Orbital Margin Research Articles

Analysis of aging-related changes in the lower eyelid tissue structure in Han Chinese women

To analyze aging-related regional changes in the lower eyelid tissue structure of Han Chinese women as data reference and theoretical basis for rejuvenation treatment of lower eyelids. Magnetic resonance imaging (MRI) data of healthy Han Chinese women with a body mass index (BMI) between 18.5-23.9kg/m2 were collected and stratified by age. MRI of the mid-sagittal plane of the eyeball was analyzed. The orbital margin was marked as the coordinate O point while the surface of the zygomatic bone was marked as the coordinate y-axis. The vertical line between the O point and y-axis was marked as the x-axis. The position of each point of the orbicularis oculi muscle contour and the subcutaneous fat tissue contour on the coordinate axis was measured. The thickness and contour morphology of the subcutaneous fat and orbicularis oculi muscle at different positions were calculated according to the coordinate position of each point. Age-related changes in the structure, contour, and position of the subcutaneous tissue in the lower eyelid area were analyzed. With aging, the thickness of the orbicularis oculi muscle decreased while its width increased. Notably, the radian of the orbicularis oculi muscle in the tarsal portion protruding to the skin increased. The subcutaneous fat of the orbital margin thinned while the subcutaneous fat below the orbital margin thickened with age. The subcutaneous tissue structure of the lower eyelid region in Han Chinese women showed regular changes during aging, chiefly characterized by the widening and thinning of the orbicularis oculi muscle, and the gradual shifting of the subcutaneous fat to the middle and lower regions.

Fulminant Orbital Myiasis - A Rare Case Report from Central India

A 42 year old male farmer presented to eye OPD with a history of painful, foul smelling discharging wound over the lower lid along the inferior orbital margin since two weeks and crawling sensation over the wound with diminution of vision right eye since three days. He gave history of trauma to right eye after falling on sharp edge of stone one month back when he was in a drunken state due to which he had a lacerated wound of about 5cm x 2 cm x 2cm along inferior orbital margin.
 The wound was cleaned and dressed only once at a local hospital, however, he neglected the wound and didn’t open the dressing for about next 15 days until he noticed a crawling sensation and maggots teeming from the wound. He denied a history of diabetes mellitus, hypertension or any other chronic systemic disease or any prolonged use of medications, progressive loss of weight or appetite. However, he was a chronic alcoholic. He belonged to low socioeconomic strata with poor personal hygiene and was residing in a rural area.
 On presentation, the patient was in agony due to pain. On examination of the right eye, the eyelids were severely oedematous and indurated with severe mechanical ptosis. The lower lid along the inferior orbital rim had a deep open, macerated wound of size about 5cm x 2cm x 2cm, filled with necrotic tissue (slough), discharge and around 5-6 maggots were seen teeming from the wound [Fig. 1]. The skin around the wound was red and friable. On separating the lids gently and mechanically, the conjunctiva was severely congested and chemosed. Unaided visual acuity was 3/60; best-corrected visual acuity could not be assessed as the patient was in agony due to pain. The cornea, anterior chamber and iris were normal. The pupil was normal-sized reacting to light. The eyeball had deviated inwards and ocular movements were painful and restricted in all directions. Lens had immature senile cataract. Intraocular pressure and nasolacrimal passage could not be assessed because of gross lid oedema. Fundus examination of the right eye was within normal limits. On examination of the left eye, unaided visual acuity was 6/18 and best-corrected visual acuity was 6/9. Anterior segment was within normal limits with pupil normally reacting to light and fundus examination was normal.
 Five to six superficially lying maggots were removed with the help of turpentine oil and forceps after adequate local anaesthesia. Many more deep-seated maggots were seen but were difficult to remove.

Glyptothorax yuensis, a new species of sisorid catfish (Teleostei: Sisoridae) from Myanmar.

Glyptothorax yuensis, new species, is described from the Yu River, Sagaing division, Myanmar. It is characteristic in having a shallow adipose fin acutely incised at the posterior extremity of its base with an elongated pointed tip, adipose-fin base length 7.610.0 % SL; short nasal barbel, not extending to anterior margin of orbit; thoracic adhesive apparatus present with a conical-shaped median depression opening caudally, its length 11.713.0% SL and width 8.210.1% SL, anteromedial striae present; deep caudal peduncle, its depth 9.411.0 % SL; and two thin yellowish stripes on the body. A key to the species of the genus of Chindwin drainage is provided.

A 10 ka intentionally deformed human skull from Northeast Asia

AbstractThe oldest‐known undoubted cultural practices of intentional cranial deformation (ICD, also known as artificial cranial modification) appeared in the Middle East, Australia, and Northeast China in the terminal Pleistocene‐early Holocene populations. Here, we report an ICD calvarium fossil (Songhuajiang II) discovered from an underwater sand mining site near Harbin City in Northeast China. With a calibrated accelerator mass spectrometry (AMS) radiocarbon age of 11,095–10,745 BP, the fossil calvarium is among the oldest‐known ICD records in the world. A combination of pronounced superciliary arches, salient temporal lines, and relatively round and dull supraorbital margin, together with moderately wide interorbital space, flat glabella region without infraglabellar notch, flat and small zygomatic trigon, round and inclined superior‐lateral orbital margin, and largely closed sutures, suggests that Songhuajiang II skull belonged to a middle‐aged Asian man. The man has flat frontal and occipital bone, conical posterior parietal region, and a circular depression posterior to the coronal suture, and more subdivisions and many crenulated terminal branches on the anterior branch of the middle meningeal vessels. These features are typical for the tabular deformation methodology of ICD. The discovery, together with previously known ICD records (Songhuajiang I, Qianguo Man Qingshantou 1, and Djalai‐Nor cranium), suggests that the ICD cultural practice has a long and continuous history in Northeast Asia.

Topography of the orbital part of the lacrimal gland for treating epiphora using botulinum toxin injection.

The purpose of this study is to identify the location of the orbital part of the lacrimal gland using external landmarks to facilitate effective botulinum toxin A (BTX-A) injections for epiphora treatment. Dissections were performed on 45 hemifaces from 27 cadavers. The length, anterior protrusion, and thickness of the orbital part of the lacrimal gland were measured directly. The midpoint of the line running horizontal through the medial and lateral canthus was used as the horizontal reference point. Vertical lines perpendicular to the midpoint of the horizontal reference line were the vertical reference lines. The angles from the horizontal reference line to the lacrimal gland center and to the frontal tubercle were also measured. The length and thickness of the lacrimal gland were 12.8 and 2.4 mm, respectively. The lacrimal gland had an anterior protrusion of 4.1 mm from the superolateral orbital margin. The superior and inferior margins of the lacrimal gland were located 35.7° and 15.8° from the two reference lines, respectively. The angle from the horizontal reference line to the lacrimal gland center was 35.1°, which was similar to that to the frontal tubercle (34.4°). The orbital part of the lacrimal gland was more inferior in elderly subjects and the angle between the horizontal reference line and its center was 35.1°, which was similar to the location of the frontal tubercle. The location of this tubercle can help clinicians to perform BTX-A injections into the lacrimal gland, thereby enhancing the effectiveness of epiphora treatment.

Precise Localization in Craniotomy With a Retrosigmoid Keyhole Approach: Microsurgical Anatomy and Clinical Study.

ObjectiveWe aimed to explore a method of precise localization within craniotomy based on skull anatomical landmarks via the suboccipital retrosigmoid approach.MethodCraniometric measurements were taken from 15 adult dry skulls and eight cadaver head specimens. In the anatomical study, the keypoint corresponded to the transverse-sigmoid sinus junction's corresponding point on the external surface of the temporal mastoid process, eight cadaveric heads underwent a simulated craniotomy using the suboccipital retrosigmoid approach. The center of the burr hole is precisely oriented 12 mm vertically above the top point of the mastoid groove based on the line between the infraorbital margin and the upper edge of the external auditory canal. Clinical application was verified in clinical surgery by evaluating the accuracy, safety, rapidity, and minimal invasiveness of the procedure in 29 patients.ResultNo venous sinus injuries were observed. Within clinical application, 29 patients underwent craniotomy using the suboccipital retrosigmoid approach. The operative area was clearly exposed in all patients and the microsurgical anatomy of the intracranial region after the dura mater incision was satisfactory. No venous sinus ruptures were observed. The average craniectomy time was 27.02 ± 0.86 min. The diameter of the bone window was 1.7–2.9 cm.ConclusionWe conclude that the method can ensure safe, accurate, and rapid craniotomy with good vision while avoiding injury to the venous sinus.

Plasticity in the morphology of the fused frontals of Albanerpetontidae (Lissamphibia; Allocaudata)

ABSTRACT Albanerpetontidae form an enigmatic extinct group of lissamphibians, ranging from the early Bathonian to the early Pleistocene. The Upper Jurassic outcrops of Portugal yield a large collection of material, suitable for addressing the intraspecific variation in and diagnostic potential of the characteristic fused frontals. We revise 58 specimens from the Guimarota beds of the Kimmeridgian Alcobaça Formation and describe 62 new frontal bones from the Kimmeridgian – Tithonian Lourinhã Formation. Smaller specimens exhibit a vermicular dorsal ornamentation, while it is polygonal in larger specimens and other albanerpetontids. Compared to small specimens, larger specimens display: (1) larger ventrolateral crests extending posteriorly after the parietal margin; (2) a relatively shorter internasal process; (3) a frontal width across posterior edges relatively smaller; and (4) a ventromedian crest less pronounced. Morphometric analyses suggest a single species with different ontogenetic stages. Specimens are attributed to aff. Celtedens sp., based on a bell-shaped outline with a curved orbital margin (although variable in Portuguese specimens), and a flabellate, bulbous-shaped internasal process. The species is more similar to C. megacephalus than C. ibericus, but its phylogenetic position comprises an unresolved trichotomy. Our results show that intraspecific variation and homoplasy render the fused frontal non-diagnostic below the generic level.

Possible abnormal origin of inferior oblique from a congenital dermoid cyst

A 4-year-old female child presented with a cystic swelling medially along the floor of the orbit with mild ipsilateral medial canthus dystopia on the left side. This swelling was present since birth with no significant orbital dystopia or any extraocular movement defects. During surgery, a trilobed yellowish cyst was found near the inferomedial wall of the orbit. Incidentally, the inferior oblique muscle was found to be originating from the medial lobe of the cyst. The cyst was removed completely, and the inferior oblique was reinserted to the inferomedial orbital margin. Histopathology was consistent with dermoid cyst. To the best of the authors' knowledge, the case of abnormal origin of inferior oblique muscle from an orbital dermoid cyst has not been reported before.

Pneumocephalus after surgical treatment of NOE fracture: Case report

Introduction: Naso-orbital-ethmoidal fractures are complex fractures involving the bones of the nose, orbit region, maxilla and ethmoid. This complex structure has a close relationship with the brain and the orbital region, which frequently suffer injuries during trauma. Among traumatic brain injuries, there is the pneumoencephalon. The present study aims to report the treatment of a patient who suffered an accident involving a rural animal. Case Report: A 63-year-old male patient was brought to the highly complex hospital for the Oral and Maxillofacial Surgery and Traumatology service, five days after the trauma. The physical examination showed traumatic telecanthus,anisocoria and mydriasis of the right eye, right eyelid ptosis, laceration in the right eyebrow and deviation of the nasal bone to the left. In the imaging exam (computed tomography), traces of fractures were observed in the nasal bone region, medial orbital wall, infra-orbital margin, frontal-zygomatic pillar and right orbital blow out fracture. After a surgical approach to fix the fractures, it was observed the development of a hypodense area in the intracranial region, suggestive of pneumocephalus. Conclusion: These complications, such as pneumocephalus, must be diagnosed early and appropriate treatment must be started as soon as possible to reduce possible sequelae, requiring the intervention of a multidisciplinary team.

Morphometric analysis of infraorbital foramen in human dry skull of south Indian population and its clinical implications

Infraorbital foramen,an important anatomical landmark in anaesthetic and surgical interventions of the maxillary region, transmits the infra orbital vessels and nerve. Infraorbital nerve block is commonly used in regional anaesthesia for the midface and paranasal surgeries. The purpose of our study to obtain detailed knowledge of the anatomical location and variations of IOF which is imminent for successful regional anaesthesia and endoscopic surgeries of the maxillary region. The study was conducted on 50 Human skull bones of unknown gender from the Department of Anatomy, Mysore Medical College and Research Institute, Mysore. Both side of skulls were visually observed for shape, direction of the infraorbital foramen and presence of accessory infraorbital foramina. 1. Sagittal Distance between the infraorbital margin to upper margin of infraorbital foramen were measured. 2. Transverse diameter from lateral margin of pyriform aperture to medial margin of IOF were measured. 3. Oblique distance from anterior nasal spine to inferior margin of IOF, were measured. 4. Vertical and transverse diameter of the IOF were measured. 50 skulls (100 sides – both right and left) were studied.Most commonly observed shape of IOF is semilunar 36% on right side, 40% on left side, transversely oval 20% on right side, 28% on left side, vertically oval 18% on right side, 12% on left side, circular 18% on right side, 8% on left side, triangular 8% on right side 12% on left side. Direction of IOF is 88% medially downwards, 12% downwards.The mean distance between IOM and IOF is 6.58±0.28 mm on the right side, 6.78 +0.233 mm on the left side. The mean distance between pyriform aperture to of IOF 16.88+3.7mm on the right side 16.46 +2.7 on the left side. The mean distance between ANS to inferior margin IOF on the 34.77+0.55 mm on right side 34.22+0.3 mm on the left side.Mean vertical diameter of IOF 3.76 mm on right side & 3.94 mm on left side. Mean transverse diameter of IOF 4.18 mm on right side & 4.32+15 mm on left side.Accessory IOF were present in 6% of skulls bilaterally. Our study results will be of immense help to the surgeons and anaesthetists, handling this region for operative procedures.

HP43: Electrophysiological reactions to intraoperative irritation of the optic nerve: A clue for intraoperative optic nerve mapping?

Intraoperative control of optic nerve function preservation during neurosurgical operations currently relies mainly on monitoring of visual evoked potentials. Unfortunately, they detect peril only when the visual pathways are already compromised, sometimes irreversibly. In contrast, electrophysiological stimulation mapping of the nerves can be a fully preventive measure. However, direct sensory nerve mapping requires the patient to be awake during surgery, which is hardly feasible for surgeries targeting the optic nerve area. Another possible approach to sensory nerve mapping involves unconditioned electrophysiological responses evoked by sensory nerve stimulation. The necessary prerequisites for this approach are existence and stability of such responses for a particular sensory nerve in conditions of surgical anesthesia. Case report . A 52-year-old woman presented with meningioma in the area of right optic nerve and chiasm. She underwent microsurgical removal of the tumor through a transciliary supraorbital approach. Total intravenous anesthesia with propofol was used throughout the surgery. During the surgery, electrodes at the inferior margin of the right orbit repeatedly recorded electrophysiological reactions following touches, tractions and releases of tractions of the right optic nerve by the surgical instruments. Conclusions . The observed reactions suggest that either the unconditioned blink reflex or antidromic electroretinographic response to optic nerve irritation was conserved under the total intravenous anesthesia. This observation might be of value for development of intraoperative optic nerve mapping. This in turn could increase patients safety by identifying the optic nerve location without negative impacts on it. This report is accepted for publication in the Neurochirurgie journal: https://doi.org/10.1016/j.neuchi.2021.03.014.

Anatomy of the lateral orbital wall: A topographic investigation for identification of the lateral canthal attachment

There is a growing effort to develop implantable bionics for restoring eye closure in paralytic lagophthalmos. Knowledge of the natural eyelid attachments is important for active implants that mobilise these attachments or replace them with a sling. Whitnall's tubercle (WT) is traditionally used to identify lateral canthal attachments; however, it is not always present. This study seeks an alternative means of identifying the insertion of the lateral canthus to aid the application of bionic implants. Complete CT head scans of patients in the Sydney Head and Neck Cancer Institute database were retrieved for analysis. The CT scans were segmented using bone and soft-tissue thresholding and then reconstructed. The location of WT and the lateral canthal insertion were recorded and their relation to key anatomical landmarks assessed. Ninety orbits from 45 complete head scans were analysed. WT could be identified bilaterally in 18/45 (40%) samples. The average distance from WT to zygomaticofrontal suture and to lateral orbital margin was 10.8 ± 0.4 mm and 4.4 ± 0.2 mm, respectively. The average height of the lateral canthal insertion from the Jugale point was 13.9 ± 1.8 mm. On regression analysis, the height of lateral canthal insertion was strongly predicted by the height of lateral orbital wall as the determined by the maximum distance of the ZFS from the Jugale point (p = <0.001). In the absence of WT, the height of the lateral orbital wall can be reliability used to localise the insertion site of the lateral canthus.

Analysis of Variation of Orbital Soft Tissue by a Novel Method in Magnetic Resonance Imaging

Summary:Accurate evaluation of the orbital soft tissue is essential when conducting surgery to remove excess lower eyelid fat. However, the eyelid puffiness decreases in the supine-position intraoperatively and when magnetic resonance imaging is performed preoperatively, compared with the standing/sitting-position in which patients are commonly examined. We investigated the orbital soft tissue difference between standing/sitting and supine positions. The study was conducted on six patients with an average age of 58.5 years. Anterior soft tissue and adipose tissue of eyeball axis, anterior adipose tissue in front of the infraorbital margin, total adipose tissue, and horizontal and vertical orbital positions were determined. Statistical examination by t test showed that soft tissue and adipose tissue, except for total adipose tissue, were significantly reduced in the supine-position compared with the standing/sitting-position. There was a significant difference in eye position only in the vertical direction. Anterior adipose tissue in front of the infraorbital margin, which is important during lower eyelid surgery, appeared 17.5% lower in the supine-position than in the standing/sitting-position. It is necessary to consider this postural discrepancy during the surgical management of lower eyelid fat.

A compsemydid turtle from the Upper Cretaceous of Var, southern France

Calissounemys matheroni gen. et sp. nov. (Testudines) is described on the basis of a skull and shell elements from the Upper Cretaceous of Var, southern France. This new taxon is assigned to the family Compsemydidae and characterized by a thick-boned, robust skull, a shallow temporal emargination, a crista supraoccipitalis not extending beyond the posterior edge of the skull roof, large nasals meeting along the midline for their full length; frontals retracted from the orbital margin, absence of a cheek emargination, a large jugal forming a substantial part of the orbital margin, absence of a secondary palate and an uneven upper triturating surface; and the shell with vertebral 1 clearly wider than vertebrals 2-3, with the lateral margins strongly divergent towards the anterior border and wider than long vertebrals 2-3. This find increases the diversity of the Late Cretaceous turtle fauna from southern France, and fills a stratigraphical gap in the fossil record of Compsemydidae between the Early Cretaceous and the Paleocene in Europe.

Clinical application of autologous chyle fat transplantation in the correction of sunken upper eyelid

Aim: We investigated the clinical application of autologous chyle fat in the correction of sunken upper eyelid. Methods: From November 2020 to October 2021, 89 cases of correction with autologous chyle fat to sunken upper eyelid were performed (with or without other cosmetic procedures related to the eyes). An appropriate amount of fat was extracted from the superficial layer of the patient’s thigh and processed to chyle fat. About 0.5-2.8 mL of fat was injected under the orbicularis oculi muscle (roof-retro orbicularis oculi fat) or in the area where the orbital septal fat exists from the outer orbital margin of the upper eyelid. Results: In total, 59 patients were followed up for 1-11 months after surgery. No infection, necrosis, vascular embolism, upper eyelid lumpiness, fat calcification, or liquefaction occurred in all patients, while seven cases showed inadequate correction. The depression basically disappeared, the shape was relatively full, the youthfulness was greatly improved, and the satisfaction of patients was high during the follow-up period. Conclusion: The correction with autologous chyle fat to sunken upper eyelid showed little trauma, short recovery periods, and satisfactory results, and it is worthy of being popularized and applied more widely.

Atypical Recurrent Presentation of Histologically Aggressive Type of Basal Cell Carcinoma with a Challenging Management- A Rare Case Report

Basal Cell Carcinoma (BCC) is the most common type of eyelid malignancy among white race individuals but is rare among blacks and Indians. BCC predominantly affects the sun exposed parts like the neck, back and face (88-90%). These tumours are mostly located on the lower eyelid margin and the medial canthus as upper eyelids are protected from the Ultraviolet (UV) sunrays by the eyebrows and superior orbital margin. Although BCC seldom metastasizes, it is nonetheless considered malignant, since it can infiltrate adjacent tissues and cause substantial deformity and destruction. Here, authors have reported a rare case of 55-year-old female patient with recurrence of surgically treated BCC of upper eyelid involving eyebrow. Surgical excision is the most common employed treatment of choice in extensive tumours. Patient had extensive recurrent spread of BCC in left upper eyelid with multiple small ulcers in and around the left eye with pain and no Perception of Light (PL) vision. Exenteration of left eye was done followed by split skin autografting at the site. BCC is usually not fatal, but early diagnosis and appropriate treatment promises better functionality and aesthetic outcome.

Apocrine hidrocystoma of the orbit mimicking basal cell carcinoma: a case report

Apocrine hidrocystomas are benign cystic lesions derived from the sweat glands. They are rarely seen in the orbit with very few adult cases published in literature. We present a case of a 40-year-old female, with no prior medical history or ocular trauma, referred for an orbital tumor. We found a raised, pearly, blue-grayish and painless mass, medial to her left upper eyelid, in the supero-medial orbit margin. The diagnosis of a basal cell carcinoma was suspected, and a complete excisional biopsy was performed. Histopathologic examination revealed apocrine hidrocystoma. Apocrine hidrocystomas, although rare, should be part of the differential diagnosis of orbital cystic tumors at any age. Our aim was to emphasize the resemblance of apocrine hidrocystoma to basal cell carcinoma.

Sexual dimorphism and infraorbital foramen: a computerized tomography-scan study in a cohort of Senegalese population.

The infraorbital foramen (IOF) is an essential anatomical structure for maxillary block anesthesia in dental practice and maxillofacial surgery. The literature also reports the importance of knowing the morphometric characteristics of the IOF because it can be damaged. The aim of our study was to determine anthropometric characteristics of infraorbital foramen in Senegalese population in relationship with the sex. A total of 87 CT-Scan of patients were included in our sample and data collected from patient's cerebral CT-Scan. The transverse and vertical diameters of the IOF and its distance to the nearest point of the infraorbital margin, lateral nasal border and lower border of the maxillary were measured, and the shape determined. Eighty-seven CT-scan of patients were analyzed. This research showed that the transverse diameter of the left IOF in female subjects was 5.05±0.205 and 4.97±0.22 in male patients. The mean vertical diameter of the right foramen found in our study was 5.30±0.191 for the female subject and 5.28 mm±0.137 for the men foramen was located at 46% on the line above the 2nd premolar. The right IOF was round in 52% of subjects. An accessory IOF was found in 20% of female subjects. Knowledge of the precise anatomical location of IOF is important in surgical procedures and reduce the relative risks during clinical procedures. This study showed many differences in the location of the IOF with Caucasians measurements done.

Blepharoplasty in Extensive Lower Eyelid Eversion of Severe III–IV Degree

Purpose. To analyze the efficacy of the lower eyelid eversions surgical treatment.Patients and Methods. We have analyzed the outcomes of treating patients with severe lower eyelid eversion during 2013–2019 — 153 patients, 156 operations. The patients were divided into 4 groups: atonic and paralytic eversion (109 eyes), traumatic tearing of the lower eyelid (8 eyes), cicatricial ectropion (28 eyes) and mechanical ectropion (in tumors) of the lower eyelid (11 eyes). The following surgeries were performed: duplicature surgery by Willer; by Kuhnt-Szymanowski; resection of the framework structure of the lower eyelid with fixation to the eyelid ligaments; implantation of various materials based on the orbital margin; sling to the eyelid ligaments; free skin plasty; local flaps; excision of tumors with one-stage reconstructive plastics.Results. Postoperatively the improvement was observed in all cases. The lower eyelid eversion was eliminated. There were no any complications. The efficacy criteria was the level of the eyelid margin height with regards to limbus, absence or reduction of lagophthalmus. “Good” result — symmetrical width of the eyelid fissure, absence of lagophthalmus was achieved in 100 % of cases in groups IA and II, in 28.12 % — in group IB, in 71.43 % — in group III, in 63.63 % — in group IV. “Satisfactory” result — the difference in the eyelid fissure width was 1.0–2.0 mm, absence or reduction of lagophthalmus was achieved in 65.62 % of cases in group IB, in 21.43 % — in group III, in 27.28 % — in group IV. “Unsatisfactory” result — the difference in the eyelid fissure width was more than 2.0 mm, the presence of lagophthalmus was achieved in 6.25 % of cases in group IB, in 7.14 % — in group III, in 3.33 % — in group IV.Conclusions. When operating the lower eyelid eversion it is possible to achieve good result. The pathogenically based combined methods of surgical treatment are the most effective. In case of traumatic tearing of the lower eyelid, we need to restore the lacrimal duct. In cicatricial ectropion it is possible to achieve engraftment of the skin graft, elimination of eversion and lagophthalmus. In mechanical eversion (due to eyelid tumors) it is necessary to perform radioexcision of the neoplasm with a single-stage reconstructive plastic surgery of the eyelid.

Influence of fractures in different inferior orbital wall locations on ocular motility disorders.

Influence of fractures in different inferior orbital wall locations on ocular motility disorders.