Medial Limbus Research Articles

Transconjunctival Levator Aponeurosis-Müller Muscle Complex Plication to Correct the Acquired Ptosis Following Double-Eyelid Surgery.

One of the most common adverse outcomes of an upper blepharoplasty involving double-eyelid surgery is asymmetric upper eyelids due to unbalanced supratarsal folds or a difference in the palpebral fissure height. This study aimed to evaluate the efficacy and safety of transconjunctival levator aponeurosis-Müller muscle complex plication for correcting acquired ptosis following double-eyelid surgery. This retrospective study evaluated 18 patients who underwent transconjunctival levator aponeurosis-Müller muscle complex plication between June 2016 and June 2019 to correct acquired ptosis. On the basis of the main area of eyelid drooping, ptosis was categorized as central (mid-pupillary), medial (medial limbus), or lateral (lateral limbus). Preoperative and postoperative palpebral fissure heights were measured and compared. Three months postsurgery, the mean difference in palpebral fissure height between bilateral eyes decreased from 0.96 to 0.04mm in the medial ( P <0.001), from 0.93 to 0.00mm in central ( P =0.003), and from 1.30 to -0.03mm in lateral ptosis ( P =0.079). In 13 patients who underwent unilateral correction, the amount of plication was significantly associated with increased palpebral fissure height at the medial limbus ( P =0.043) and mid-pupillary line ( P =0.035). All patients reported a significant improvement in satisfaction. Five patients experienced acute postoperative complications, including chemosis, conjunctival injection, and foreign body sensation, all of which were resolved after a month of observation. No asymmetries or recurrences were observed. Transconjunctival levator aponeurosis-Müller muscle complex plication is a minimally invasive, safe, and effective technique for correcting acquired ptosis following upper eyelid surgery.

Changes in eyebrow position following blepharoptosis surgery

Background The position of the eyebrows is critical when planning blepharoptosis surgery. However, insufficient scholarly attention has been paid to the details of postoperative eyebrow height changes at each anatomical landmark. This study investigated the effect of blepharoptosis surgery on brow height and evaluated the change in brow position.Methods After a retrospective review of 247 patients, this study analyzed 53 patients (106 eyelids) who underwent levator and Müller’s complex advancement between March 2010 and January 2022. Brow heights were measured from the distance between the upper brow margin of each landmark and horizontal line of pupillary center on a digital photograph.Results The mean change of eyebrow lowering was 1.54 mm (P&lt;0.001) at the medial canthus, 1.29 mm (P&lt;0.001) at the medial limbus, 1.44 mm (P&lt;0.001) at the center of the pupil, 1.40 mm (P&lt;0.001) at the lateral limbus, 1.15 mm (P=0.001) at the lateral canthus, and 0.75 mm (P=0.021) at the lateral eyebrow end. The brow change was most prominent at medial canthus and least prominent at the lateral brow end. The preoperative brow position was only statistically significant factor predicting brow height descent after surgery according to multiple linear regression analysis (R&lt;sup&gt;2&lt;/sup&gt;=0.305, B=–0.375, P&lt;0.001).Conclusions The eyebrows lowered in most patients after blepharoptosis surgery. The preoperative brow position is the most important factor in predicting the change in brow height after blepharoptosis surgery.

A Case of Combination Therapy of IFN-β1b and Mitomycin-C on Recurred Ocular Surface Squamous Neoplasia

Purpose: To report a case of combination therapy with interferon β1b (IFN-β1b) and mitomycin-C (MMC) for recurrent ocular surface squamous neoplasia (OSSN).Case summary: A 72-year-old female presented with a white mass at the medial conjunctiva of the right eye. A gelatinous, nodular white lesion was observed near the medial limbus of the right eye. On histological examination, it was diagnosed as squamous cell carcinoma in situ. A white nodule was found at the resection site 1 year after the resection. IFN-β1b (1 mIU/mL) and 0.02% MMC were administered daily with a diagnosis of recurrent OSSN. IFN-β1b was instilled four times a day for 1 month, while MMC was instilled four times a day for 4 weeks. After 1 month of the combination treatment, the lesion disappeared. MMC was stopped, while IFN-β1b was reduced to twice daily instillation, maintained for 1 month, and then stopped. On examination 12 months after discontinuation of the combination treatment, there were no recurrences or drug-related complications.Conclusions: Combination therapy with IFN-β1b and MMC for recurrent OSSN after surgical resection was relatively safe with no major complications.

Volk eye check ocular measurement device for objective periorbital measurements: A prospective study.

Volk Eye Check (VEC) is a portable digital ocular measurement device that automatically captures clinical photographs with facial measurements in real time (Volk Optical Inc), claiming to reduce measurement errors. The accuracy and repeatability of this ocular measurement device in the periorbital region has not been reported. To report the reproducibility and repeatability of periocular biometric measurements using Volk Eye Check Ocular measurement device. Prospective, single blind, comparative study. Two experts performed digital photography of 100 volunteers using the standard photography technique using Oculoplasty module of the Volk Eye Check ocular measurement device. Each expert photographed the volunteer twice, to obtain two sets of automated printouts of 13 periorbital biometrics that were measured automatically by the ocular measurement device. Bland Altman plot and multiple comparisons of means from linear mixed-effects model fit by REML using simultaneous contrasts with p values reported by Bonferroni method were used as statistical tests to analyze following parameters: MRD1 (margin reflex distance-1), MRD2 (margin reflex distance-2), PFH (palpebral fissure height), HVID (horizontal visible iris diameter), ALL (aperture length at lateral limbus), and ALM (aperture length at medial limbus). The mean inter-observer difference in measurement (mm) was as follows: MRD1 (0.04), MRD2 (0.02), HVID (0.01), PFH (0.03), ALL (0.05), ALM (0.08). The mean intra-observer difference in measurement (mm) was as follows: MRD1 (0.02), MRD2 (0.09), HVID (0.0), PFH (0.09), ALL (0.06), ALM (0.05). Periorbital biometric measurements using Volk Eye Check ocular measurement devices are highly reproducible and repeatable. The oculoplasty module of Volk Eye Check ocular measurement device can provide reliable periorbital measurements for routine clinical use and for objective clinical studies.

Ocular surface squamous neoplasia at a tertiary eye facility, Southwestern Nigeria: a 10-year review

Ocular surface squamous neoplasia (OSSN) is a low-grade malignancy arising from the squamous epithelium of the ocular surface AIM: To describe the clinical presentation, histological diagnoses, treatment, and outcome of treatment in patients with OSSN managed at a tertiary health facility. Medical records of all patients with OSSN managed using a standardized treatment protocol over a 10-year period were reviewed. Eighty-six patients comprising 44 (51.2%) males and mean age of 48.2 ± 15.8years were studied. The most common presentation was a fleshy growth in the eye in all patients, and 43 (50.0%) patients tested positive to human immunodeficiency virus. The right eye was affected in 44 (51.2%) patients with no bilateral tumors, and the medial limbus was involved in 28 (32.6%) patients. Morphologically, 40 (46.5%) patients had gelatinous growth, 24 (27.9%) patients were in Tis category while 30 (34.9%) patients were in T4 category. Twenty-eight (32.6%) patients received complete course of adjuvant topical mitomycin C (0.04%) while nine (10.5%) patients completed adjuvant systemic chemotherapy and external beam radiation. Overall, 61 (70.9%) patients had no tumor recurrence, seven (8.1%) patients had recurrent tumor, while the status of 18 (20.9%) patients was not known. OSSN occurs more commonly in younger age group in our studied population and is strongly associated with HIV seropositivity. Intraoperative cryotherapy in patients with carcinoma in situ and intraoperative cryotherapy with adjuvant topical mitomycin C in those with invasive SCC that is limited to the ocular surface are associated with low tumor recurrence.

Periorbital ecchymosis and subconjunctival hemorrhage due to leech therapy for headache

A 62-year-old woman was admitted to our clinic with the complaints of periorbital ecchymosis and subconjunctival hemorrhage that are visible, especially on the right eye. We noted that her complaints began the day after she underwent leech therapy on the glabella area for headache. On the glabella, 2 leech bites were observed close to the right side. Examination revealed ecchymosis on the bilateral eyelids and subconjunctival hemorrhage on the inferolateral and medial limbus on the right eye. No treatment was initiated, rather control measures were recommended. The follow-up after 1 month revealed that the patient's complaints had disappeared.

The Value of Integrating Fluorescent Imaging and Immunohistochemistry for Future Anatomical Studies in Aesthetic Surgery: Lessons From the Cerebrospinal Fluid Circulatory System of Human Nerves and Brain.

During their work on the cerebrospinal fluid (CSF) circulatory system of human nerves and brain, the authors applied imaging and tissue techniques that complemented basic anatomical dissection. The authors sought to show how integrating fluorescent imaging and basic immunohistochemistry (IHC) with facial anatomy can address current problems in aesthetic surgery. The authors developed an algorithm and a set of principles from their work on the CSF circulatory system and applied these to 3 problems in aesthetic surgery: the functional anatomy of the vermilion-cutaneous junction; chemosis; and the functional anatomy of periosteal fixation. Integrating fluorescent imaging and IHC with anatomical dissection characterizes structural and functional anatomy. Fluorescent imaging helps to identify and locate easily missed structures. IHC defines cell type and function. The vermilion-cutaneous junction is defined by a major lymphatic vessel. Lymphatic flow from the medial limbus to the lateral canthus suggests the etiology of chemosis. Periosteal sites of fixation prevent shear where dural CSF vessels drain directly to subcutaneous lymphatics. Integrating anatomical dissection with fluorescent imaging and basic IHC characterizes structural and functional anatomy and helps to better understand many problems encountered in aesthetic surgery.

Modified double-eyelid blepharoplasty with the combined partial- And minimal-incision method.

Double-eyelid surgery remains a popular esthetic surgery in East Asian people. The partial-incision method provides the benefits of full-incision and nonincision techniques. It can create a predictable and durable double-eyelid crease. To create a long-lasting double-eyelid crease with a minimal scar, the author has described the modified partial incision technique with a small and minimal incision. A preoperative design was developed with the patient in an upright sitting position. A partial incision was made between the medial limbus and the middle pupillary line; the minimal incision was made just adjacent to the lateral limbus. After local anesthesia, a strip of orbicularis oculi below the incision was dissected, and the pretarsal orbicularis oculi, anterior tarsal fascia and part of the anterior tarsal fat were removed. The skin, dermis and orbicularis oculi were sutured together with the pretarsal fascia. From July 2016 to September 2018, 138 patients received a modified partial-incision double-eyelid surgery. A total of 119 patients were followed up. The postoperative shape and height were stable. Five patients developed loss of the unilateral fold (2.17%), and one patient complained of bilateral narrow eyelid folds (0.87%). No serious complications were noted. The modified partial-incision technique for creating a double eyelid described here provides stable results with no visible scar and no serious complications.

Dermatochalasis Through Decades: A Histopathologic Study.

Three prior studies (2008, 2011, 2018) histopathologically compared the eyelid specimens of patients with dermatochalasis (DC, undergoing blepharoplasty) with a control group and proposed that DC may begin with subclinical inflammation leading to elastolysis and lymphostasis. With growing number of younger patients consulting for blepharoplasty, the unanswered question is whether histopathologic changes of DC differ between the younger and the older. In this prospective case series, 20 right upper eyelid skin of 20 nonsmoker, class 3 Fitzpatrik skin type women (30-68 years old) were histopathologically examined. Patients were divided into 2 age groups of 50 years or older and older than 50 years. Upper eyelid skin was preoperatively marked, intraoperatively removed, postoperatively divided into 3 sections: lateral (lateral limbus to lateral canthus), central (between medial and lateral limbi), and medial (medial limbus to medial canthus), and separately (totally 60 specimens) sent for histopathological examination. A masked pathologist recorded skin thickness in all specimens (60) as well as lymphatic vessels diameter and density, elastic fiber density, macrophage number, collagen intrafibril edema, and depth of collagen stromal bed in central sections (20 specimens). There were 10 patients at each age group. Histopathological measurements were not significantly different between the 2 age groups except mean lymphatic vessel diameter (P = 0.034) that was larger in the second group (>50 years). A significant positive correlation was also observed between the age and lymphatic vessel diameter (rs = 0.3, P = 0.009). Lymphangiectasia progresses significantly by age. Histopathological characteristics of DC are the same in the 2 age groups.

Modified Infrabrow Excision Blepharoplasty for Severity of Medial Blepharochalasia.

Infrabrow excision blepharoplasty can be a satisfactory and useful alternative for patients with blepharochalasia. Sixty patients underwent modified infrabrow excision blepharoplasty from March 2017 to February 2018. The design of the skin excision was modified according to the severity of the medial blepharochalasia: (1) excision up to the medial limbus was performed if there was no medial blepharochalasia, (2) excision up to the medial epicanthus was performed if there was mild medial blepharochalasia, and (3) excision with triangular back cut was performed if there was moderate-to-severe medial blepharochalasia. The surgical method included (1) skin excision, (2) orbicularis oculi muscle excision, (3) orbicularis oculi muscle closure, and (4) skin closure. The mean postoperative follow-up period was 9 months, and the photographic results were collected retrospectively and evaluated. There were no complications related to surgery in terms of the resulting scar and dysesthesia. The mean operative time was 55 minutes. Patient satisfaction was very high in terms of both aesthetic outcome and comfort. Modified infrabrow excision blepharoplasty can be an easy and satisfactory alternative in a selected group of patients.

A Randomized, Controlled Study Comparing Subbrow Blepharoplasty and Subbrow Blepharoplasty Combined with Periorbital Muscle Manipulation for Periorbital Aging Rejuvenation in Asians.

Improving periorbital aging is, currently, of great concern. The previous literature has reported some surgical methods for periorbital aging. The purpose of this study was to compare subbrow blepharoplasty (SBB) with subbrow blepharoplasty combined with periorbital muscle manipulation (SBB-pm) with regard to improving periorbital aging. A prospective, randomized, controlled study was designed to evaluate and compare the effects of two different surgical techniques on upper lid relaxation, brow shape and periorbital wrinkles. Patients were divided into two groups. Group 1 underwent resection of excess skin; group 2 underwent a modified technique that involved resection of an elliptical island of skin, separation of the corrugator supercilii muscle and dissection of the orbicularis oculi muscle, followed by suturing it to the orbital periosteum and cross-fixation with itself. The upper eyelid and eyebrow height, periorbital wrinkle score and patient satisfaction were measured preoperatively and postoperatively. This study included 70 patients (140 eyes). At 1month, 3months, 6months and 12months after surgery, group 2 was superior to group 1 with regard to the improvement in upper eyelid relaxation at the medial limbus, middle pupil and lateral canthus. The eyebrow assumed a low and flat appearance in group 1. The eyebrow showed a low and flat appearance and then returned to the preoperative level in group 2. When comparing the two surgical techniques, the authors found statistically significant differences in regard to changes in crow's feet and glabellar frown lines. Two patients in group 2 experienced forehead numbness after surgery, which resolved by the 6-month follow-up. Patients in group 2 were significantly more satisfied with their surgery than patients in group 1. SBB-pm is more effective than SBB for improving upper eyelid relaxation and preventing secondary brow ptosis after surgery as well as for alleviating periorbital wrinkles, although it is accompanied by transient forehead numbness. 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.

Location of the infraorbital foramen with reference to soft tissue landmarks for regional nerve blocks during midface surgery.

An infraorbital nerve (ION) block is widely used to accomplish regional anesthesia during surgical procedures involving the midface region. This study aimed to elucidate the exact location of the infraorbital foramen (IOF) in relation to clinically useful soft-tissue landmarks for achieving an effective ION block. Forty-three hemifaces from 23 embalmed Korean cadavers were dissected. The lateral canthus, peak of Cupid's bow, medial limbus, and midline were used as reference points. The distances from the IOF to the midline and the lateral canthus were measured. The IOF was located approximately 25 mm below the lateral canthus and 27 mm lateral to the midline. In all cases, the IOF was situated within 9.0 mm of the crossing point of the oblique line connecting the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus. Considering the spread of an anesthetic agent, injecting it into the crossing point of the oblique line through the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus would successfully block the ION in most patients.

New algorithm for planning superior tarsal muscle resection for blepharoptosis: description of technique and results

Background. Transconjunctival techniques for blepharoptosis correction are popular because of ease of implementation and good predictability. For a long time, the phenylephrine test remained the main factor influencing the choice of blepharoptosis correction method. Recently, more and more researches indicate the possibility of the superior tarsal muscle resection in patients with negative responses to the phenylephrine test. Authors have proposed and described a new modified technique for resection of the superior tarsal muscle, which can be used to correct blepharoptosis in patients with different responses to phenylephrine test.&#x0D; Materials and methods. The study included 2 groups of patients with mild to moderate blepharoptosis with levator muscle function 8 mm or more. The main group (75 patients, 103 eyelids) underwent a modified resection of the superior tarsal muscle, and in the comparison group (26 patients, 35 eyelids) an open sky resection of the superior tarsal muscle was performed. Surgery in the main group was planned according to the following algorithm. In positive and sufficient response to the test, 2/3 of the superior tarsal muscle was resected. In case of positive but insufficient response to the phenylephrine test, subtotal superior tarsal muscle resection was performed. In case of negative or slightly positive result of phenylephrine test, an assessment of the white line motility was additionally performed intraoperatively. If the motility of the white line (in mm) was equal to the amount of ptosis, subtotal superior tarsal muscle resection was performed without resection of the superior tarsal plate. If the motility of the white line was less than desired amount of correction, then subtotal superior tarsal muscle resection was combined with tarsal plate resection to reach the desired amount of correction. The residual height of the tarsal plate was always left 5 mm or more. If superior tarsal plate was compromised or not high enough to perform desired amount of resection then white line was advanced to the tarsal plate.&#x0D; Results. The degree of ptosis, the result, the width of the palpebral fissure in the center, lateral and medial limbus, MRD 1 and MRD 2 did not significantly differ between the groups (p 0.05). However, the frequency of hypo- and hypercorrections was significantly lower in the main group (p 0.05).&#x0D; Conclusion. New algorithm of planning modified superior tarsal muscle resection gives an opportunity to use transconjuctival methods of blepharoptosis correction in cases of weak and negative phenylephrine test and to reduce the amount of hypo- and hypercorrections

Objective Brow Height Measurements Following Pretrichial Brow Lift and Upper Lid Blepharoplasty.

Background:As the ptotic brow drops below the supraorbital rim, it can exacerbate dermatochalasis by pushing the adjacent skin of the upper lid further down.Aim:The purpose of this study was to evaluate the outcomes associated with a combined pretrichial brow lift and upper lid blepharoplasty in patients with dermatochalasis and mild to moderate brow ptosis.Materials and Methods:A retrospective case series of 46 patients with dermatochalasis and mild to moderate brow ptosis treated with a combined, bilateral pretrichial brow lift and upper lid blepharoplasty from January 2008 to December 2011. Main outcome measures included measurements of brow lift at 3 months post-operatively, complications encountered, patient satisfaction and surgeon satisfaction.Results:Outcomes from 46 patients were evaluated. The mean brow lift was 1.85 mm at the lateral canthus, 1.54 mm at the lateral limbus, 1.31 mm at the mid-pupil, and 1.07 mm at the medial limbus. Brow lift at the lateral canthus was significantly more elevated than at the medial limbus (P < 0.001). Minor complications were encountered in seven of 46 patients (15.2%). Mean patient satisfaction score was 3.20 and surgeon satisfaction 3.24 (max = 4, very satisfied).Conclusions:The modified pretrichial brow lift offered effective lateral lift that complements an upper lid blepharoplasty. This technique was met with a high degree of patient and surgeon satisfaction, and had a minimal complication profile.

Ocular Surface Squamous Cell Carcinoma with Intraorbital Extension in a Patient with Long-Term Immunosuppression

Purpose: To report a case of ocular surface squamous cell carcinoma with intraorbital extension in a patient with renal transplantation and long-term immunosuppressive therapy. Case summary: A 59-year-old Korean male presented with a whitish mass in the medial limbus and conjunctiva of the right eye. The patient had undergone renal transplantation 17 years prior due to lupus nephritis and was on systemic immunosuppression with daily prednisolone (10 mg), tacrolimus (5 mg), and mycophenolate sodium (720 mg). The complete excision of the mass was performed and mitomycin C application and amniotic membrane transplantation on the excised area were combined. Histopathological examination revealed the mass was squamous cell carcinoma. There were no abnormal findings on the orbit computed tomography (CT). The patient was additionally treated with topical interferon alpha 2b 6 months postoperatively. One year later, a mass recurred at the same site in the right eye. The complete excision of the mass, mitomycin C application, cryotherapy, and amniotic membrane transplantation were performed. Orbit CT showed a 1.9 cm-sized intraorbital mass involving the medial rectus of the right eye. The orbital exenteration was performed and the intraorbital mass was histologically proven to be squamous cell carcinoma. Conclusions: Ocular surface squamous neoplasia in patients with renal transplantation and long-term immunosuppressive therapy should be monitored closely for the possibility of orbital invasion. J Korean Ophthalmol Soc 2016;57(3):507-512

Origin of the Lower Orbicularis Oculi Muscle in Relation to the Nasojugal Groove.

The aim of this study was to clarify the location of the origin of the lower orbicularis oculi muscle (OOM) in relation to the nasojugal groove.In 45 lower eyelids of 44 patients, the origin of the lower OOM was identified. In 4 lower eyelids of 2 fresh cadavers, the breaking strength was measured. In 4 lower eyelids of 4 fixed cadavers, 3 parasagittal sections and 2 horizontal sections were made. In computed tomographic scans of 182 orbits of 99 patients, the maxillary attachment of the OOM was measured.The lower OOM originated along the orbital margin, and the mean (SD) width of the attachment was 10.5 (1.4) mm. The lower OOM ran obliquely laterally and downward. The force needed to tear the 3-mm-wide OOM was 8.40 (0.21) N. Histologically, the OOM was attached to the periosteum on the medial limbus line; however, it was not attached at the midpupillary line or the lateral limbus line. The most medial part of the lower OOM was attached to the periosteum. In the middle and lateral part of the lower eyelid, however, a fibrofatty tissue was found between the OOM and the periosteum. In computed tomographic scans, the OOM was almost always attached to the maxilla at the medial epicanthus (100%) and at the medial limbus line (92.3%). At the midpupillary line, fewer than half (45.6%) were attached. At the lateral limbus line (14.3%) and the lateral canthus (4.4%), they were rarely attached.In a relaxed state, the nasojugal groove is not evident because the attached portion does not pull at the wings. While squinting, the OOM contracts and the vertical width shortens, and thereafter, a surface puckering of the delicate periorbital skin appears.

Characterizing the lateral slope of the aging female eyebrow

Ideal eyebrow aesthetics give a framework for brow rejuvenation and surgical procedures do not always provide satisfying results. Previous studies have shown elevation of the medial brow with aging; however, they failed to characterize overall shape changes. To characterize changes in eyebrow slope with increasing age to better direct brow rejuvenation. From standardized anteroposterior facial photographs of 100 women 20 to 80 years of age, eyebrow height was measured at the medial limbus and arch apex from a mid-pupillary horizontal. The slope of the eyebrow was calculated. Using group analysis, mean height and slope were compared using the Mann-Whitney U test. Regression analysis was used to determine the relationship between slope and age. Mean slope significantly decreased from 20 to 29 years of age to 40 to 49 years of age (0.22 versus 0.12; P=0.03), and then increased between 40 and 49 years of age and ≥60 years of age (0.12 versus 0.21; P=0.05). Medial height did not change significantly, and arch apex significantly decreased between 20 and 29 years of age and 40 and 49 years of age. Regression analysis showed a quadratic relationship between age and slope, with the decrease in slope until the fifth decade of life being directly related to increasing age. After this, age was not a significant contributor to slope changes. With increasing age, the slope of the eyebrow decreases until the fifth decade dependent on age. After the fifth decade, age no longer plays a significant role. Therefore, choice of brow lift technique should be carefully selected.

Tear meniscus measurement in nasolacrimal duct obstruction patients with Fourier‐domain optical coherence tomography: novel three‐point capture method

Fourier-domain optical coherence tomography (FD ODT) for the evaluation of marginal tear film has not been performed in patients with watery eye or in a controlled study. We used FD OCT to evaluate the height of the lower lid tear film at three points in normal adults and compared it with two watery eye groups. We prospectively evaluated with FD OCT 25 normal subjects and 44 patients with a watery eye. Twenty-three patients with primary acquired nasolacrimal duct obstruction (PANDO) and 21 patients with functional nasolacrimal duct obstruction (FNLDO) were enrolled. Three images were obtained by three vertical FD OCT scans centred on the lower eyelid and inferior cornea, the medial limbus and the lateral limbus. The tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus area (TMA) were measured with computer calipers and compared at three points between the two groups. Watery eyes have significantly greater median TMHs at three points (medial: 584 μm, central: 592 μm, lateral: 470 μm) than controls (274, 291, 205 μm, p < 0.001). Medial and central TMHs were higher than lateral TMH in controls and watery eyes. TMD and TMA also increased significantly in watery eyes (p < 0.001). There was a significant increase in central TMH compared to medial TMH in FNLDOs than in PANDOs (p < 0.05). Fourier-domain OCT is a valuable clinical tool in the evaluation of TMH in normal and watery eyes. TMH at three points can be a useful clinical parameter that investigates changes of lower tear meniscus pattern in both PANDO and FNLDO groups.

Size of the Superior Palpebral Involuntary Muscle (Müller Muscle)

The aim of this study was to elucidate the width and length of the superior palpebral muscle by using anti-α-smooth muscle actin antibody. Ten orbits of 5 adult Korean cadavers were used. Eyelids were cut in vertical planes through midpupilliary, medial limbus, and lateral limbus and in horizontal planes at the anterior border of the superior transverse ligament and 2 mm proximal to the upper tarsal border. Superior palpebral muscle was localized using mouse monoclonal anti-α-smooth muscle actin and counterstained with light green for collagen. In enlarged pictures of sections, widths, lengths, and thicknesses of the superior palpebral involuntary muscle were measured with a curved scale and were analyzed. The levator palpebrae superioris muscle was divided into superficial and deep parts below the superior transverse ligament. The levator aponeurosis originated from the superficial part and the superior palpebral muscle originated from the deep part of the levator palpebrae superioris muscle. The aponeurosis was inserted into the upper border of tarsus. The superior palpebral muscle fibers arose 2.71 ± 0.64 mm posterior to the anterior border of the superior transverse ligament. The superior palpebral muscle was trapezoidal. The lengths of its sides were 15.58 ± 1.82 and 22.30 ± 5.25 mm, and its height was 13.70 ± 2.74 mm. The levator aponeurosis covered the superior palpebral muscle anteriorly. The width of the levator aponeurosis was approximately 4 mm wider than the superior palpebral muscle. The thicknesses of the superior palpebral muscle were 0.14 ± 0.13 mm at the anterior border of the superior transverse ligament, 0.45 ± 0.11 mm at the superior fornix level, and 0.10 ± 0.03 mm at the upper border of the tarsal plate. One vascular layer was between the levator aponeurosis and the superior palpebral muscle (upper vascular layer), and the other was between the superior palpebral muscle and the conjunctiva (lower vascular layer). At the superior fornix level, thickness of the upper and lower vascular layers was 0.28 ± 0.06 and 0.38 ± 0.21 mm, respectively. The result of our study might contribute to corrective blepharoptosis surgery.

Co-existing squamous cell carcinoma and hemangioma on the ocular surface of a cat

A 14-year-old spayed female domestic short-haired cat was presented for evaluation of a mass in the right eye. Ophthalmic examination revealed a blind right eye and presence of two distinct masses: a pink and a red-to-brown mass, the latter occupying most of the cornea and part of the conjunctiva. Exenteration was performed under general anesthesia, and the ocular tissues were processed routinely for histopathology. Upon microscopic examination, a malignant epithelial neoplasm and a benign vascular neoplasm were present in the cornea. The conjunctiva and the third eyelid were also affected. Upon immunohistochemistry, the epithelial tumor was positive for cytokeratin and negative for vimentin and the endothelial tumor was negative for cytokeratin and positive for vimentin. A diagnosis of squamous cell carcinoma (SCC) and hemangioma was made. The SCC was affecting the cornea, bulbar conjunctiva (lateral and inferior) and the base of the third eyelid, whereas the hemangioma was affecting the cornea and medial limbus. To the authors' knowledge, this is the first report of concomitant SCC and hemangioma affecting the ocular surface in a cat.