Orbital Fat Prolapse Research Articles

Effectiveness of Transconjunctival Fat Removal and Resected Fat Grafting for Lower Eye Bag and Tear Trough Deformity.

The main treatment of lower eye bags is changing from fat removal techniques to fat repositioning techniques. However, fat repositioning techniques have potential complications because of disruption of the middle lamellae, leading to contracture and shortening. To determine whether transconjunctival fat removal followed by resected fat grafting is an effective alternative method of eye bag treatment. This retrospective study of 229 consecutive patients who underwent transconjunctival fat removal followed by resected fat grafting from November 1, 2011, to October 31, 2017, was conducted by review of medical records from the Seoul H Dermatology Clinic in Seoul, Korea. Comparison of patient satisfaction and modified Goldberg scores before and after surgery. A total of 229 patients (mean [SD] age, 41.24 [11.11] years; range, 20-69 years; 164 [71.6%] female) underwent transconjunctival fat removal followed by resected fat grafting. Of the 229 patients, 224 (97.8%) were satisfied with their surgical results, and major improvements were seen in the mean (SD) preoperative and postoperative scores for orbital fat prolapse (preoperative: 1.94 [0.63]; postoperative: 0.07 [0.21]), tear trough depression (preoperative: 1.61 [0.75]; postoperative: 0.33 [0.42]), skin transparency (preoperative: 1.15 [0.97]: postoperative: 0.22 [0.37]), and triangular malar mound (preoperative: 0.37 [0.61]; postoperative: 0.34 [0.58]). Although the orbicularis prominence worsened after surgery, this outcome should be interpreted as a good result for Asian patients. Skin elasticity deteriorated postoperatively. The findings suggest that transconjunctival fat removal followed by resected fat grafting is an effective and safe technique to treat lower eyelid fat herniation without increased complication rates and provides good patient and surgeon satisfaction. 4.

The kissing puncta: an under-reported and stubborn cause of epiphora.

'Kissing puncta' (KP) or punctal apposition is an anatomical phenomenon sparsely reported in the English literature. We describe our experience of managing chronic epiphora in patients with punctal apposition. A retrospective audit of five patients (nine eyes) with KP associated with epiphora. Data including: presenting symptoms, physical signs and surgical outcomes were collected. Five patients aged between 66 and 77 years were reviewed. Common clinical features were: chronic epiphora, involutional eyelid laxity, kissing puncta (present at all phases of the blink) and reduced upper and lower margin-reflex distances. Medial upper eyelid ptosis with orbital fat prolapse was a prominent feature. Four patients (nine eyes underwent eyelid-tightening surgery to restore normal anatomical position of the puncta. Only one of the four patients achieved improvement in epiphora at 3 months. One patient with continued epiphora underwent subsequent dacrocystorhinostomy with improvement in symptoms. The fifth patient had mild laxity and underwent dacrocystorhinostomy at first instance, with no improvement in symptoms, despite surgical success. The KP sign is commonly found in those with involutional eyelid changes. Epiphora is present in variable degrees in the presence of punctal apposition. Restoration of normal punctal position with eyelid-tightening surgery does not always confer an improvement in epiphora. Surgical management in the setting of KP is therefore challenging with a guarded prognosis. Symptomatic patients with KP should be counselled accordingly.

In-Office Sutureless Correction of Prolapsed Subconjunctival Orbital Fat.

To describe a minimally invasive, sutureless, small incision surgical technique for the treatment of subconjunctival orbital fat prolapse (SOFP) performed using local anesthesia in an office setting. Retrospective study of the surgical outcome of 45 patients with either bilateral or unilateral SOFP treated by a single surgeon (R.S.) between July 2010 and February 2015. Forty-five patients (39 male, 6 female) had a mean age of 67 years. Fat prolapse was bilateral in 23 patients (51%). A total of 68 eyes were operated on. All surgeries were without any intra- or postoperative complications such as infection, dry-eye symptoms, ocular motility impairment, or recurrence with a mean follow up of 37 months. All patients had a favorable postoperative cosmetic improvement. The authors propose an office-based, cost-effective, minimally invasive, sutureless technique for treating SOFP with local anesthesia in a safe and effective manner. The lack of complications or recurrence with an adequate follow-up period following this technique is encouraging. Surgeons should consider this technique in the surgical correction of SOFP.

Evaluation of the association between subconjunctival orbital fat prolapse and thyroid-associated orbitopathy.

Evaluation of the association between subconjunctival orbital fat prolapse and thyroid-associated orbitopathy.

Subconjunctival orbital fat prolapse and thyroid associated orbitopathy: a clinical association.

BackgroundThyroid associated orbitopathy (TAO) comprises a spectrum of well-recognized clinical signs including exophthalmos, eyelid retraction, soft tissue swelling, ocular misalignment, keratopathy as well as a number of less common manifestations. Subconjunctival fat prolapse is a rare clinical condition occurring typically spontaneously in elderly patients with a mean age of 65–72 years. We describe subconjunctival prolapse of orbital fat as an uncommon clinical association of TAO.Materials and methodsObservational study of six patients presenting with a subconjunctival protrusion under the lateral canthus in a series of 198 consecutive cases with TAO examined at a tertiary care referral center.ResultsA superotemporally located yellowish, very soft, freely mobile subconjunctival protrusion developed unilaterally in two and bilaterally in four patients with TAO (incidence 3.03%). It was one of the presenting manifestations of TAO in four of ten eyes studied and incited the diagnostic work-up for TAO in two of six patients in this series. Magnetic resonance imaging of the orbit indicated fat density in continuity with intraorbital fat in the area of protrusion. A male to female preponderance of 4:2 and an advanced mean age at onset of TAO is noteworthy for these six patients compared to the pool of 192 patients (64.8 versus 51.8 years, respectively, P=0.003) not bearing this sign.ConclusionSubconjunctival orbital fat prolapse, a clinically impressive age-related ocular lesion, may occasionally predominate amid other clinical manifestations of TAO. It is a nonspecific sign developing most commonly among patients with a relatively advanced age at presentation. Awareness of this association may alert to the diagnosis of thyroid orbitopathy and reassure the patient and physician as to the benign character of the lesion.

Subconjunctival Herniated Orbital Fat Mimicking Adipocytic Neoplasm.

To describe and discuss rare and benign conditions of subconjunctival orbital fat herniation that may mimic adipocytic neoplasm. Sixteen eyes of 13 patients with subconjunctival orbital fat herniation were included. They all underwent transconjunctival excision owing to cosmesis, discomfort, or suspicion of malignancy. Histopathologic examination, postoperative complications, and recurrent conditions were analyzed. Eleven male and two female patients were included. The lesion was unilateral in 10 and bilateral in 3 cases. Excision was performed via conjunctival wound and removing the prolapsed orbital fat. The conjunctiva was then closed with two to three interrupted sutures. All the histopathologic specimens revealed Lochkern cells, floret cells, and mature adipocytes separated by fibrovascular septae without hyperchromatic cells, consistent with subconjunctival herniated orbital fat. All the patients were treated successfully with transconjunctival excision without recurrence at an average follow-up of 10.6 months (range, 6 to 16 months). Prolapse of subconjunctival orbital fat is an uncommon entity of intraorbital masses and may mimic adipocytic neoplasm. It is usually associated with a dehiscence in the Tenon capsule. Surgical excision is indicated and pathologic evaluation is necessary if any malignancy is suspected.

Surgical repair of orbital fat prolapse by conjunctival fixation to the sclera.

PurposeThe aim of the study described here was to report the outcomes of surgery for orbital fat prolapse by conjunctival fixation to the sclera.Patients and methodsTwenty-three consecutive eyes of 19 patients with orbital fat prolapse were retrospectively reviewed. All cases were treated with the same simple procedure without resection through conjunctival incision: fixation of conjunctiva to the sclera with interrupted sutures of 10-0 nylon in two rows located approximately 12–14 mm posterior to the limbus. These sutures formed an embankment to keep the prolapsed fat posteriorly. Postoperative results were determined by slit-lamp examination and recurrence of prolapse was defined as the presence of orbital fat anterior to the embankment.ResultsDuring the mean follow-up period of 19 months (range: 1−59 months), one case experienced recurrence which required further surgery. None of the other cases experienced recurrence, and there were no intraoperative or postoperative complications.ConclusionConjunctival fixation to the sclera was a simple and effective surgical technique for orbital fat prolapse, with less invasion compared to the conventional method that requires conjunctival incision.

Anatomical landmarks of the lateral nasal wall: implications for endonasal lacrimal surgery.

An accurate understanding of the anatomy of the lateral nasal wall is key to achieving complete exposure of the lacrimal sac during endonasal dacryocystorhinostomy (EnDCR) and the avoidance of complications such as basal skull fracture and orbital fat prolapse. This review provides a comprehensive summary of the clinical and cadaveric anatomical studies of the lateral nasal wall to date and their application to endonasal lacrimal surgery. The maxillary line and the axilla of the middle turbinate are the major landmarks commonly utilized by lacrimal surgeons to localize the lacrimal sac. Numerous clinical, cadaveric and radiologic studies have attempted to define the relationship of these and other important anatomical landmarks, closely related to the lacrimal sac and routinely encountered during endonasal surgery, such as the frontal process of the maxilla, the agger nasi air cell and the uncinate process. A greater understanding of the relevant endonasal anatomy over time has led to safer and more effective surgical techniques. Greater insights into the precise anatomical relationship of the lacrimal sac to other structures on the lateral nasal wall has enabled lacrimal surgeons to perform EnDCR surgery in a more accurate, efficient and well tolerated manner, matching its success to that of the external approach.

Subconjunctival Orbital Fat Prolapse

Subconjunctival orbital fat prolapse has been rarely described in the literature, often leading to misdiagnosis. In this article, we present the clinical features and treatment of patients with subconjunctival orbital fat prolapse as experienced in our clinic. Cases of subconjunctival orbital fat prolapse were evaluated retrospectively from the records of the Zhongshan Ophthalmic Center at Sun Yat-sen University for the period of January 1, 1991 to December 31, 2010. A total of 46 patients (33 males and 13 females) with subconjunctival orbital fat prolapse were identified. Their ages ranged from 44.0 to 82.0 years (mean age, 65.8 y). The right eye was involved in 16 cases, the left eye was involved in 11 cases, and both eyes were involved in 19 cases. Subconjunctival fat prolapse appeared as a soft, mobile yellowish mass, quite different from conjunctival dermolipoma, which presents as a congenital soft or firm pinkish-white or pinkish-yellow mass with hairs on the surface. The conjunctival fat prolapse was located in the superotemporal quadrant in 45 patients and in the superonasal quadrant in the remaining patient with no history of trauma or previous eye surgery in all the patients. Forty patients underwent surgical excision of the prolapsed fat and fixation of Tenon's capsule to the sclera. There were no recurrences of orbital fat prolapse or surgical complications in these patients with a mean follow-up of 2.4 years. Subconjunctival orbital fat prolapse is a rare benign entity and can be easily diagnosed when this condition is considered. The surgical management usually has an excellent therapeutic outcome.

Analysis of Lower Eyelid Aging in an Asian Population for Customized Lower Eyelid Blepharoplasty

The objectives of this study were to evaluate the factors that contribute to aging in the lower eyelids and periorbital changes in Asians and to analyze the contribution of different anatomic factors before surgery. We analyzed photographs and examination findings of 108 patients older than 80 years who had consultations for lower eyelid blepharoplasty. Structural changes were categorized to 7 anatomical categories, and each category was scored from 0 to 3 based on severity. The total point for each category for all patients was divided by the 456 total possible points and was considered a cumulative contribution score for that category. "A uniqueness score" for each patient was calculated as the maximum score in 1 category divided by the patient's total score to reflect the percentage contribution of the patient's most severe anatomic problem. A total of 108 cases (51 male and 57 female patients) were evaluated. The mean age was 57 ± 11 years (age range, 30-75 years). The cumulative contribution score for each category was as follows: orbital fat prolapse 33.8 (medial 15.3, central 11.7, lateral 6.8), skin laxity 22.3%, periorbital hollow 20.8 (tear trough 15.5, lateral orbital rim 5.3), septal confluence 9.5, orbicularis oculi muscle hypertrophy 3.6, triangular malar mound 3.4, and eyelid fluid 0.5. The average uniqueness score was 40.1%, and skin laxity and orbital fat prolapse had the highest average uniqueness score, but no single category played a dominant role in most patients. Medial orbital fat prolapse and skin laxity had the highest proportion of grade 3 scores of 9.5% and 6.7%, respectively. When the patients were grouped according to age, either younger than 50 years or older than 50 years, there was a prominent difference in orbital fat prolapse and skin laxity between the 2 groups. Various anatomic factors were related to periorbital changes in Asian patients. Understanding of the complex factors that contribute to periorbital changes during the aging process may allow for adequate and customized surgery for each patient and help in prevention of postoperative complications.

Age-matched, case-controlled comparison of clinical indicators for development of entropion and ectropion.

Purpose. To analyze the clinical findings associated with involutional entropion and ectropion and compare them to each other and to age-matched controls. Methods. Prospective, age-matched cohort study involving 30 lids with involutional entropion, 30 lids with involutional ectropion, and 52 age-matched control lids. Results. The statistically significant differences associated with both the entropion and ectropion groups compared to the control group were presence of a retractor dehiscence, presence of a “white line,” occurrence of orbital fat prolapse in the cul-de-sac, decreased lower lid excursion, increased lid laxity by the snapback test, and an increased lower lid distraction. Entropion also differed from the control group with an increased lid crease height and decreased lateral canthal excursion. Statistically significant differences associated with entropion compared to ectropion were presence of a retractor dehiscence, decreased lateral canthal excursion, and less laxity in the snapback test. Conclusion. Entropic and ectropic lids demonstrate clinically and statistically significant anatomical and functional differences from normal, age-matched lids. Many clinical findings associated with entropion are also present in ectropion. Entropion is more likely to develop with a pronounced retractor deficiency. Ectropion is more likely to develop with diminished elasticity as measured by the snapback test.

Dacryoendoscopic Findings in the Lacrimal Passage in Failed Dacryocystorhinostomy

To examine the appearance of the lacrimal passage using dacryoendoscopy in failed dacryocystorhinostomies, examining the relationship between the remnant lacrimal sac mucosa and the obstruction tissue, and to detect canalicular obstruction. Twenty failed dacryocystorhinostomies (4 right and 16 left) in 19 Japanese patients (8 males and 11 females) aged 36 to 81 years (average, 69.5 years) were reviewed. Dacryoendoscopy was used to examine the lacrimal passage of the failed dacryocystorhinostomies. An occluded space was found with no adhesion between the remnant lacrimal sac mucosa and the fibrous obstruction tissue in every failed dacryocystorhinostomy. None of the lacrimal canaliculi or the common internal ostia was obstructed. A space without adhesion between the remnant lacrimal sac mucosa and the obstruction tissue was visualized in all the failed dacryocystorhinostomies. No canalicular stenosis was seen, including the common internal ostium, in this cases. Based on these results, endoscopic revision for failed dacryocystorhinostomies is a safe procedure, performed without orbital fat prolapse.

Efficacy of transconjunctival excision of orbital fat prolapse: a long‐term follow‐up study

To describe the long-term efficacy of transconjunctival excision of subconjunctival orbital fat prolapse. Retrospective study of consecutive cases of orbital fat prolapse treated with transconjunctival resection between December 2002 and December 2011. Thirty-two eyes of 23 patients (19 males and four females) were included. The lesion was unilateral in 14 and bilateral in nine cases. It was located superotemporally in a majority of cases. Excision was performed by opening the conjunctiva and excising the prolapsing orbital fat. The conjunctival wound was closed with 1-2 interrupted sutures. With an average follow-up of 29 months (range 4-108), a recurrence was seen in three cases. The average time to recurrence was 46 months (range 40-52 months). Transconjunctival excision is a simple, safe and effective primary surgical procedure to treat subconjunctival fat prolapse. In our series, the recurrence rate was 9%, but no additional surgery was required. As the average time to recurrence was longer than our average follow-up, more patients may develop a recurrence in future.

Success rate and complications of endonasal dacryocystorhinostomy with unciformectomy.

BackgroundEndonasal dacryocystorhinostomy (DCR) has been widely used to treat nasolacrimal duct obstruction. Here, we evaluated the anatomical advantages of the uncinate process as a landmark and to study the effect of unciformectomy on success rate and complications of endonasal DCR .MethodsIn total, 288 eyes of 265 adult patients who underwent endonasal DCR between January 2003 and February 2010 were reviewed retrospectively. The eyes were classified into two groups, according to whether unciformectomy was performed or not. All surgical procedures and surgical indications were the same except unciformectomy and endonasal DCR was performed by one surgeon. Unciformectomy was performed by resecting the anterior part of uncinate process.ResultsOne hundred and eighty-six eyes of 168 patients received endonasal DCR with unciformectomy, and 102 eyes of 97 patients received endonasal DCR alone. The average success rate of endonasal DCR with unciformectomy was 97.8 % and that of endonasal DCR alone was 90.2 %, with statistically significant difference (Student's t-test, p-value < 0.05). There were 14 eyes with post-operative nasolacrimal obstruction, caused by granuloma in five eyes, intranasal synechia in two eyes, membranous obstruction in six eyes, and canalicular stenosis in one eye. There were no serious complications such as orbital fat prolapse, cerebrospinal fluid leak, or delayed hemorrhage.ConclusionsAnterior resection of the uncinate process gives improved access to the lacrimal bone by exposing the medial aspect of the lacrimal fossa and forming the precise location of the osteotomy on the lacrimal bone during endonasal DCR. Thus, the uncinate process can be used as an anatomical landmark for endonasal DCR. The unciformian endonasal DCR improves operation success rate by allowing access to the large space of the nasal cavity and reducing the synechiae of the nasal cavity.

Using Multidetector Row Computed Tomography to Evaluate Baggy Eyelid

BackgroundBaggy eyelids, formed by intraorbital fat herniation in the lower eyelids, are a sign of aging observed in the midface. This study aimed to identify the cause of baggy eyelids by evaluating the relationship between orbicularis oculi muscle thickness, orbital fat prolapse length, and age using multidetector row computed tomography (MDCT).MethodsThe 34 patients in the study ranged in age from 20 to 79 years. The patients were divided into three age groups: 20–29 years, 30–54 years, and 55–79 years. Orbicularis oculi muscle thickness and orbital fat prolapse length were measured using reconstructed computed tomography (CT) images.ResultsThe orbicularis oculi muscle was found to be significantly thinner in the oldest group. Likewise, orbital fat prolapse was found to be significantly more prominent in the oldest group. A strong and significant negative correlation was found between orbicularis oculi muscle thickness and orbital fat prolapse length (r = −0.78; P < 0.001) and between orbicularis oculi muscle thickness and age (r = −0.77; P < 0.001). A strong and significant positive correlation was found between orbital fat prolapse length and age (r = 0.78; P < 0.001).ConclusionsThe use of MDCT provides insight into the detailed changes associated with aging that take place within the lower eyelids. This study objectively demonstrated that the major factors associated with baggy eyelids include orbicularis oculi muscle thickness, orbital fat prolapse length, and age. Decreased orbicularis oculi muscle thickness leads to the orbital fat prolapse.

Macrophakia in three cats

This report describes three cases of bilateral macrophakia in 3-, 5-, and 9-year-old cats, respectively. All cats were presented because of visual deficits. Ophthalmic examination revealed macrophakia (the vitreous was replaced by the lens) and retinal changes (tapetal hyper-reflectivity, attenuation of retinal vessels, and retinal folds) in all cats. In addition, bilateral subconjunctival orbital fat prolapse in one cat and microphthalmos in another cat were present. To confirm the ophthalmologic diagnosis of macrophakia, gross pathology examination in one cat and ultrasound examination in another cat were performed.

Factors Associated With Outcome of Endonasal Dacryocystorhinostomy

To identify factors associated with outcome of endonasal dacryocystorhinostomy. One hundred thirty-four cases of endonasal dacryocystorhinostomy in 111 patients performed for primary acquired nasolacrimal duct obstruction by a single surgeon between March 12, 2002 and November 10, 2008 were included in a retrospective, noncomparative case series. Variables assessed during the surgery included intranasal view, difficulty of bone removal, size of the lacrimal sac, presence of lacrimal sac stones, orbital fat prolapse and degree of bleeding. Successful outcome was defined as patency to lacrimal irrigation at final follow up. One hundred twenty-one of the 134 cases (90%) were patent to irrigation at final follow up (mean 8.8 ± 8.6 months). A small lacrimal sac opening intraoperatively was associated with higher risk of failure (odds ratio [95% confidence interval] of 5.7 [1.6, 20] [p = 0.0072]). Orbital fat prolapse had a trend toward higher risk of failure that approached statistical significance (odds ratio [95% confidence interval] of 5.3 [0.87, 32] [p = 0.0698]). A narrow intranasal view, difficult bony opening, lacrimal sac stones, and bleeding were not associated with outcome. A small lacrimal sac opening intraoperatively was associated with failure of endonasal dacryocystorhinostomy.

Subconjunctival Prolapse of the Palpebral Lobe of the Lacrimal Gland Occurring in Association with Occult Orbital Fat Herniation

Introduction: Sub-conjunctival prolapse of the palpebral lobe of the lacrimal gland can be a disfiguring and sometimes uncomfortable problem, usually caused by lacrimal gland enlargement or associated orbital lobe displacement. However, we present two novel cases associated with occult orbital fat herniation.Method: Retrospective interventional case series of two middle-aged/elderly male patients presenting with unilateral prolapse of the palpebral lobe of the lacrimal gland and no clinically apparent orbital fat prolapse. Neither patient had proptosis, globe displacement or diplopia, but both were aware of a subconjunctival mass in the lateral fornix causing a cosmetic concern.Results: Imaging in both cases revealed a normal sized lacrimal gland with a prominent orbital fat pocket behind this. This fat was excised through an upper-eyelid skin crease approach with temporary detachment of the levator muscle in one case, and through a trans-conjunctival incision in the other. In both cases fat excision resulted in retroplacement of the palpebral lobe of the lacrimal gland such that it was no longer visible. Neither patient experienced any additional dry eye post-operatively.Conclusion: Sub-conjunctival prolapse of the palpebral lobe of the lacrimal gland can be associated with occult orbital fat herniation, revealed on imaging. Localised orbital fat excision is an effective means of treating this condition.

Prolapso de gordura orbitária e oftalmopatia de Graves

We report two cases of orbital fat prolapse. One associated with Graves’ ophthalmopathy. Both patients presented similar clinical exams and an increase in intraorbital fat as seen in computerized orbital tomography. The patient with Graves’ ophthalmopathy also presented an increased volume in orbital muscles in the tomography. This work seeks to include Graves’ ophthalmopathy as differential diagnosys for Orbital fat prolapse. Orbital fat prolapse and Graves’ ophthalmopathy

Clinicoradiologic Relationships in Case of Grave's Orbitopathy

Purpose. To evaluate the relationship of clinical and radiologic findings in improving of diagnostics and amendment of the outcome.Material and methods. 52 patients (104 orbial cavities) in the age of 18–61 years were examined. Patients with the clinical symptoms of Grave’s orbitopathy were examined using ophthalmological evaluation and MSCT-visualization of orbial cavities.Results. The most significant MSCT-parameters for the determination of severity are: prolapse of orbital fat (р = 0.0009), protrusion of eye bulb (р = 0.001), apical inspissations (р = 0.019), density of RBCmin (р = 0.004), size of external terminal membrane (р = 0.001), size of LRM (р = 0.002), size of MRM (р = 0.006), length of optic nerve (р = 0.0001), diameter of optic nerve in 1 cm from the macula (р = 0.01), width of lacrimal gland (р = 0.0002).Conclusions. There is significant relationship between clinical and radiologic (MSCT) features. It lets develop the protocolof examination for diagnostics and treatment of Grave’s orbitopathy.