case of persistent bleeding caused by conjunctival melanoma containing abundant vascular channels. A 44-year-old Japanese woman presented with a left upper eyelid nodule in February 2023. A pigmented conjunctival mass was present in the upper palpebral conjunctiva. Enhanced computed tomography demonstrated marked enhancement in the left eyelid in the artery phase, indicating hemangioma. The patient suffered blunt trauma to the face in May 2023 and continuous bleeding occurred. Doctors in the emergency room attempted hemostasis by diathermy and suture, but the bleeding could not be stopped. The patient eventually underwent emergent orbital exenteration of the left eye. At high magnification of the histology sample of the bleeding site, small-to-large vascular channels with various vascular lumens made up of endothelial cells within the conjunctival melanoma tissue could be observed. The tumor cells were positive for SOX10, Melan A, S100 and HMB45. We herein propose a novel variant of conjunctival melanoma with rich vascularization, clinically causing persistent bleeding.

Lid Margin Microbiome in Stevens-Johnson Syndrome Patients With Lid Margin Keratinization and Severe Dry Eye Disease.

The current study evaluated the lid margin microbiome of keratinized lid margins of patients with chronic Stevens-Johnson syndrome (SJS) and compared it with healthy controls and historically reported lid margin microbiome of patients with meibomian gland dysfunction (MGD). Eyelid margin swabs of 20 asymptomatic adults (mean age = 29 ± 12years) and 10 patients with chronic SJS (mean age = 31.2 ± 14years) with lid margin keratinization were sequenced using next generation of 16S rDNA V3 to V4 variable region. Within SJS, the keratinized lid margin microbiome was compared with adjacent eyelid skin. All patients had obstructive MGD, and mean Schirmer I value was 2.8 ± 1.9 mm. The phyla were similar in two groups, whereas at the genera level, an increase in the relative abundance of Corynebacterium, Haemophilus, Azotobacter, and Afipia and a decrease of Acinetobacter was noted in SJS compared to healthy lid margins. SJS-associated microbiota displayed lesser diversity and more heterogeneity than healthy controls. The Principal Components Analysis (PCA) plot revealed wide separation in the SJS and the control groups. Correlational network analysis revealed Corynebacterium and Sphingomonas forming a major hub of negative interactions with other bacterial genera in the SJS group. Significant differences exist in the prevalent genera between keratinized lid margins and historically reported meibum microbiome of patients with MGD. In addition, the eyelid skin of patients with SJS had predominant Staphylococcus, whereas Corynebacterium and Pseudomonas were more in the keratinized lid margins compared to the eyelid skin microbiome. Lid margin microbiome is significantly altered in the keratinized lid margins of patients with SJS compared to the eyelid skin of patients with SJS, normal lid margins, and patients with MGD.

Selection of Optimal Double-Lid Blepharoplasty Based on Asian Upper Eyelid Tissue Structure.

To investigate the postoperative effect of double-lid blepharoplasty based on the histological difference in the upper eyelid of Asian patients. A total of 76 patients with poor bilateral upper eyelid morphology or a single eyelid were included in this study. Different techniques of double-eyelid blepharoplasty were performed based on the thickness of the palpebral tissue. The improved PARK method (group A: 15 participants) was employed for patients with orbicularis oculi muscle being thinner, and the fat bulge of orbital septum was less. The improved traditional method (group B: 52 participants) was employed for patients with hypertrophy of the eyelid skin, orbicularis oculi muscle, and fat bulge in the orbital septum. All 76 patients achieved satisfactory outcomes in a single surgical procedure. Postoperative follow-up ranged from 3 to 6 months. In group A, there was no obvious swelling of flap near the palpebral margin and the double blepharon line becomes shallow. Although some patients in group B experienced varying degrees of bruising in the early postoperative period, all patients returned to a more natural shape 1-3months after surgery. Furthermore, after 3-6months postoperatively, there were no obvious scar adhesion and ladder sensation in the both sides of the incision. Preoperative analysis of the thickness of the upper eyelid tissue is essential to determine the appropriate surgical technique for double-eyelid blepharoplasty. The improved traditional method is recommended for patients with hypertrophy of the upper eyelid tissue (group A), as it minimizes scar adhesion and reduces the stair-step sensation in the lower eyelid tissue during long-term follow-up. For patients with thin upper eyelid tissue, the improved PARK method should be employed to avoid issues such as tissue accumulation, double eyelid crease became shallower, or disappearance. In order to obtain natural and long-term surgical results, different surgical methods should be provided according to the patient's eye tissue condition. 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 ILux® compared to the mechanical meibomian gland expression for the treatment of moderate and severe meibomian gland dysfunction.

To compare the safety and effectiveness of eyelid treatment with the ILux®-MGD Treatment System in one session versus five sessions of mechanical meibomian gland expression (MMGE) in patients with moderate to severe meibomian gland dysfunction (MGD). A prospective, randomized, open-label, and controlled clinical trial that compared one session of the ILux® MGD Treatment System versus five sessions of MMGE in both eyes of 130 patients aged ≥18y with Ocular Surface Disease Index (OSDI) scores ≥13, total meibomian gland scores (MGS) of <15 in the lower eyelid of each eye, and non-invasive tear break-up time (NI-TBUT) <10s, who were randomized 1:1 to ILux® or MMGE. The mean age was 58±17.49y. Baseline total MGS scores in both treatment groups were comparable. During follow-up, there were significant differences in total MGS and per sector with P<0.001. Multivariate analysis was performed using generalized estimating equations corresponding to the generalized linear model for repeated means to determine the treatment relationship with total MGS, NIBUT, and OSDI. There was a significant difference between ILux® and MMGE (P<0.001) at follow-up from the first to the twelfth month in MGS, NI-BUT, and OSDI scores. No adverse events were reported. ILux® treatment compared to MMGE significantly improves symptoms and signs in patients with moderate to severe MGD for one year without adverse events.

Endoscopic Transpterygoid Approach to Meckel’s Cave: Technical Considerations and Retrospective Analysis of a Clinical Series

ObjectiveTumors located within the Meckel's cave (MC) pose a significant surgical challenge. Although several corridors to access this complex region have been described, the endoscopic transpterygoid approach (ETPA) and the endoscopic transorbital superior eyelid approach (ETOA) have emerged in recent years, as viable alternatives to traditional microsurgical transcranial approaches (MTA). To date, there is a limited literature on surgical series considering endoscopic-assisted approaches to the MC. MethodsWe conducted a retrospective analysis of patients with primary MC tumors treated at our Institution between 2015 and 2022, specifically those managed via the ETPA assisted by intraoperative Endoscopic Diving Technique (EDT). Lesion resection extent was evaluated using pre- and post-intervention radiological images and surgical videos. Moreover, a literature review on ETPA was performed. ResultsThis series comprises 7 patients affected by 4 trigeminal schwannomas, 1 benign notochordal cell tumor, 1 dermoid cyst and 1 mesenchymal tumor. In 71 % of cases, trigeminal neuralgia was the presenting symptom. Post-operative clinical improvement was observed in all but one case. Notably, 85.7 % of patients achieved total or near-total resection (NTR), with the remaining case undergoing subtotal resection (STR). No significant intraoperative complications occurred, and no recurrences were observed during the mean follow-up period of 41 months. ConclusionsIn selected cases, the ETPA offers a direct and safe path to lesions located into the MC. This approach circumvents complications and constraints associated with ETOA or MTA. Moreover, the use of the EDT reduces manipulation of critical neurovascular structures, enhancing the efficacy of the ETPA.

Upper Blepharoplasty through Infrabrow Skin Excision to Treat Dermatochalasis with Lateral Hooding and Medial Orbital Fat Loss in Selected Patients.

Dermatochalasis with lateral hooding and medial orbital fat loss are common signs of aging in the upper eyelid. Removing the excess skin in this area through infrabrow skin excision can effectively lift the loose skin of the upper eyelid and minimizes visible scarring. Additionally, we have identified three compartments of orbital fat prolapse based on orbital anatomy. Transferring volume from the lateral compartment to the intermediate region can flatten the lateral upper eyelid and create medial fullness, which ultimately rejuvenates the upper eyelid. This study presents an operative method for correcting age-related changes in the upper eyelid using this technique. A total of 34 eyelids from 17 patients underwent a surgical procedure involving infrabrow skin excision, along with repositioning and lifting of lateral orbital fat. The inclusion criteria consisted of patients with moderate to severe upper eyelid dermatochalasis, coupled with middle fat loss and lateral hooding. To correct lateral hooding and restore midfacial fullness, lateral orbital fat was repositioned to an intermediate position, and the orbicularis oculi muscle was fold-sutured to the corrugator supercilii muscle. The mean age of the patients was 55.59 ± 3.20 years, with a range of 48 to 61 years. The mean follow-up period was 9.94 ± 1.35 months, ranging from 8 to 12 months. Patients were evaluated at 1-month, 3-month, and 6-month intervals. The Strasser system was used to evaluate the surgical outcomes at 3 months. All patients achieved good surgical outcomes, expressed through satisfactory cosmetic improvements, and improved visual field. The procedure effectively corrected lateral hooding and loss of middle orbital fat through infrabrow skin excision. No complications, such as wound dehiscence, lagophthalmos, noticeable scarring, ocular dyskinesia, or sensory changes, were observed. The combination of infrabrow skin excision, repositioning of lateral orbital fat, and lifting of the orbicularis oculi muscle effectively addresses moderate to severe dermatochalasis, lateral hooding, medial fat loss, and improves elasticity of the anterior wall of the upper lid in our patients. This procedure can produce satisfactory and long-lasting aesthetic results with an inconspicuous scar beneath the brow.

Lower Eyelid Reconstruction with Mustardé Flap

Restoring defects in the lower eyelids, particularly those that extend beyond two-thirds, can be challenging, especially after tumor resection. Basal cell carcinoma (BCC) is the most common form of skin cancer, affecting the lower eyelid and inner canthus. Grafts are often combined with flaps for replacing the posterior lamella or anterior lamella. The Mustardé rotational cheek flap is a popular choice for reconstructing the anterior lamella of the lower eyelid, as it meets the basic requirements of an ideal cutaneous flap. This wide-based pedicle flap can support free grafts needed to line the inside of the flap. Other autogenous grafts, such as labial mucosa, hard palate mucoperiosteum, auricular cartilage, and nasoseptal cartilage, have also been used in eyelid reconstruction. However, hard palate mucosa transplants provide uniformity and can be expensive. Hughes procedures are not suitable for individuals with amblyogenic age or one-seeking eyes. Combining a vascular flap with a superior graft like pericranium may provide a viable surgical option for enduring functional and aesthetic outcomes.

Ocular rosacea without facial erythema involvement manifesting as bilateral multiple recurrent chalazions: A case report

BACKGROUND In addition to the non-specific symptomatology of ocular rosacea, currently, there are no reliable diagnostic tests for the disease, which may lead to its misdiagnosis. Here, we report a case of ocular rosacea presenting with multiple recurrent chalazion on both eyelids. CASE SUMMARY A 63-year-old female patient presented with multiple chalazion and dry eyes in both eyes, with no facial erythema. Initial management done were application of steroid eye ointment on both eyelids, hot compresses, and eyelid margin cleaning; noting that there was no relief of symptoms. Surgical excision of the chalazion was done on both eyes, however, bilateral recurrence occurred post-operatively. The pathological studies showed infiltration of a small amount of fibrous tissue with many chronic inflammatory cells. Immunohistochemistry studies were positive for LL-37. Resolution of the chalazion occurred after oral administration of doxycycline and azithromycin. CONCLUSION Our findings show that ophthalmologists should recognize the ocular manifestations of skin diseases.

Understanding of Krimigranthi w.s.r. to Blepharitis

Ayurveda deals with Ashtangas (8 branches of ayurveda) and Shalakya tantra is one among them. Acharya Sushruta has explained seventy-six eye diseases with their medical and surgical management in detail. Krimigranthi is one among the nine Sandhigata Roga which can be correlated to blepharitis based on the signs and symptomatology. The signs and symptoms include a swelling in the lid margin, lodging of organism in the junction of the eyelids and eyelashes to produce severe itching in the lids. These organisms can move along the eyelid junction which can penetrate and affect the Shuklamandala. Blepharitis is said to be the most common chronic inflammatory disease of the lid margin which can occur at any age. The disease is usually bilateral and become chronic with recurrence and relapse associated with seborrhea of scalp, trichiasis and ectropion. Krimigranthi is said to be a Kaphaja Vyadhi and the management constitutes Swedana, Bhedana, Pratisarana, Rasakriya Anjana and also Nidanaparivarjana, following Pathya-Apathya. The selection of the appropriate treatment depends on the Yukti of the physician and following the appropriate treatment methodology can be helpful to remove the disease from the root and also it is helpful to reduce the recurrence rate.

Functional inferior canalicular reconstruction using a monocanalicular probe after tumor resection of the medial third of the lower eyelid

Purpose: To describe a surgical technique for functionally reconstructing a lacrimal drainage duct and to assess its long-term functionality.Methods: This observational review includes six cases involving reconstruction of the inferior canaliculus after surgical resection of lower eyelid carcinoma. Following lesion excision with safety margins, the epithelium of the distal portion of the inferior canaliculus is located and intubated with a monocanalicular probe. Subsequently, the eyelid lamellae are reconstructed without displacing the probe. The Monoka collarette is then sutured using a 10/0 nylon suture. Data collection included anatomic pathology of the lesion and data from ophthalmic examinations at each visit (including epiphora, inferior canalicular irrigation, and fluorescein dye disappearance test (FDDT)), as well as stent extrusion or other complications.Results: No complications were observed during the surgeries. The stents remained in place for an average of 4 months, with no extrusions prior to removal. The mean follow-up period was 4.8 years (SD=2.0), during which no other complications were noted. Only one patient experienced intermittent epiphora, also present in the fellow eye. At the final visit, FDDT was normal in all eyes, and all patients demonstrated patency of the inferior canaliculus upon irrigation.Conclusion: Primary reconstruction of an inferior lacrimal drainage duct following tumor resection can be successfully performed, resulting in favorable functional recovery.

Electroacupuncture for oculomotor nerve palsy after chemotherapy: A case report.

Oculomotor nerve palsy (ONP) is often discovered in the ophthalmology department, manifested as ptosis with the same side, eyeball in the fixed external booth, or accompanied by limited inward, upward, and downward movements. The present case report described the effect of electroacupuncture (EA) on a breast cancer patient with ONP after chemotherapy. A 56-year-old breast cancer patient presented with severe ptosis and fixed right eye exotropia. Besides, it is challenging to perform the movement inward, upward, and downward, and with obvious diplopia. The breast cancer patient was diagnosed with ONP, chemotherapy history. The patient was introduced to acupuncture department to receiving EA treatment. After 12 times of EA treatments, the symptom of ptosis was significantly improved, and the right upper eyelid can lift autonomously as same as the left eye. Besides, the patient's right lateral eye could move freely, and the symptoms of double vision disappeared. The case suggests that EA may be an effective alternative treatment for ONP.

A Comparison between 2-Octyl Cyanoacrylate and Conventional Suturing for the Closure of Epiblepharon Incision Wounds in Children: A Retrospective Case-Control Study.

Background: Tissue adhesive has been widely used in ophthalmic surgery for various procedures, proving both effective and safe. However, no studies have compared the surgical efficacy of the tissue adhesive 2-octyl cyanoacrylate (SurgiSeal®) to that of traditional suture closure in Asian children undergoing surgery for lower lid epiblepharon. Methods: This is a single-center retrospective case-control study. Surgical correction for epiblepharon was performed on 22 patients from November 2019 to May 2023. A total of 20 patients who were followed up for at least 1 month were included for analysis. After standardized epiblepharon surgery, group A underwent wound closure with a subcuticular suture and 2-octyl cyanoacrylate, and group B underwent closure with a 6-O fast-absorbing surgical gut suture. Patients were followed up at 1, 4, and 12 weeks post-surgery. Results: A total of 10 patients (20 eyes) underwent skin closure with tissue adhesives (group A), and 10 patients (18 eyes) underwent wound closure using conventional suture material (group B). No significant differences in the sex ratio, mean age at operation, pre- and postoperative best-corrected visual acuity (BCVA), or average surgical time were observed between groups. Both groups exhibited improved postoperative BCVA, with symptom relief and a significant decrease in the severity of keratopathy after surgery. Neither recurrence nor complications were reported during follow-up. The aesthetic results were similar between groups, while caregivers of children in the tissue adhesive group expressed high satisfaction regarding the ease of postoperative care. Conclusions: Successful closure of lower lid epiblepharon surgery wounds in children can be performed using 2-octyl cyanoacrylate (SurgiSeal®). This method is simple, safe, and effective when compared to conventional sutures.

Lower Eyelid Position Changes Following Müller's Muscle-Conjunctival Resection Blepharoptosis Surgery.

Asymmetry of the lower eyelids and a lower position of the lower eyelid on the ptotic side are common issues in patients with upper lid ptosis. Understanding the relationship between upper lid ptosis correction and lower eyelid position will facilitate better treatment strategies for ptosis. The aim of this study was to assess the lower eyelid position before and after Müller's muscle-conjunctival resection (MMCR) in unilateral myogenic ptosis (MP) and aponeurotic ptosis (AP). This prospective interventional before-and-after study included adults with blepharoptosis. Measurements were taken before and 6 months after the surgery. A total of 47 patients were included, with 29 having MP and 18 having AP. The mean [standard deviation] ages were 31.55 [5.30] years and 50.11 [6.45] years, respectively. In the MP group, there was a significant association between baseline margin reflex distance 2 (MRD2) and the severity of ptosis (MRD1) (β = -0.739, P = .004, multivariate regression analysis). After MMCR, significant decreases were observed in MRD2 for both the MP (-0.38 [0.48] mm, P < .001) and AP (-0.39 [0.47] mm, P = .003) groups. The symmetry of MRD2 remained stable at 41.4% in the MP group, while it decreased from 44.4% to 16.7% in the AP group. The baseline MRD2 was the only factor associated with postoperative MRD2 in the MP group. Patients with MP and AP often exhibit a lower position of the lower eyelid, which typically elevates after posterior upper lid ptosis surgery. In myogenic cases, the severity of preoperative lower eyelid position correlates with the severity of upper lid ptosis and predicts postoperative elevation of the lower lid.

Case Report: Sebaceous carcinoma of the eyelid

Sebaceous carcinoma is an extremely rare malignant disease and it is more aggressive when it occurs in the eyelids and orbit. It can mimic several benign lesions, resulting in diagnostic delay. We present a case of sebaceous carcinoma in a 50-year-old male who presented with complaints of swelling of the upper eyelid, which was followed by appearance of an ulcerative growth over the eyelid. Magnetic resonance imaging (MRI) reports showed an ulcerated mass in the left periorbital and orbital region appearing heterogeneously hyperintense. Fine needle aspiration cytology (FNAC) showed malignant epithelial differentiation which was followed by exenteration of the eyeball. Histopathology showed the rare diagnosis of sebaceous carcinoma. The disease has a poor prognosis as the entity is associated with increased morbidity and if not detected early it can metastasize to other organs which may be fatal sometimes.