Eyelid Research Articles

Glabellar rotation flap technique in patient with squamous cell carcinoma in right upper eyelid: case reports

Introduction : Squamous cell carcinoma (SCC) is the second most common skin malignancy after basal cell carcinoma, with an increasing incidence worldwide. Found in various parts of the body, in the eye and periocular area, it may affect the skin of the conjunctiva, cornea, and eyelid. Surgical excision is the preferred mode of SCC treatment. After excision, reconstructive surgery is often required for the best functional and cosmetic results. Early diagnosis and treatment of tumors and follow up care for at least 5 years have a significant impact on patient survival.
 Case Illustration: Description of two cases squamous cell carcinoma that had undergone reconstructive biopsy and blepharoplasty procedure with glabellar rotation flap technique alone in one case and together with a cheek advancement flap in the second one. In both cases, conjunctival replacement by using lower labial mucosa.
 Discussion : In both cases tumor affects the margin of the upper eyelid, therefore flap reconstruction is necessary to maintain eyelid function and esthetics. The glabellar flap has the advantages of being a fast surgery, having a good vascular supply, and being able to fill deep abnormalities because it is a thick flap. A cheek lateral rotation flap was designed to avoid unnecessary facial distortion in second case.
 Conclusion : Glabellar rotation flap alone or together with cheek advancement flap was done to maintain function and physical aesthetic of eyelid. Additional cheek lateral rotation flap could reduce skin tension.

Managing Periorbital Necrotizing Fasciitis: How Invasive Should We Go?

Introduction : Periorbital necrotizing fasciitis (PNF) is rapidly progressive and severe infection that may result in vision loss, serious facial disfigurement, and death. Primary management includes surgical debridement; however, here we report a case in which conservative approach resulted in favorable resolution.
 Case Illustration : A 24-year-old male presented with swollen right upper eyelid, with watery eye, pain, and blurry vision since 1 week prior. No history of trauma or known systemic diseases was reported. Restricted movement of the right eye (RE), slight nonaxial proptosis, and skin defect along the right superior palpebra with pus, blood, necrotic and granulation tissues were found. Visual acuity (VA) of RE decreased to 6/40 with normal intraocular pressure. No abnormalities on the left eye, fever, and other signs of systemic involvement were present. Contrast orbital computed tomography (CT) scan revealed right preseptal and postseptal tissue lesions, suggesting orbital cellulitis. Initial blood work showed leukocytosis, elevated neutrophil and lymphocyte counts, and high liver function markers. The diagnosis of right orbital cellulitis with PNF was established. Skin swabs and blood cultures were taken, while intravenous ampicillin-sulbactam, bedside wound debridement, and chloramphenicol ointment application were initiated. The swab culture later showed Acinetobactersp. The infection improved, VA was restored to 6/6, and wound closure was achieved without any surgery.
 Discussion : Management of necrotizing fasciitis localized in periorbita in an otherwise healthy patient may be successfully accomplished with a less invasive approach.
 Conclusion : Timely diagnosis and correct antibiotic therapy are mandatory to decrease morbidity and mortality related to PNF.

Levator Resection in Neurogenic Ptosis Oculi Sinistra et causa Third Nerve Paresis + Type II Diabetes: A Case Report

Introduction : Neurogenic ptosis is abnormal position of the upper eyelid caused by dysfunction or damage to the oculomotor or sympathetic nerves supplying the eyelids. Third nerve palsy (35.7%) is the most common cause among others. We report a case of neurogenic ptosis managed surgically by levator resection.
 Case Illustration : A 67-year-old male complained of drooping left upper eyelid, getting worse in 7 months. He had history of falling off motorcycle 6 months ago. Clinical histories of hypertension and diabetes mellitus were found. Right and left eyelids measurements in millimeter showed horizontal palpebral fissure (HPF) 28/26, vertical palpebral fissure (VPF) 6/3, margin reflex distance 1 (MRD1) 2/-2, margin reflex distance 2 (MRD2) 6/5, margin limbal distance (MLD) 8/4, and levator function (LF) 8/3. Bell’s phenomenon was negative in both eyes. Ice pack test was negative. There were ocular movement restriction in his left eye. Patient underwent a maximum levator resection and had better levator function after 3 weeks follow up.
 Discussion : Neurogenic ptosis caused by third nerve injury is associated with microvascular ischemia such as diabetes mellitus and hypertension. Operative management is carried out after 3 to 6 months observation. Evaluation of levator function allows the clinician to correctly classify the degree and type of ptosis. Maximal levator resection is the treatment of choice for ptosis with poor levator function.
 Conclusion : Although various surgical techniques have been developed, ptosis correction should be performed according to the indications and clinical condition of the patient.

Full Thickness Skin Graft Procedure for Basal Cell Carcinoma : A Case Report

Introduction : To present a case of basal cell carcinoma (BCC) of the right upper eyelid using a full thickness skin graft (FTSG) procedure
 Case Illustration : 69 year old woman with the main complaint of a lump on the upper right eye that has been getting bigger and bleeding more and more since 4 years ago. Examination revealed a tumor measuring 22mm x 12mm x 5mm, smooth surface of pearl-like nodules, talengectiasis, madarosis, palpebral retraction towards the medial canthus. The patient works as a farmer. Wide excision of the tumor and FTSG procedure was performed from the right infraclavicular area, histopathological results of basal cell carcinoma tumor.
 Discussion : BCC accounts for 90% of malignant eyelid tumors. The biggest risk factor for BCC is UV exposure. BCC rarely metastasizes but orbital invasion occurs in approximately 2%. This patient underwent an FTSG procedure. The graft was taken from the infraclavicular area. One of the key factors for graft success is revascularization of the graft area.
 Conclusion : FTSG procedure for BCC can give good results. The risk after the procedure is sometimes difficult to predict so that it can become difficult in graft attachment and even failure in attachment to the excision area can occur. This patient was under close observation due to a hematoma under the graft skin.

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

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

Shave Excision Of Marginal Lower Eyelid Nevus

Introduction : INTRODUCTION: Nevus is a common benign melanocytic lesion and may appear in palpebral region. It may appear congenitally or acquired. Such lesions contain melanocyte derived from neural crest. Palpebral nevus is a group of heterogenous lesion with varying clinical and histological presentation depending on age and nevus stage. PURPOSE: To report shave excision procedure of the left inferior palpebral nevus located in the palpebral margin using local anesthesia.
 Case Illustration : CASE REPORT: A 43-years old woman came to the hospital with a solitary mass in the lower right eyelid. The mass was experienced since 2 year ago and slowly increasing in size and most notably 3 months prior. The mass was round, tender, painless, black-greyish colored, with a smooth surface, mobile, and measured 0,5 cm x 0,5 cm in size. The lesion was located in the middle portion of right lower palpebral margin without extension to the tarsal or bulbar conjunctiva. No bleeding or discharge was found. No history of trauma, use of medication, family history, previous ocular and systemic disease was found. Histopathological examination concluded the lesion was nevus pigmentosus. The nevus was excised entirely using shave excision technique with local anesthesia. Follow-up examination revealed an excellent result with no complications.
 Discussion : 
 Conclusion : CONCLUSION: Palpebral nevus pigmentosus are common benign tumor with wide range of clinical and histological manifestation. Not all palpebral nevus required surgical intervention. The most effective treatment is complete excision of the nevus and recurrence rate is generally low.

A Rare Embryological Phenomenon: Kissing Nevus Incidence and Clinical Features

Introduction & Objectives : Kissing nevus is a condition where the nevus extends up to the lid margins, its edges touch or “kiss” when the eyelids are closed. Although commonly presenting at birth, there have been cases where it appeared in later life. This occurs due to a rare embryological phenomenon and thus only 30 cases have been reported worldwide until 2020. Meanwhile in M Djamil Hospital Padang we found 4 cases during 2020-2022. This paper is aim to present this so called rare cases in a modest way
 Methods : This is a descriptive study related to kissing nevus cases in M Djamil Hospital Padang during 2020-2022. We diagnosed it clinically based on ophthalmology examination. The data were collected into master table and being analyzed. We put patient’s identity (name, age, and gender), nevus location, size, gross anatomy of the nevus and surgical procedure
 Results : Four patients were discussed in this study. Most of the patients (75%) is a woman. We found more cases in the first 2 decades of life (50%). The predilection location is at the temporal eyelid (50%), it’s size is equal, both (10-19 mm and 20-29 mm) is 50%. In study we only found a melanotic lesion (100%). Most of the patient were treated with excision biopsy + skin flap (75%)
 Conclusion : The prevalence of kissing nevus in M Djamil Hospital is high. Kissing nevus mostly suffered by young women, most cases affected temporal eyelid, the size 10-29 mm so that skin flap is the most suitable surgical procedure

How to Quickly and Affordably Reduce Corneal Neovascularization

Abstract
 Introduction : Fine needle diathermy (FND) is one of the treatment modalities for corneal neovascularization (CoNV). Occlusion of the CoNV will reduce vascular leakage, thus preserving visual acuity. This case report presents FND as a treatment for CoNV due to ocular rosacea.
 Case Illustration : A 25-year-old volleyball athlete came to Cicendo Eye Hospital after experiencing blurry vision for a week, followed by flushing on the face. A general examination revealed telangiectasia and pustules on the central face (Figure 1). Visual acuity was 0.2 RE. A slit-lamp examination revealed hyperemiain the lid margins, oedema, and superficial-stromal neovascularization on the cornea (Figure 2). The patient was diagnosed with blepharo-kerato-conjunctivitis on RE due to ocular rosacea. The patient then underwent FND (Figure 3). The procedure was performed by using a 10.0-gauge needle inserted in the corneal stroma along the CoNV. The vessels were occluded by conducting monophasic diathermy at a power of 1 mA (Figure 4). On the 5th day, corneal oedema and neovascularization were reduced, and visual acuity improved to 0.4 ph 0.5 (Figure 5).
 Discussion : Corneal neovascularization may affect corneal transparency and thus reduce visual acuity. FND is relatively affordable and widely available. Compared to another modality, FND has not been widely performed to treat CoNV. A literature search using PubMed or Google Scholar found few case reports or reviews regarding successful cases of FND.
 Conclusion : Fine needle diathermy is a safe and effective treatment for CoNV due to ocular rosacea. Further studies should be conducted to evaluate the safety and long-term efficacy of FND.

Peripheral Orbital Schwannoma : A Case Report

Introduction : The aim of this study was to report a rare case of a peripheral orbital nerve schwannoma. One of a thinkable diagnose and the goal of treatment.
 Case Illustration : A 17-years-old young lady with chief complaint was inferior eyelid lesion since 1 year and has gradually enlarged. Examination showed a space occupying lesion in the inferior right orbit around 10x5 mm that was firm to palpation, didn’t attach to the deep planes, painless, and did not displaced the eye. Computed tomography revealed a homogenous orbital mass, encapsulated, and did not invade adjacent structures
 Discussion : Lesion was treated with complete tumour resection via conjunctival / posterior site, and pathologic examination showed a schwannoma.Conclusion : Orbital schwannoma are infrequent tumours arising from the orbit coming behind inflammatory, vascular, and lymphoproliferative diseases. Treatment is complete resection of the lesion with subsequent monitoring to prevent recurrence.

Retroauricular Graft as a Management of Simple Kissing Nevus in a Young Woman : a Case Report

Introduction : Kissing nevus is a rare case. The existence of this kissing nevus often causes disturbances not onlyof function but also cosmetic for the patient. This case report aims to report the surgical management of a simple kissing nevus that occurred in a young woman.
 Case Illustration : A 27 years old woman came to the ophthalmology department of Karangasem Hospital with complaint of visual disturbances and blackish mass growth on lateral aspect of upper and lower eyelids of left eye since birth. She underwent surgery to excise the mass. Eyelid reconstruction was carried out using a retroauricular graft.
 Discussion : Most cases of kissing nevus are usually present at birth. Eyelid reconstruction after kissing nevus excision can be a challenge for the surgeon to achieve functionally and cosmetically satisfactory results. In this case, eyelid reconstruction was chosen using retroauricular graft with the consideration that this technique is quite easy to do, the skin color is relatively similar, and the scar tissue behind the ears can also be hidden. Two months after surgery , the color of the graft is getting similar to the color of the surrounding skin, and the patient was quite satisfied with the results.
 Conclusion : Retroauricular graft can be an alternative graft for eyelid reconstruction after kissing nevus excision. It can provide quite satisfactory results functionally and cosmetically, especially for simple kissing nevus.

Multi-physics simulations for investigating the effect of electrode conditions on transscleral ocular iontophoresis for particulate drug delivery into ocular tissues.

Transscleral ocular iontophoresis has been proposed to deliver charged particulate drugs to ocular tissues effectively by transmitting a weak electrical current through the sclera. The electric fields formed are influenced by the electrode conditions, thus affecting the amount of particulate drugs delivered to the ocular tissues via iontophoresis. Computational simulation is widely used to simulate drug concentrations in the eye; therefore, reflecting the characteristics of the drugs in living tissues to the simulations is important for a more precise estimation of drug concentration. In this study, we investigated the effect of electrode conditions (location and size) on the efficacy of transscleral iontophoresis. We first determined the simulation parameters based on the comparison of the amount of drug in the sclera in the simulation and in vivo experimental results. The injection of the negatively charged nanoparticles into the cul-de-sac of the lower eyelid was simulated. The active electrode (cathode) was attached to the skin immediately above the injection site, while the return electrode (anode) was placed over the eyebrow. The drug concentration distribution in the eye, based on either the location or size of each electrode, was evaluated using the finite element method with the estimated simulation parameters. Our results indicate that drug permeability varies depending on the location and the size of the electrodes. Our findings demonstrate that the determination of optimal electrode conditions is necessary to enhance the effectiveness of transscleral iontophoresis. The online version contains supplementary material available at 10.1007/s13534-024-00359-2.

Lower Eyelid Laceration in Children: A Case Report

Introduction : Eyelid lacerations may be associated with serious ocular injury and are often accompanied by other ocular injuries. Most injuries occur in children. Eyelids have an important role in protecting the globe. Effective management of eyelid lacerations requires an understanding of the basic anatomical features of the eyelids.
 Case Illustration : A two-year-old boy was brought to our emergency department after getting scratched in the eyelid by the family dog. The patient has received first aid and a tetanus shot at another hospital. Eye examination shows a lower eyelid laceration on the right eye, extending from the medial downwards around 3 cm. Visual examination was central+, steady+, maintenance+, and eye movement was within normal limits. The patient was admitted to undergo eyelid repair in the operating room.
 Discussion : The first step in eyelid repair is wound irrigation and removal of foreign particles to avoid infection and inflammation, and primary repair of eyelids should be performed within 12 to 24 hours of the injury to reduce subsequent complications. The recommended method for best wound closure and healing is gently handling tissue edges, slight eversion, and using the smallest diameter sutures. A proper pre-operative assessment and surgical planning include evaluation of the thickness of the defect, the size, the location, and the involvement of canthus and lacrimal drainage. The goals are to provide adequate eye closure, preservation of tear film, maintenance of visual field, and aesthetics.
 Conclusion : A thorough knowledge of the eyelid anatomy and suture technique is important to successfully repair the defect while maintaining eyelid function.

Challenging Management in Work-Related Eye Injuries: A Case Report of Steam Boiler Explosion-Induced Open Globe Injury

Introduction : Work-related eye injuries (WREIs) are major health problems leading to vision loss worldwide. In this study, we reported a case of WREIs from blast injury caused by a steam boiler explosion
 Case Illustration : A 55-year-old male, laundry worker presented to the emergency unit with pain, bleeding, and sudden vision loss in the left eye, 8-hours after a blast injury from steam boiler. He was conscious with normal vital signs. He had lacerations to his left eyelid, frontal, and temporoparietal. Ocular examination revealed a visual acuity of no light perception, full-thickness laceration of the lower eyelid and inferior canalicular, diffuse subconjunctival hemorrhage, corneoscleral laceration with choroidal expulsion, and active bleeding. On investigation, B-scan ultrasonography revealed vitreous hemorrhage and CT scan showed no orbital fracture. He underwent evisceration, eyelid reconstruction, and lacrimal canaliculi repair surgery under general anesthesia and planned to custom-made ocular prosthesis.
 Discussion : WREIs include eyeball injuries, eye adnexa injuries, eyelid lacerations, and orbital wall fractures that occur during work-related activities. The incidence of WREIs is higher in men aged 20-40 years. In this case, the patient presented with an open globe injury resulting in sudden vision loss, requiring urgent surgical intervention to prevent further complications. Ocular prostheses can provide acceptable aesthetics and improve the patient's quality of life by helping them to integrate into society.
 Conclusion : WREIs can lead to permanent vision loss and require urgent surgical intervention. Employers must prioritize workplace safety by providing adequate training and appropriate eye protection such as safety goggles to minimize the risk of eye injuries.

Prospective Study on the Surgical Outcome of Eyelid Carcinoma

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

Customized Prosthetic Management for Post Orbital Exenteration Patient: A Case Report

Introduction : Orbital exenterations are performed to treat malignancies, orbital injury or other chronic conditions unresponsive to conservative therapy. Exenteration can result in depression, difficulties in daily activities, and aesthetic problems. Orbital prosthetic is an alternative therapy for aesthetic rehabilitation and protection of the orbital cavity.
 Case Illustration : A 46-year-old woman came with a chief complain of a black mass on the left lower eyelid ten years ago. Patient was diagnosed with basal cell carcinoma and underwent extirpation of the mass with skin graft reconstruction. On histopathological examination, it was discovered that the incision base was not free of tumor. Patient came two years later with recurrent black mass invaded cornea and sclera, and then underwent exenteration of the left eye (Figure 1). Patient completed 40 cycles of radiotherapy and then used spectacle retained orbital prosthetic (Figure 2 & 3).
 Discussion : Orbital prosthetics are synthetic replacement after exenteration that can restores orbit, eyelid, eye and periorbita anatomy. Orbital prosthetic retention can be aided by attachment to spectacle, use of magnets, adhesives or osseointegrated implants. Spectacle retained orbital prosthetic is the easiest and the most affordable prosthetic to construct.
 Conclusion : Orbital defects rehabilitation improves physical and psychological well-being. Due to the complexity of prosthetic fabrication and production cost, retention of the orbital prosthetic with spectacles is the most suitable alternative treatment option in some cases, it is also the easiest prosthetic to construct and inexpensive.

ORBITAL TRAUMA IN A CHILD WITH RETROBULBAR HEMORRHAGE

Introduction : Retrobulbar hemorrhage vision threatening condition associated with cranio- facial trauma. Rapidly fill the orbit and cause an “orbital compartment syndrome” that subsequently cuts off perfusion to vital ocular structures. Treatment must be initiated immidietly to prevent permanent visual loss.
 Case Illustration : 10-year-old boy, with left eye blurring of vision, swelling and multiple facial injury post motor accident. Visual acuity was perception of light on left eye, 6/5 and right eye with upper and lower lid laceration wounds. He had a dense afferent pupillary defect and the ocular movements of the left eye were limited in all directions of gaze. The orbit was tense with significant resistance to retropulsion. Diagnosed with acute retrobulbar haemorrhage following blunt trauma with medial wall fracture. Intravenous acetazolamide and timolol was commenced continued with emergency lateral canthotomy. His vision immediately improved to 6/60 and 3 hours later was 6/18. He was treated for left traumatic optic neuropathy with IV Mehtylprednisolone for 3 days followed two weeks oral prednisolone
 Discussion :
 Conclusion : Retrobulbar haemorrhage is a vision-threatening emergency often necessitating immediate lateral canthotomy for preservation of vision. In children, as the optic nerve canal is smaller, a lesser volume is available for the nerve to expand, thus early visual impairment could occur following trauma. Prompt recognition and appropriate treatment of this ocular emergency is imperative, for timely management determines the ultimate outcome.

ORBITAL TRAUMA IN A CHILD WITH RETROBULBAR HEMORRHAGE

Introduction : Retrobulbar hemorrhage vision threatening condition associated with cranio- facial trauma. Rapidly fill the orbit and cause an “orbital compartment syndrome” that subsequently cuts off perfusion to vital ocular structures. Treatment must be initiated immidietly to prevent permanent visual loss.
 Case Illustration : 10-year-old boy, with left eye blurring of vision, swelling and multiple facial injury post motor accident. Visual acuity was perception of light on left eye, 6/5 and right eye with upper and lower lid laceration wounds. He had a dense afferent pupillary defect and the ocular movements of the left eye were limited in all directions of gaze. The orbit was tense with significant resistance to retropulsion. Diagnosed with acute retrobulbar haemorrhage following blunt trauma with medial wall fracture. Intravenous acetazolamide and timolol was commenced continued with emergency lateral canthotomy. His vision immediately improved to 6/60 and 3 hours later was 6/18. He was treated for left traumatic optic neuropathy with IV Mehtylprednisolone for 3 days followed two weeks oral prednisolone
 Discussion :
 Conclusion : Retrobulbar haemorrhage is a vision-threatening emergency often necessitating immediate lateral canthotomy for preservation of vision. In children, as the optic nerve canal is smaller, a lesser volume is available for the nerve to expand, thus early visual impairment could occur following trauma. Prompt recognition and appropriate treatment of this ocular emergency is imperative, for timely management determines the ultimate outcome.

ORBITAL TRAUMA IN A CHILD WITH RETROBULBAR HEMORRHAGE

Introduction : Retrobulbar hemorrhage vision threatening condition associated with cranio- facial trauma. Rapidly fill the orbit and cause an “orbital compartment syndrome” that subsequently cuts off perfusion to vital ocular structures. Treatment must be initiated immidietly to prevent permanent visual loss.
 Case Illustration : 10-year-old boy, with left eye blurring of vision, swelling and multiple facial injury post motor accident. Visual acuity was perception of light on left eye, 6/5 and right eye with upper and lower lid laceration wounds. He had a dense afferent pupillary defect and the ocular movements of the left eye were limited in all directions of gaze. The orbit was tense with significant resistance to retropulsion. Diagnosed with acute retrobulbar haemorrhage following blunt trauma with medial wall fracture. Intravenous acetazolamide and timolol was commenced continued with emergency lateral canthotomy. His vision immediately improved to 6/60 and 3 hours later was 6/18. He was treated for left traumatic optic neuropathy with IV Mehtylprednisolone for 3 days followed two weeks oral prednisolone
 Discussion :
 Conclusion : Retrobulbar haemorrhage is a vision-threatening emergency often necessitating immediate lateral canthotomy for preservation of vision. In children, as the optic nerve canal is smaller, a lesser volume is available for the nerve to expand, thus early visual impairment could occur following trauma. Prompt recognition and appropriate treatment of this ocular emergency is imperative, for timely management determines the ultimate outcome.

CLINICAL PROFILE OF PTOSIS PATIENTS IN DR. M. DJAMIL HOSPITAL PADANG

Abstract
 Introduction & Objectives : Ptosis is one of the most common upper eyelid abnormalities. Ptosis surgery is indicated when there is visual compromise. Patient clinical profile is important in diagnosing and planning treatment for ptosis correction. The aim of this study is to describe the clinical profile of ptosis surgery patient in Dr. M. Djamil Hospital Padang.
 Methods : This study was conducted in descriptive and retrospective manner. This research has been approved by the Medical Faculty of Andalas University research ethics committee No: 332/UN.16.2/KEP- FK/2021. All patients that were diagnosed with ptosis in Dr. M. Djamil Hospital Padang from January 2016 to December 2021 were included.
 Results : There were 33 patients included in this study. Most common age range was 11-20 years old (51.5%), patients were dominantly female (51.5%). According to laterality, the most common was unilateral ptosis, 21 cases (63.6%). Congenital ptosis comprises 51.5% of the cases with myogenic as the most common etiology. Severe ptosis was found in 20 cases (57.6%), poor levator function was found in 17 cases (51.5%). Levator resection was performed in 19 cases (57.6%). Thirty patients (90.9%) had MRD1 ≥2 mm post-surgery.
 Conclusion : Levator function is important in determining the surgical method. In severe ptosis with poor levator function, frontalis suspension is the surgery of choice. Appropriate surgical procedure in accordance to accurate pre-operative evaluation will show a good surgical result.

Blepharotomy Versus Levator Recession With Adjustable Sutures for Correction of Upper Eyelid Retraction in Thyroid Eye Disease.

To compare outcome, complications and surgical time of blepharotomy versus levator recession with adjustable sutures (LRWAS) for correction of upper eyelid retraction in thyroid eye disease. In the period 2019-2023, we performed a prospective randomized comparative study between blepharotomy and LRWAS. We examined patients, recorded time consumption, and obtained photographs preoperatively, 1 day, 1 week, 3 months, and 6 months after surgery. Outcome was categorized according to Mourits and Sasim`s classification from 1999 (perfect-acceptable-unacceptable). A total of 30 patients (25 women) with a median (range) age of 51.5 (34-74) years at surgery were included. A significant different ( p < 0.01) median operation time was found between blepharotomy (41.5 (17-105) minutes) and LRWAS (68 (35-101) minutes). Median time from operation to last examination was 6 (6-18) months. Fifteen patients (24 eyelids) were operated with blepharotomy and 15 patients (25 eyelids) with LRWAS. Preoperative median margin reflex distance 1 was 6.5 (5-8) mm, and at final visit, median margin reflex distance 1 was 3.5 (3-4) mm after blepharotomy and 3.5 (2-5.5) mm after LRWAS. Reoperation was performed in 11 eyelids, 10 due to overcorrection and 1 because of a residual retraction. Significantly more eyelids needed reoperation after LRWAS (n = 9) compared with blepharotomy (n = 2). At final examination, a perfect or acceptable result was found in 14 (93%) patients after both procedures. Significantly shorter total duration of all visits was observed after treatment with blepharotomy (50 (35-70) minutes) compared with LRWAS (65 (40-115) minutes). Wound dehiscence occurred in 1 patient after blepharotomy, and 1 postoperative infection was observed after LRWAS. We demonstrate equally high success rates after blepharotomy and LRWAS for correcting upper eyelid retraction in thyroid eye disease, but blepharotomy is less time-consuming and implies fewer reoperations.