Treatment Of Ectropion Research Articles

Applied Anatomy of the Lower Eyelid Preseptal Space for Treating Ectropion and Retraction with Soft-Tissue Fillers.

Lower eyelid malposition can result from age-related changes, such as ectropion, or postsurgical changes, such as retraction after lower lid blepharoplasty. The current accepted treatment is surgical, but soft-tissue fillers have been used as well, with good outcome. The underlying anatomy, which is incompletely described, would be useful information for practitioners desiring to provide minimally invasive injections of the lower eyelid. The authors describe a minimally invasive injection technique adjusted to the complex anatomy of the lower eyelid for the treatment of ectropion and retraction of the lower eyelid. A total of 39 periorbital regions of 31 study participants were retrospectively analyzed using photographs before and after reconstruction of the lower eyelid with soft-tissue fillers. Two independent raters assessed the degree of ectropion and lower eyelid retraction (0 to 4, best to worst) before and after the reconstruction and the overall aesthetic improvement using the Periorbital Aesthetic Improvement Scale. The median degree of ectropion and lower eyelid retraction score improved statistically significantly from 3.00 (SD, 1.5) to 1.00 (SD, 1.0) ( P < 0.001). The mean volume of soft-tissue filler material applied per eyelid was 0.73 cc (SD, 0.5). The median Periorbital Aesthetic Improvement Scale score after the treatment was rated as 4.00 (SD, 0.5), indicating improvement of the periorbital functional and appearance. Anatomic knowledge of the lower eyelid and of the preseptal space is of clinical relevance when reconstructing the lower eyelid with soft-tissue fillers. The targeted space provides optimal lifting capacities for improved aesthetic and functional outcome. Therapeutic, IV.

Reconstruction of eyelid defects using the diplene adhesive membrane

BackgroundThe abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult. MethodsIn this novel article, we described a method for closing lower eyelid defects after tumor excision using a skin-muscle flap from the upper eyelid along with the use of an adhesive diplene biodegradable membrane. The membrane was used for seamless fixation of the flap and to prevent the development of lower eyelid deformity. ResultsThe case presented herein demonstrated that using diplene adhesive biodegradable membranes has excellent functional and aesthetic results. ConclusionOur findings suggest that an adhesive biodegradable diplene membrane can be used for the reconstruction of the lower eyelid to prevent the occurrence of retraction, for the surgical treatment of ectropion including recurrent cases, and for seamless fixation of flaps to wound surfaces in patients with a tendency to form keloids and hypertrophic scars.

Pioneer in refractive lens surgery

AbstractWincenty Fukala (1847–1911) was born in a Polish family in Zolkiew in Polish Galicia (now Ukraine). He studied medicine in Vienna. He specialized in ophthalmology under the well‐respected professor, Karl Ferdinand von Arlt. He was a pioneer in systematically extracting the clear crystalline lens in young patients with high myopia (Fukala operation). This is the earliest refractive surgery performed in ophthalmology. He demonstrated the benefit to this group of increased visual acuity, which enabled them to work, and ophthalmologists gradually began to carry out surgery in high myopes worldwide. He persisted in operating despite the vigorous opposition of several authorities but, through sheer determination he convinced sceptics of the efficacy of his surgical method of lens dissection. He performed the first lens discission in 1887 and in 1894, he had successfully treated 44 patients. The late complication of retinal detachment, which was not understood until years later, eventually led surgeons to abandon the procedure until the recent improvements in both lenticular and retinal surgery techniques that led to better prognosis. He studied trachoma in Egypt in 1872. His research on scrofulous eye disease led him twice to the United States, in 1891 and 1892. Fukala also developed highly successful, pioneering techniques for the treatment of ectropion in blepharitis, of trachoma, and of shallow sockets following enucleation. In glaucoma, he recommended early iridectomy of the fellow eye when the first eye has gone blind. He was also an expert on the history of ancient European texts and of Arabic ophthalmology.

Colposcopic outcomes for symptomatic patients with a negative oncogenic human papillomavirus test.

This study assesses outcomes of colposcopy referrals for post‐coital, intermenstrual, or other abnormal bleeding with negative oncogenic human papillomavirus and negative to low‐grade cytology. Of 112 cases with median age of 34.5 years, cervical biopsy occurred in 19%, treatment of ectropion in 19%, endometrial sampling in 8%, polypectomy in 4%, and contraceptive change in 2%. No cervical or endometrial neoplasia was detected. Patients with bleeding symptoms and reassuring co‐test may instead attend a general gynaecology clinic.

Surgical Treatment of Ectropion at Polyclinic “SHOSHI” in Prishtina—Case Report

Ectropion is an outward turning of the eyelid margin, as a result the conjunctiva is permanently irritated, thickened and dry. Since the lacrimal puncta are moved away from the eyeball, the tear elimination is difficult, tears are always present. Materials and Methods: This study includes patients suffering from senile ectropion, who were treated surgically at Polyclinic “SHOSHI” in Prishtina. Our study includes 19 patients suffering from senile ectropion, out of which, 17 were older than 75 years old and in those patients the ectropion was preset on both lower eyelids, while 2 patients were under 75 years old and the ectropion was present only on one side lower eyelid. Prior to surgery, patients have undergone laboratory examinations. The surgery was performed under local anesthesia. The suturing was done in three layers using 6.0 vicryl sutures. No operative or post-operative complications were encountered. Purpose: The purpose of this case report study is to show the success of the surgical treatment of ectropion, a procedure that is mainly performed so the tear elimination is enabled, and there are no tears present constantly. Conclusion: In old patients where the eyelid is turned outwards its margin, conjunctiva is constantly irritated, thickened and dry, the best method of treatment is the surgical treatment, making it possible for the tears to drain properly.

Experience of surgical treatment of post-burn oral commissural contracture (Microstomia)

Introduction: One of the significant problems of facial burns is post burn oral commissural contracture (Microstomia) occurring as a result of circumferential scarring at the junction between the lips and cheek. It results in aesthetic disfigurement of face and functional impairments like feeding, speech and oral hygiene and difficulty of intubation. Objective: This study aims to share the experience of treatment of microstomia with various methods. Methods: This study comprised of 7 cases of microstomia of variable severity over a period of 10 years. Case number 1, 2 and 3, having severe microstomia, were treated with Converse method of commissuroplasty without waiting for scar maturation. Case number 4 and 5 had moderate severity microstomia, in these patients the correction of the neck contracture was considered as priority and were treated with release of neck contracture and split skin grafting. Case number 6 and 7 had pressing priority of treatment of ectropion which was treated first but unfortunately further the treatment of microstomia was given back seat by the patients. Results: Case number 1 to 5 treated operatively showed significant improvement in mouth opening while case number 6 and 7 who rejected treatment, showed no improvement.Conclusion: Post burn microstomia is infrequent yet important functional condition causing difficulty for feeding and for intubation during anesthesia and hence its correction falls under essential procedure to be done earliest without waiting for scar maturation. Cases which were treated operatively showed significant improvement in mouth opening. In cases that rejected treatment, hence considered as conservatively treated, the results were inferior.

Topical Tazarotene for the Treatment of Ectropion in Ichthyosis

Ectropion is a complication of certain subtypes of ichthyosis and is often associated with substantial medical and cosmetic consequences. At present there is no standard of care for the treatment of ectropion in this population. Retinoids cause dyshesion and thinning of stratum corneum, thereby reducing hyperkeratosis that likely underlies ectropion in patients with ichthyosis. As such, retinoids provide a potential effective treatment for ectropion in this group of patients. We describe a patient with recessive ichthyosis for whom daily application of topical tazarotene produced rapid and persistent improvement of bilateral lower eyelid ectropion without adverse effects. Additional studies will be necessary to more fully and systematically address the safety and efficacy of topical retinoids for the treatment of ectropion in patients with ichthyosis; however, this case illustrates that topical tazarotene and other retinoids provide a potential treatment option for ectropion in this population. We encourage clinicians to explore medical therapies as alternatives to surgical intervention for the treatment of ectropion in patients with ichthyosis.

Vincenz Fukala (1847–1911): Versatile Surgeon and Early Historian of Ophthalmology

Vincenz Fukala is best known for his technique of discission and linear extraction of the lens in young, highly myopic eyes—the technique adopted by Harold Ridley in preparation for lens implantation in young patients. He was Polish and trained in Vienna under Karl Ferdinand. von Arlt. Fukala practiced first in Pilsen (1889–1894), but returned to Vienna in 1895. He studied trachoma in Egypt in 1872. His research on scrofulous eye disease led him twice to the United States, in 1891 and 1892. Fukala also developed highly successful, pioneering techniques for the treatment of ectropion in blepharitis, of trachoma, and of shallow sockets following enucleation. In glaucoma, he recommended early iridectomy of the fellow eye when the first eye has gone blind. He was also an expert on the history of ancient European texts and of Arabic ophthalmology.

The Lateral Transorbital Canthopexy for Correction and Prevention of Ectropion

There are numerous approaches to correcting laxity of the lateral canthal tendon, each with advantages and drawbacks. Critical evaluation of these techniques is not possible, however, as there is no grading system currently in use to describe this condition or to report outcomes, and prospective trials are lacking. To report and assess a new procedure for repair of the lateral canthus (lateral transorbital canthopexy) and to describe the Ectropion Grading Scale (EGS), with a prospective outcome analysis of their use. Prospective outcome study of 15 consecutive patients (16 procedures). Tertiary referral center in Zurich, Switzerland. Consecutive sample of patients referred for treatment of ectropion of various causes. Preoperative and postoperative EGS grades were recorded, a preoperative and postoperative patient-based questionnaire was administered, and lateral transorbital canthopexy was performed. Outcome was determined by improvement in EGS grade and results of the patient-based symptom questionnaire. There were no surgical failures or complications in the study. An average of 83% reduction in patient-reported discomfort was achieved. Two patients with facial paralysis needed medial canthal repositioning. The EGS allowed clear recording of lower eyelid position before and after lateral transorbital canthopexy, and the procedure was uncomplicated to perform. Lateral transorbital canthopexy is an effective technique for the correction of lower eyelid laxity and appears to allow refined, durable adjustment of the lateral canthus. Self-reported patient satisfaction confirmed the high rate of success of the procedure in this study. The EGS permits critical evaluation and reporting of results and may assist in predicting which patients will need concomitant correction of the medial canthus. Arch Facial Plast Surg. 2000;2:9-15

A cheek island flap for the lower eyelid

An island transposition flap for use in lower eyelid reconstruction and the treatment of ectropion is described. The flap is based on a subcutaneous pedicle 1 to 2 cm lateral to the outer canthus. Its long axis extends inferolaterally from this point, and the donor site can be closed directly. The skin of the full width of the lid can be replaced, and where skin replacement is not required the flap may be de-epithelialised and used to provide bulk and support only. The flap has also been successfully lined with a nasal muco-chondral graft. Clinical examples are described, including the treatment of cicatricial, senile and paralytic ectropion, and the repair of defects ranging from skin alone to the full thickness of the lid.

Combined Method of Treatment of Ectropion IV Stage of Both Lower Eyelids, Resulting from a Wide Chemical Burn of the Eyelids, Face, and Neck

Combined Method of Treatment of Ectropion IV Stage of Both Lower Eyelids, Resulting from a Wide Chemical Burn of the Eyelids, Face, and Neck

The use of preputial skin to replace conjunctiva and to correct ectropion

The prepuce can provide a large amount of soft delicate skin suitable for replacement of lost conjunctiva or in the surgical treatment of ectropion. Three typical examples of its uses are described: two of ectropion following burns and one case with a carcinoma of the conjunctiva which was excised and replaced with a free graft from the inner lining layer of the prepuce.

Surgical Treatment of Ectropion caused by Blepharoadenitis

Surgical Treatment of Ectropion caused by Blepharoadenitis