Ptosis assessment spectacles: a new method of measuring lid position and movement in children.

PubMed

Khandwala, Mona; Dey, Sarju; Harcourt, Cassie; Wood, Clive; Jones, Carole A

2011-01-01

Accurate assessment of eyelid position and movement is vital in planning the surgical correction of ptosis. Conventional measurements taken using a millimeter ruler are considered the gold standard, although in young children this can be a difficult procedure. The authors have designed ptosis assessment spectacles with a measuring millimeter scale marked on the center of the lens to facilitate accurate assessment of eyelid position and function in children. The purpose of the study was to assess the accuracy and reproducibility of eyelid measurement using these ptosis assessment spectacles. Fifty-two children aged 2-12 years were recruited in this study. Each child underwent 2 sets of measurements. The first was undertaken by an ophthalmologist in the conventional manner using a ruler, and the second set made with ptosis assessment spectacles. On each occasion the palpebral aperture, skin crease, and levator function were recorded in millimeters. A verbal analog scale was used to assess parent satisfaction with each method. Clinically acceptable reproducibility was shown with the ruler and the spectacles for all measurements: palpebral aperture, skin crease, and levator function. Parents significantly preferred the glasses for measurement, as compared with the ruler (p < 0.05). The spectacles are as accurate as conventional methods of measurement, but are easier to use. Children tolerate these spectacles well, and most parents preferred them to the ruler.

Complications of Blepharoplasty: Prevention and Management

PubMed Central

Oestreicher, James; Mehta, Sonul

2012-01-01

Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. The surgery involves removing redundant skin, fat, and muscle. In addition, supporting structures such as canthal tendons are tightened. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. Due to the complexity and intricate nature of eyelid anatomy, complications do exist. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. Finally, management of complications is just as important as surgical technique. PMID:22655191

Eyelid bags

PubMed Central

2010-01-01

Eyelid bags are considered a sign of ageing, but they often appear prematurely due to the variety of causes that favor them. This brief report describes the case of a patient who was referred to us for the correction of a second degree bilateral palpebral ptosis that the patient had suffered from for several years and that in recent months had worsened to the point of interfering with vision and who, aside from modest eyelid bags, presented a massive protrusion of "preocular" fatty tissue. Despite the indication of classic blepharoplasty through a lower lid incision and, therefore, the possibility of removing excess skin, the patient opted instead only for the removal of the bulging fat. The patient's postoperative results were normal and the patient was extremely satisfied with both the correction of the ptosis and the "rejuvenating" effect of removing the protruding orbital fat in the eyelid. PMID:20565888

[Juvenile myasthenia gravis in sub-Saharan Africa: a case study of two consanguine sisters born from consanguinity in Togo].

PubMed

Maneh, Nidain; Apetse, Kossivi; Diatewa, Bénédicte Marèbe; Domingo, Sidik Abou-Bakr; Agba, Aidé Isabelle; Ayena, Koffi Didier; Balogou, Koffi Agnon; Balo, Komi Patrice

2017-01-01

Myasthenia gravis is a rare acquired autoimmune pathology causing neuromuscular transmission impairment. Juvenile onset of myasthenia gravis is often characterized by ocular involvement. We report two cases of ocular juvenile myasthenia gravis (JMG) in two siblings. They were two young girls, XA and XB, aged 11 and 9 years, of Malian origin, residing in Togo, born from first-degree of consanguinity presenting to Ophthalmology due to progressive decrease in visual acuity. XA showed visual acuity 8/10 on both eyes while XB showed improvement in visual acuity from 3/10 to 7/10 using a pinhole occluder, suggesting ametropia. XA had a 2-year history of bilateral ptosis lifting the upper eyelid of 7 mm, while XB had a 3-year history of bilateral ptosis with no lifting of the upper eyelid. Ice pack test was strongly positive in both patients. They had Cogan's lid twitch with paresis of the oculomotor nerve without diplopia. The dosage of acetylcholine receptor autoantibodies was normal. The diagnosis of JMG associated with ametropia was suspected. Ametropia was corrected by glasses and a specific treatment with pyridostigmine was initiated, but both patients were lost to follow-up. Autoimmune myasthenia gravis with inaugural ophthalmologic manifestation is rare but it can occur among children living in sub-Saharan Africa. Studies should be conducted to establish the features of this disease.

The putative forkhead transcription factor FOXL2 is mutated in blepharophimosis/ptosis/epicanthus inversus syndrome.

PubMed

Crisponi, L; Deiana, M; Loi, A; Chiappe, F; Uda, M; Amati, P; Bisceglia, L; Zelante, L; Nagaraja, R; Porcu, S; Ristaldi, M S; Marzella, R; Rocchi, M; Nicolino, M; Lienhardt-Roussie, A; Nivelon, A; Verloes, A; Schlessinger, D; Gasparini, P; Bonneau, D; Cao, A; Pilia, G

2001-02-01

In type I blepharophimosis/ptosis/epicanthus inversus syndrome (BPES), eyelid abnormalities are associated with ovarian failure. Type II BPES shows only the eyelid defects, but both types map to chromosome 3q23. We have positionally cloned a novel, putative winged helix/forkhead transcription factor gene, FOXL2, that is mutated to produce truncated proteins in type I families and larger proteins in type II. Consistent with an involvement in those tissues, FOXL2 is selectively expressed in the mesenchyme of developing mouse eyelids and in adult ovarian follicles; in adult humans, it appears predominantly in the ovary. FOXL2 represents a candidate gene for the polled/intersex syndrome XX sex-reversal goat.

Prosthetic Correction of Postenucleation Socket Syndrome: A Case Report.

PubMed

Kamble, Vikas B

2014-12-01

Postenucleation socket syndrome is a frequent late complication of enucleation of eye globe. Several pathophysiological mechanisms have been proposed to account for the symptoms of postenucleation socket syndrome, which include lost orbital volume, superior sulcus deformity, upper eyelid ptosis, lower eyelid laxity, and backward tilt of the prosthesis. The goal of postenucleation socket syndrome treatment is to achieve the best possible functional and esthetic result. The treatment can be either conservative or surgical. For the patient interested in a non-surgical correction, the conservative treatment is simple and non invasive and can be done with prosthesis modification for good positioning, comfort, and mobility. This paper describes prosthetic correction of a patient with postenucleation socket syndrome by modified ocular prosthesis.

Numerical Correlation of Levator Advancement in Preoperative Planning.

PubMed

Makeeva, Valeria; Collawn, Sherry S; Pierce, Evelina N; Mousa, Mina S; Yang, Jennifer H; Davison, Peter N; Jospitre, Elodie C

2017-06-01

Several procedures have been proposed for the treatment of eyelid ptosis, and both levator advancement and levator plication are widely used to shorten the levator palpebrae superioris. The purpose of this study was to quantify perioperative lid measurements in patients undergoing bilateral levator aponeurosis advancements to aid in preoperative planning. Between July 2014 and June 2016, the authors performed a retrospective analysis of all bilateral upper eyelid levator advancement procedures for ptosis performed by the senior surgeon. There are a total of 21 patients (6 men and 15 women) with a mean age of 63 years (range, 48-79 years). The average time at follow-up was 5.3 months, with a range of 1 to 26 months. In this retrospective study, we collected data on presurgical measurements including marginal reflex distance 1 (MRD1), surgical technique used (symmetrical/asymmetrical levator advancement) with millimeters of advancement used, and postsurgical measurements. We found that on average, an advancement of 4 mm led to an improvement in MRD1 of 2.26 mm (n = 14), and advancement of 5 mm led to an improvement in MRD1 of 2.74 mm (n = 15). Patients also reported improvements in their quality of life. Our results may be used to guide clinicians in preoperative planning.

Raising the suborbicularis oculi fat (SOOF): its role in chronic facial palsy

PubMed Central

Olver, J.

2000-01-01

AIMS—To determine the adjuvant role of unilateral suborbicularis oculi fat (SOOF) lift in the periorbital rehabilitation of patients with chronic facial palsy.
METHODS—In a non-comparative prospective case series nine adult patients (seven male, two female) aged 34-90 years (mean 60.5) with chronic unrecovered facial palsy (over 1 year), who had not had any previous rehabilitative periorbital surgery, were studied. Lateral tarsal strip and adjuvant transconjunctival approach subperiosteal SOOF lift under local or general anaesthesia were performed; medial canthoplasty was performed where indicated. There was clinical observation of the long term (over 1 year) effect on the ptotic palpebral-malar sulcus and lower eyelid retraction.
RESULTS—The patients were followed up for 12-24 months (mean 16). Seven patients (77%) had sustained clinical reduction of palpebral-malar sulcus ptosis. All patients had sustained reduction of lagophthalmos. Early postoperative complications included conjunctival cheimosis in 77%. Three patients with persistent keratitis required further surgical procedures on their upper eyelid to reduce the palpebral aperture. There were no cases of infraorbital nerve anaesthesia or recurrent lower eyelid retraction.
CONCLUSIONS—The SOOF lift has an adjuvant role in chronic facial palsy with lower eyelid retraction and ptotic-palpebral malar sulcus. It supports the lower eyelid elevation and tightening achieved with the lateral tarsal strip. The best results were obtained in congenital facial palsy.

 PMID:11090482

Sarcoidosis of the lacrimal gland as a first manifestation.

PubMed

Peralta-Gómez, M Y; Ávila-Ocampo, K A; Huerta-Velázquez, S; Rivera-Salgado, M I

2018-04-01

The first manifestation of sarcoidosis is usually at the pulmonary level. The case is described of a 40-year-old female patient, who presented with an increased volume of the lacrimal gland and mechanical ptosis of upper left eyelid as the first expression of this disease. The diagnosis of systemic sarcoidosis with primary presentation of the lacrimal gland was made after performing several immunological studies with negative results, imaging studies, and taking of glandular and lymph node biopsies. A favourable response was achieved with oral methotrexate treatment. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

A gene prenature ovarian failure associated with eyelid malformation maps to chromosomes 3q22-q23

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1996-05-01

Premature ovarian failure and XX gonadal dysgenesis leading to female infertility have been reported in association with an autosomal dominantly inherited malformation of the eyelids: blepharophimosis-ptosis-epicanthus inversus syndrome (BPES; MIM 110100). This association distinguishes BPES type I from BPES type II, in which affected females are fertile and the transmission occurs through both sexes. Recently, a gene responsible for BPES type II has been mapped to chromosome 3q22-q23, and the critical region for the gene location has been reduced to the interval between loci D3S1615 and D3S1316. Hitherto, however, no information regarding the localization of the gene for BPES typemore » I, in which female ovarian failure is associated with eyelid malformation, has been available. We have studied two independent families affected with BPES type I, including a total of 12 affected individuals (6 infertile women) and 6 healthy relatives. The diagnostic criteria for the ophthalmological anomaly included (1) reduced horizontal diameter of palpebral fissures, (2) drooping of the upper eyelids, and (3) an abnormal skinfold running from the lower lids. Telecanthus and a flat nasal bridge were present in most cases. In both families the disease was transmitted only by the male, and no affected woman of childbearing age was fertile. 12 refs., 2 figs., 1 tab.« less

Stress-relaxation and fatigue behaviour of synthetic brow-suspension materials.

PubMed

Kwon, Kyung-Ah; Shipley, Rebecca J; Edirisinghe, Mohan; Rayment, Andrew W; Best, Serena M; Cameron, Ruth E; Salam, Tahrina; Rose, Geoffrey E; Ezra, Daniel G

2015-02-01

Ptosis describes a low position of the upper eyelid. When this condition is due to poor function of the levator palpebrae superioris muscle, responsible for raising the lid, "brow-suspension" ptosis correction is usually performed, which involves internally attaching the malpositioned eyelid to the forehead musculature using brow-suspension materials. In service, such materials are exposed to both rapid tensile loading and unloading sequences during blinking, and a more sustained tensile strain during extended periods of closure. In this study, various mechanical tests were conducted to characterise and compare some of commonly-used synthetic brow-suspension materials (Prolene(®), Supramid Extra(®) II, Silicone rods (Visitec(®) Seiff frontalis suspension set) and Mersilene(®) mesh) for their time-dependent response. At a given constant tensile strain or load, all of the brow-suspension materials exhibited stress-relaxation or creep, with Prolene(®) having a statistically different relaxation or creep ratio as compared with those of others. Uniaxial tensile cyclic tests through preconditioning and fatigue tests demonstrated drastically different time-dependent response amongst the various materials. Although the tests generated hysteresis force-strain loops for all materials, the mechanical properties such as the number of cycles required to reach the steady-state, the reduction in the peak force, and the cyclic energy dissipation varied considerably. To reach the steady-state, Prolene(®) and the silicone rod required the greatest and the least number of cycles, respectively. Furthermore, the fatigue tests at physiologically relevant conditions (15% strain controlled at 6.5 Hz) demonstrated that the reduction in the peak force during 100,000 cycles ranged from 15% to 58%, with Prolene(®) and the silicone rod exhibiting the greatest and the least value, respectively. Many factors need to be considered to select the most suitable brow-suspension material for ptosis correction. These novel data on the mechanical time-dependent performance could therefore help to guide clinicians in their decision-making process for optimal surgical outcome. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Novel Supra-Brow Combined with Infra-Brow Lift Approach for Asian Women.

PubMed

Shu, Maoguo; He, Lin; Su, Yingjun; Shi, Junli; Zhang, Xi; Liu, Xiangyu; Yu, Xueyuan

2016-06-01

Direct brow lift surgery remains popular among Asian women despite its disadvantages. The traditional direct brow lift by a supra-brow incision is not suitable for Asian women because of their unique facial features, such as higher eyebrows, wider upper eyelids, and more orbital fat. Therefore, we designed a novel brow lift technique via a supra-brow combined with an infra-brow approach for Asian women. An area of skin above and below the eyebrow was measured, demarcated, and surgically removed. The redundant orbicularis oculi muscle (OOM) was excised while keeping the frontalis muscle intact. The OOM in the inferior flap was elevated and sutured to the frontalis muscle. In cases of puffy eyelids, orbital fat was partially removed through an infra-brow incision. Finally, a series of modifications were performed to reduce post-operative scarring. A total of 496 patients underwent this surgery from July 2009 to December 2013 and 432 patients were followed up for at least 6 months after surgery. Post-operative scars, in most patients (428/432), were inconspicuous. There were no facial nerve injuries documented and eight patients reported transient forehead numbness. The height of the palpebral fissure was increased but there was no marked increase observed of the distance between the upper eyelid edge and the eyebrow. In follow-up visits, 409 out of 432 patients (94.7 %) were satisfied with their surgical results. This new brow lift technique via a supra-brow combined with an infra-brow approach provided a simple and safe surgical repair of lateral brow ptosis, upper eyelids hooding, and crows' feet in Asian women. The surgical outcomes were predictable and the scars were inconspicuous. 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 .

Surgical management of advanced ocular adnexal amyloidosis.

PubMed

Patrinely, J R; Koch, D D

1992-06-01

Ocular adnexal amyloidosis is characterized by amyloid deposition within the deep connective tissue layers of the eyelids, conjunctiva, and anterior orbit. Management of advanced cases has traditionally been unsatisfactory, with either no surgery offered because of fear of hemorrhage or an en bloc resection performed of the entire involved area. We present two cases of advanced periorbital amyloidosis successfully managed by preserving the anatomic planes of the eyelids and meticulously debulking the deposits with a spooned curette. Lax eyelid tendons and aponeuroses were simultaneously repaired, and no sacrifice of eyelid tissues was necessary. One patient remained asymptomatic for 2 years after surgery before developing early reaccumulation in the lower eyelids. The other patient required additional eyelid debulking and ptosis revision 8 months after surgery, but was in stable condition at follow-up 2 years after surgery. This technique offers safe, easily repeatable, nondestructive treatment for advanced periocular amyloidosis.

Characterization of the Venom of C. d. cumanesis of Colombia: Proteomic Analysis and Antivenomic Study

PubMed Central

Vargas, Leidy Johana; Bueno-Sánchez, Julio César; Alarcón, Juan Carlos

2018-01-01

The Colombian rattlesnake Crotalus durissus cumanensis is distributed in three geographic zones of the country: the Atlantic Coast, the upper valley of the Magdalena River, and the eastern plains of the Colombian Orinoquía. Its venom induces neurological symptoms, such as eyelid ptosis, myasthenic facies, and paralysis of the respiratory muscles, which can lead to death. Identification and analysis of C. d. cumanensis showed nine groups of proteins responsible for the neurotoxic effect, of which the crotoxin complex was the most abundant (64.71%). Immunorecognition tests of C. d. cumanensis showed that the use of a commercial antivenom manufactured in Mexico resulted in immunoreactivity. PMID:29462980

Browlift--a South East Asian experience.

PubMed

Almousa, Radwan; Amrith, Shantha; Sundar, Gangadhara

2009-01-01

To describe the indications, techniques and outcomes of various browlift procedures in a predominantly East-Asian community. Retrospective review of patients who underwent browlift procedures performed by 2 oculoplastic surgeons or under their direct supervision, in a tertiary referral hospital in South East Asia from 2002 to 2007. Forty-six patients (30 female, 16 male) had browlift surgery for 89 sides from 2002 to 2007. Mean follow-up period was 10 months (6 to 44 months). 43 patients had bilateral browlift, 3 patients had unilateral browlift, 2 of whom had underlying facial nerve palsy and one had involutional brow ptosis. involutional brow ptosis (42), mitochondrial myopathy (2), and facial palsy (2). Ethnicity of patients: Chinese (40), Indian (4) and Malay (2). direct browlift (18), transblepharoplasty browpexy (6), midforehead lift (3), coronal browlift (2) and pretrichial browlift (4), endoscopic browlift (7), limited incision nonendoscopic browlift (5) and temporal browlift (3). Adjuvant procedures included upper blepharoplasty (26), blepharoptosis correction (4), midface lift (2), upper eyelid entropion correction (1), lacrimal gland fixation (1), and upper lid gold implant (1). Encountered complications included: undercorrection 6 (12%), segmental facial nerve palsy 1(2%), visible scar 2 (5%), paraesthesia 2 (5%), suture granuloma 1 (2%). Overall 94% of our patients were satisfied. Browlift provides satisfactory results for both patient and surgeon. A comprehensive knowledge and proper surgical technique, along with a thorough discussion with patients about the pros and cons of each procedure are essential to obtain optimal outcomes.

The Magnetic Levator Prosthesis for Temporary Management of Severe Blepharoptosis: Initial Safety and Efficacy

PubMed Central

Houston, Kevin E.; Tomasi, Matteo; Amaral, Christina; Finch, Nicole; Yoon, Michael K.; Lee, Hang; Paschalis, Eleftherios I.

2018-01-01

Purpose We further optimized and evaluated the safety of the magnetic levator prosthesis (MLP) for temporary management of severe blepharoptosis, and compared efficacy and comfort against the ptosis crutch. Methods The interpalpebral fissure (IPF) of participants (n = 12) with ptosis was measured during attempted eyelid opening, volitional closing, and spontaneous closing with no device, ptosis crutch, or the MLP. A 10-point scale documented comfort. Additionally, a 20 minute and then 1 week trial of the MLP was offered. Safety measures were skin erythema rating, change in visual acuity, and change in corneal staining. Results The MLP and crutch opened the eye (IPF 11.2 and 9.3 mm), but the MLP allowed better volitional closure (IPF 1.0 vs. 4.9 mm, P = 0.009), but was no better in allowing spontaneous blink (IPF 7.5 vs. 7.7 mm, P = 0.722). Both devices were equally comfortable (both median 8/10 comfort, P = 0.46). With extended use, opening with the MLP showed IPF 9.24 mm at 20 minutes and 9.46 mm at 1 week, and volitional closure was IPF 0.95 and 0.52 mm, respectively. Closure on spontaneous blink improved with extended wear to IPF 5.14 and 5.18 mm, respectively (P = 0.002). Two participants exhibited moderate skin erythema and one had increased corneal staining without change in acuity. Conclusions The MLP is safe and feasible for temporary correction of severe ptosis. Translational Relevance First group data in patients showing successful reanimation of the eyelid with magnetic force. PMID:29367892

[Trigemino-autonomic headache syndromes].

PubMed

Busch, V; May, A

2003-01-01

This review describes the characteristics of some rare severe primary headache syndromes without any structural lesions, which are summarized as the trigemino-autonomic headaches. Pain in these syndromes is associated with autonomic symptoms such as conjunctival injection, lacrimation, rhinorrhoe, ptosis or eyelid edema. This article summarizes the diagnostics, epidemiology and therapy of these conditions.

Ocular Manifestations of Noonan Syndrome: A Prospective Clinical and Genetic Study of 25 Patients.

PubMed

van Trier, Dorothée C; Vos, Anna M C; Draaijer, Renske W; van der Burgt, Ineke; Draaisma, Jos M Th; Cruysberg, Johannes R M

2016-10-01

To determine the full spectrum of ocular manifestations in patients with Noonan syndrome (NS). Prospective cross-sectional clinical and genetic study in a tertiary referral center. Twenty-five patients with NS (mean age, 14 years; range, 8 months-25 years) clinically diagnosed by validated criteria. All patients were examined by the same team following a detailed study protocol. Genetic analyses were performed in 23 patients. Ocular abnormalities of vision and refraction, external ocular features, ocular position and motility, anterior segment, posterior segment, and intraocular pressure. Ocular features of vision and refraction were amblyopia (32%), myopia (40%), and astigmatism (52%). External ocular features were epicanthic folds (84%), hypertelorism (68%), ptosis (56%), high upper eyelid crease (64%), lower eyelid retraction (60%), abnormal upward slanting palpebral fissures (36%), downward slanting palpebral fissures (32%), and lagophthalmos (28%). Orthoptic abnormalities included strabismus (40%), abnormal stereopsis (44%), and limited ocular motility (40%). Anterior segment abnormalities included prominent corneal nerves (72%) and posterior embryotoxon (32%). Additional ocular features were found, including nonglaucomatous optic disc excavation (20%), relatively low (<10 mmHg) intraocular pressure (22%), and optic nerve hypoplasia (4%). Mutations were established in 22 patients: 19 PTPN11 mutations (76%), 1 SOS1 mutation, 1 BRAF mutation, and 1 KRAS mutation. The patient with the highest number of prominent corneal nerves had an SOS1 mutation. The patient with the lowest visual acuity, associated with bilateral optic nerve hypoplasia, had a BRAF mutation. Patients with severe ptosis and nearly total absence of levator muscle function had PTPN11 mutations. All patients showed at least 3 ocular features (range, 3-13; mean, 7), including at least 1 external ocular feature in more than 95% of the patients. Noonan syndrome is a clinical diagnosis with multiple genetic bases associated with an extensive variety of congenital ocular abnormalities. Ocular features of NS are characterized by 1 or more developmental anomalies of the eyelids (involving the position, opening, and closure) associated with various other ocular abnormalities in childhood, including amblyopia, myopia, astigmatism, strabismus, limited ocular motility, prominent corneal nerves, and posterior embryotoxon. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Combined lateral rectus augmented transposition and inferior rectus recession for monocular elevation deficiency.

PubMed

Jayakumar, Manjula; Kumar, Dhivya Ashok; Agarwal, Amar

2018-04-01

We report the case of a 21-year-old woman who presented with a drooping right upper eyelid and smaller-appearing right eye, evident since birth. Her visual acuity was 20/30 in the right eye and 20/20 in the left eye. In primary gaze she had a hypotropia of 25 Δ , with a marked elevation limitation and associated true upper lid ptosis of 3 mm. Under local anesthesia, the lateral rectus muscle was transposed to the superior rectus muscle and was augmented by a nonabsorbable suture attaching the superior rectus muscle and lateral rectus muscle 8 mm posterior to the insertion, accompanied by an inferior rectus recession. One year after surgery she was orthophoric in primary position and showed improvement in elevation. The surgical procedure can be performed at the same time as the inferior rectus recession and reduces the risk of anterior segment ischemia. Copyright © 2018 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Perception of Age, Attractiveness, and Tiredness After Isolated and Combined Facial Subunit Aging.

PubMed

Forte, Antonio Jorge; Andrew, Tom W; Colasante, Cesar; Persing, John A

2015-12-01

Patients often seek help to redress aging that affects various regions of the face (subunits). The purpose of this study was to determine how aging of different facial subunits impacts perception of age, attractiveness, and tiredness. Frontal and lateral view facial photographs of a middle-aged woman were modified using imaging software to independently age different facial features. Sixty-six subjects were administered with a questionnaire, and presented with a baseline unmodified picture and others containing different individual or grouped aging of facial subunits. Test subjects were asked to estimate the age of the subject in the image and quantify (0-10 scale) how "tired" and "attractive" they appeared. Facial subunits were organized following rank assignment regarding impact on perception of age, attractiveness, and tiredness. The correlation coefficient between age and attractiveness had a strong inverse relationship of approximately -0.95 in both lateral and frontal views. From most to least impact in age, the rank assignment for frontal view facial subunits was full facial aging, middle third, lower third, upper third, vertical lip rhytides, horizontal forehead rhytides, jowls, upper eyelid ptosis, loss of malar volume, lower lid fat herniation, deepening glabellar furrows, and deepening nasolabial folds. From most to least impact in age, the rank assignment for lateral view facial subunits was severe neck ptosis, jowls, moderate neck ptosis, vertical lip rhytides, crow's feet, lower lid fat herniation, loss of malar volume, and elongated earlobe. This study provides a preliminary template for further research to determine which anatomical subunit will have the most substantial effect on an aged appearance, as well as on the perception of tiredness and attractiveness. 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.

[Congenital ectropion of the upper eyelids due to an anomaly of the eyelids in down's syndrome (author's transl)].

PubMed

Hennighausen, U; Schmidt-Martens, F W; Reim, M

1978-05-01

A 5-months-old female baby with Down's Syndrome developed an intermittent spastic ectropion of the upper eyelids. The reasons for this are thought to be the flaccidity of the connective tissue, which is typical in Down's Syndrome, and a little anomaly of the eyelids, the tarsus was too short horizontally and very weak and the upper eyelids were somewhat larger than normal and elongated. Suturing Bangerter's lid-sheets on the upper eyelids for 15 days resulted in a scarring of the tarsus with the lax connective tissue of the upper eyelids. The ectropion disappeared and did not recur.

The Effects of Explicit Instruction on the Writing Ability of a Student with Noonan Syndrome

ERIC Educational Resources Information Center

Asaro-Saddler, Kristie; Saddler, Bruce; Ellis-Robinson, Tammy

2014-01-01

In this study, we sought to determine the effectiveness of a sentence creation intervention on the sentence writing ability of a young writer with Noonan Syndrome. Noonan syndrome is an autosomal dominant condition characterized by shortness in stature, with neck and ear anomalies, hypertelorism, ptosis of the eyelids, low set ears, and instances…

Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis.

PubMed

Park, Jun Young; Yang, Hee Kyung; Hwang, Jeong-Min

2017-01-01

Twenty-six patients with ptosis related to Myasthenia gravis (MG) and 38 controls with ptosis other than MG were included. All patients were tested with the ice test 2 times on separate days in the afternoon. The margin reflex distance (MRD) was measured before and immediately after 2-minute application of ice on the eyelids. The ice test was judged positive if there was an improvement of at least 2.0 mm of MRD after the ice test. Among the patients with negative test results, 'equivocal' was defined by improvement of MRD from at least 1.0 mm to less than 2.0 mm after the ice test. Repeated ice test results showed an agreement of 61.5% in MG, and 97.4% in nonmyasthenic ptosis. Repeated ice tests increased the sensitivity by 34.6% compared to a single test. Among the patients with repeatedly negative test results, 63.6% of those who showed equivocal results at least once turned out to be MG. Of those with repeated non-equivocal negative results, nobody turned out to be MG. There was no significant difference of the ice test results between ocular MG and generalized MG (p = 0.562).

Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis

PubMed Central

2017-01-01

Twenty-six patients with ptosis related to Myasthenia gravis (MG) and 38 controls with ptosis other than MG were included. All patients were tested with the ice test 2 times on separate days in the afternoon. The margin reflex distance (MRD) was measured before and immediately after 2-minute application of ice on the eyelids. The ice test was judged positive if there was an improvement of at least 2.0 mm of MRD after the ice test. Among the patients with negative test results, 'equivocal’ was defined by improvement of MRD from at least 1.0 mm to less than 2.0 mm after the ice test. Repeated ice test results showed an agreement of 61.5% in MG, and 97.4% in nonmyasthenic ptosis. Repeated ice tests increased the sensitivity by 34.6% compared to a single test. Among the patients with repeatedly negative test results, 63.6% of those who showed equivocal results at least once turned out to be MG. Of those with repeated non-equivocal negative results, nobody turned out to be MG. There was no significant difference of the ice test results between ocular MG and generalized MG (p = 0.562). PMID:28562609

Modified Full Thickness Graded Blepharotomy for Upper Eyelid Retraction Associated With Thyroid Eye Disease in East Asians.

PubMed

Lee, Joonsik; Lee, Hwa; Park, Minsoo; Baek, Sehyun

2016-12-01

To evaluate the functional and cosmetic outcomes of modified full thickness graded blepharotomy when used for East Asian patients with upper eyelid retraction of thyroid eye disease (TED). Medical records of each patient who underwent modified full-thickness blepharotomy at Korea University Guro Hospitals from January 2009 to February 2014 to correct upper eyelid retraction resulting from TED were retrospectively reviewed. Modified full-thickness graded blepharotomies were performed on 22 eyelids of 18 patients. The most common preoperative upper eyelid retraction-associated symptom was asymmetry of the upper eyelid (14 patients, 77.7%) followed by discomfort (10 patients, 55.5%), photophobia (5 patients, 27.7%), and epiphora (4 patients, 22.2%). Most preoperative symptoms improved after blepharotomy (Table 1). Preoperatively, upper eyelid retraction (MRD1; midpupil marginal reflex distance) ranged from 2.3 mm to 6.8 mm (mean, 5.23 ± 0.89) in 22 lids; postoperatively, lid retraction significantly decreased to 3.26 ± 1.23 mm (P = 0.03 by independent t test) (Table 2). Lid retraction was divided into 3 groups according to severity; a severe group (5 eyelids, 27.7%), a moderate group (14 eyelids, 63.6%), and a mild group (3 eyelids, 13.6%). The MRD1 improved regardless of severity (P = 0.03 in the severe group, P = 0.02 in the moderate group, and P = 0.04 in the mild group by independent t test). The MRD1 improvement did not differ significantly among groups (P = 0.08 by Pearson χ t test). At 6 months postoperatively, the midpupil marginal reflex distance was the perfect height in 13 of 22 lids (59.0%), with a mean reduction of 3 mm, whereas 7 of 22 eyelids (31.8%) were at acceptable height and 2 eyelids (9.0%) showed failure. Overall, 18 eyelids (90.9%) exhibited objectively satisfactory results (perfect or acceptable) at 6 months after surgery (Table 3). Modified graded full thickness eyelid blepharotomy is a reliable and safe method for upper eyelid lengthening for East Asian patients with upper eyelid retraction of TED that offers excellent functional and cosmetic results.

Upper Eyelid Fractional CO2 Laser Resurfacing With Incisional Blepharoplasty.

PubMed

Kotlus, Brett S; Schwarcz, Robert M; Nakra, Tanuj

2016-01-01

Laser resurfacing, performed at the same time as blepharoplasty, has most commonly been applied to the lower eyelid skin but can effectively be used on the upper eyelid to reduce rhytidosis and improve skin quality. The authors evaluate the safety and efficacy of this procedure. Fractional CO2 laser resurfacing was performed in conjunction with incisional upper blepharoplasty. The ultrapulsed laser energy was applied to the sub-brow skin, the upper medial canthal skin, and the pretarsal skin in 30 patients. Photos were obtained preoperatively and at 3 months. All patients demonstrated reduction in upper eyelid rhytidosis without any serious complications. Independent rhytidosis grading (0-4) showed a mean improvement of 42%. One patient experienced wound dehiscence that satisfactorily resolved without intervention. Upper eyelid laser resurfacing is effective and can be safely performed at the same time as upper blepharoplasty. This approach reduces or eliminates the need for medial incisions to address medial canthal skin redundancy and rhytidosis and it directly treats upper eyelid wrinkles on residual eyelid and infra-brow skin during blepharoplasty.

Bovine Acellular Dermal Matrix for Levator Lengthening in Thyroid-Related Upper-Eyelid Retraction.

PubMed

Sun, Jing; Liu, Xingtong; Zhang, Yidan; Huang, Yazhuo; Zhong, Sisi; Fang, Sijie; Zhuang, Ai; Li, Yinwei; Zhou, Huifang; Fan, Xianqun

2018-05-02

BACKGROUND Eyelid retraction is the most common and often the first sign of thyroid eye disease (TED). Upper-eyelid retraction causes both functional and cosmetic problems. In order to correct the position of the upper eyelid, surgery is required. Many procedures have demonstrated good outcomes in mild and moderate cases; however, unpredictable results have been obtained in severe cases. Dryden introduced an upper-eyelid-lengthening procedure, which used scleral grafts, but outcomes were unsatisfactory. A new technique is introduced in this study as a reasonable alternative for TED-related severe upper-eyelid retraction correction. MATERIAL AND METHODS An innovative technique for levator lengthening using bovine acellular dermal matrix as a spacer graft is introduced for severe upper-eyelid retraction secondary to TED. Additionally, 2 modifications were introduced: the fibrous cords scattered on the surface of the levator aponeurosis were excised and the orbital fat pad anterior to the aponeurosis was dissected and sutured into the skin closure in a "skin-tarsus-fat-skin" fashion. RESULTS The modified levator-lengthening surgery was performed on 32 eyelids in 26 patients consisting of 21 women and 5 men (mean age, 37.8 years; age range, 19-67 years). After corrective surgery, the average upper margin reflex distance was lowered from 7.7±0.85 mm to 3.3±0.43 mm. Eighteen cases (69%) had perfect results, while 6 cases (23%) had acceptable results. CONCLUSIONS A modified levator-lengthening procedure using bovine acellular dermal matrix as a spacer graft ameliorated both the symptoms and signs of severe upper-eyelid retraction secondary to TED. This procedure is a reasonable alternative for correction of TED-related severe upper-eyelid retraction.

Bovine Acellular Dermal Matrix for Levator Lengthening in Thyroid-Related Upper-Eyelid Retraction

PubMed Central

Sun, Jing; Liu, Xingtong; Zhang, Yidan; Huang, Yazhuo; Zhong, Sisi; Fang, Sijie; Zhuang, Ai; Li, Yinwei; Zhou, Huifang

2018-01-01

Background Eyelid retraction is the most common and often the first sign of thyroid eye disease (TED). Upper-eyelid retraction causes both functional and cosmetic problems. In order to correct the position of the upper eyelid, surgery is required. Many procedures have demonstrated good outcomes in mild and moderate cases; however, unpredictable results have been obtained in severe cases. Dryden introduced an upper-eyelid-lengthening procedure, which used scleral grafts, but outcomes were unsatisfactory. A new technique is introduced in this study as a reasonable alternative for TED-related severe upper-eyelid retraction correction. Material/Methods An innovative technique for levator lengthening using bovine acellular dermal matrix as a spacer graft is introduced for severe upper-eyelid retraction secondary to TED. Additionally, 2 modifications were introduced: the fibrous cords scattered on the surface of the levator aponeurosis were excised and the orbital fat pad anterior to the aponeurosis was dissected and sutured into the skin closure in a “skin-tarsus-fat-skin” fashion. Results The modified levator-lengthening surgery was performed on 32 eyelids in 26 patients consisting of 21 women and 5 men (mean age, 37.8 years; age range, 19–67 years). After corrective surgery, the average upper margin reflex distance was lowered from 7.7±0.85 mm to 3.3±0.43 mm. Eighteen cases (69%) had perfect results, while 6 cases (23%) had acceptable results. Conclusions A modified levator-lengthening procedure using bovine acellular dermal matrix as a spacer graft ameliorated both the symptoms and signs of severe upper-eyelid retraction secondary to TED. This procedure is a reasonable alternative for correction of TED-related severe upper-eyelid retraction. PMID:29718902

Congenital bilateral upper eyelid eversion: report of a case.

PubMed

Cingü, Abdullah Kürşat; Sahin, Alparslan; Yüksel, Harun; Ozkök, Ahmet; Arı, Seyhmus; Caça, Ihsan

2014-01-01

Congenital bilateral upper eyelid eversion is a rare condition and the definite cause is not known. It is often seen in Black babies or babies with Down's syndrome. With early diagnosis and appropriate treatment, the condition can be managed without surgery. We report a case of congenital upper eyelid eversion in an otherwise healthy Caucasian neonate, born by normal vaginal delivery. The case responded well to conservative treatment, including eyelid repositioning, lubricants, antibiotic ointment, and eyelid patching.

Pedicled fat flap to increase lateral fullness in upper blepharoplasty.

PubMed

Sozer, Sadri O; Agullo, Francisco J; Palladino, Humberto; Payne, Phileemon E; Banerji, Soumo

2010-03-01

The eyelid of a young person can be distinguished by the lateral fullness of the upper eyelid. With aging, lateral fullness decreases. Volume restoration in the periorbital area has been previously addressed by fat draping and grafting. More recently, techniques for regaining lateral fullness of the upper eyelid have focused on fat grafting, although effective graft take, reabsorption, and irregularities have been a concern. To address these issues, the concept of pedicled fat draping in the upper eyelid was explored. In a retrospective study from June 2006 to August 2008, 31 patients underwent upper blepharoplasty with augmentation of the lateral fullness with a pedicled fat flap from the central fat pad. The fat from the central compartment was elevated, dissected, and then transposed to the lateral upper eyelid below the orbicularis muscle. All patients were women ranging in age from 43 to 68 years. Pre- and postoperative picture comparison demonstrated a more youthful appearance with increased lateral fullness of the upper eyelids. There were no cases of fat necrosis encountered. Increased volume remained stable over an average of one-year follow-up. No complications were recorded. Transposing a pedicled fat pad from the central compartment laterally has proven to be an effective technique for achieving predictable upper lateral eyelid fullness and thus achieving a long-lasting, more youthful appearance.

The effect of "single" vs "double" eyelids on the perceived attractiveness of Chinese women.

PubMed

Hwang, Harry S; Spiegel, Jeffrey H

2014-03-01

A well-defined supratarsal crease has often been considered attractive, representing a significant component in a beautiful upper eyelid. Approximately 50% of East and Southeast Asian women are born with either a minimal or absent supratarsal eyelid crease. Among people of Chinese descent, the creation of a supratarsal crease ("double" eyelid blepharoplasty) is the most common cosmetic surgical procedure, but no comparative study has assessed the height by which an upper eyelid crease is deemed most attractive and depending on cultural background. The authors assess how attractiveness is interpreted by different cultural groups to determine whether double-eyelid blepharoplasty enhances attractiveness according to both Chinese and non-Chinese observers. Facial photographs were taken of 19 women of Chinese descent. The photographs were enhanced with computer imaging software to generate 3 additional pictures, depicting low, medium, and high upper eyelid creases on each model. Via an Internet-based survey tool, Chinese and non-Chinese observers were asked to rate the attractiveness of the faces with each potential eyelid position. (Surveys are available online at www.aestheticsurgeryjournal.com, as Appendix 1 and Appendix 2.) Both Chinese and non-Chinese observers considered the medium-height upper eyelid crease most attractive (P < .00001). An absent upper eyelid crease was deemed the least attractive (P < .00001). These preference data for eyelid height can be used to better counsel patients on perceived attractiveness and expectations for surgical results, since these results further elucidate which facial features are universally considered attractive.

Basal cell carcinoma of the eyelids and solar ultraviolet radiation exposure

PubMed Central

Lindgren, G.; Diffey, B.; Larko, O.

1998-01-01

AIMS—To compare the distribution of eyelid basal cell carcinoma (BCC) with the relative ultraviolet radiation (UVR) exposure to different sites on the eyelids.
METHODS—The location of BCC on the eyelids was allocated to one of seven regions. The UVR exposure was recorded with a polymer film attached to the eyelids at seven sites in a manikin and in human subjects.
RESULTS—Localisation of the 329 tumours was mainly on the lower eyelids (225 tumours), and the medial canthal regions (87 tumours). There was no association between UVR doses at the seven sites of the eyelids and the location of BCCs. The UVR exposure was similar on the upper and lower eyelids, while the number of tumours on the lower eyelids outnumbered the upper lids by a factor of 13 (17 upper, 225 lower)
CONCLUSION—UVR exposure only partially explains the aetiology of periorbital BCC.

 Keywords: polysulphone film; basal cell carcinoma; ultraviolet radiation; eyelid PMID:9930273

Oculopalpebral borreliosis as an unusual manifestation of Lyme disease.

PubMed

Murillo, Giovana; Ramírez, Beatriz; Romo, L Angel; Muñoz-Sanz, Agustín; Hileeto, Denise; Calonge, Margarita

2013-01-01

To report the case of acrodermatitis chronica atrophicans as an ocularpalpebral manifestation of Lyme borreliosis, with peripheral keratopathy and associated vasculitis. Case report. A 16-year-old girl, with a 4-year history of recurrent left eye photophobia, intense redness, and superior eyelid edema, presented with lid erythema, ptosis, superficial venous tortuosity, conjunctival hyperemia, corneal thinning with precipitates, and vascularization. Borrelia burgdorferi was confirmed by immunoblotting. Treatments with doxycycline followed by ceftriaxone were only partially effective. Eyelid biopsy revealed spirochetes and vasculitis with deposition of immunoglobulin G. Oral cefuroxime for 28 days was ineffective. Due to the vasculitis, immunosuppression with azathioprine and topical cyclosporine were given for 4 months. Since then she has been free of flare-ups. Lyme borreliosis should be considered in patients with recurrent chronic lid edema and associated keratopathy.

Unilateral external and internal ophthalmoplegia caused by intracranial meningioma in a dog.

PubMed

Larocca, R.D.

2000-01-01

Unilateral internal and external ophthalmoplegia caused by an intracranial meningioma occurred in a 15-year-old Belgian Sheepdog. The dog initially presented with ventro-lateral strabismus of the left eye, and ptosis of the left upper eyelid. Anisocoria was present with the left pupil fixed and dilated. Both eyes were visual. Neuro-ophthalmic evaluation revealed a lesion located in the left oculomotor nerve. Pharmacological testing with dilute pilocarpine (0.1% in artificial tears) revealed evidence of parasympathetic denervation of the left eye. Further evaluation via magnetic resonance imaging (MRI) revealed a well-defined mass to the left of midline and lateral to the sella turcica. An attempt was made to excise/debulk the mass due to worsening conditions and the dog died the following day. Necropsy revealed a mass of randomly arranged bundles and streams of spindle cells. Immunohistochemistry demonstrated a strong avidity for vimentin and a negative response for S-100 protein. These findings suggest a diagnosis of meningioma.

Localization and Retrieval of an Eyelid Metallic Foreign Body With an Oscillating Magnet and High-Resolution Ultrasonography.

PubMed

Yoo, Sylvia H; Rootman, Dan B; Goh, Alice; Savar, Aaron; Goldberg, Robert A

2016-01-01

A patient was found to have a metallic foreign body in the left anterior orbit on CT imaging, but the foreign body was not evident on clinical examination. On high-resolution ultrasonography, an object was identified in the left upper eyelid; however, the typical shadow with metallic foreign bodies was not seen. A high-power oscillating magnet was then applied to the eyelid, which revealed a subcutaneous metallic foreign body in the left upper eyelid. When used in conjunction, the high-resolution ultrasound and oscillating magnet successfully localized and facilitated retrieval of the metallic foreign body from the left upper eyelid.

Thyroid associated orbitopathy

PubMed Central

Verma, Rajesh; Gupta, Mani; Mehta, Vinod Kumar

2013-01-01

Thyroid-associated orbitopathy (TAO) is a self-limiting auto-immune condition usually associated with Grave's disease. It is characterised by ocular pain, eyelid swelling, chemosis, proptosis and keratopathy. As the mechanism for ophthamoplegia and optic neuropathy is the orbital swelling leading to mechanical restriction of ocular muscles and compression of optic nerve, one expects proptosis rather than ptosis in TAO. We describe a case of a young adult woman who presented with acute onset restriction of movement along with partial ptosis and severe diminution of vision in left eye. The MRI of orbit revealed significant swelling of recti along with signal alteration consistent with TAO. The radio-isotope thyroid scan revealed thyroiditis, and thyroid peroxidase (TPO) antibody was significantly high; hence, the diagnosis of Hashimoto thyroiditis was considered. A course of intravenous methylprednisolone followed by oral steroid was administered, which produced marked improvement in vision and extraocular movement. PMID:23737589

Aponeurosis of the levator palpebrae superioris in Chinese subjects

PubMed Central

Pan, Er; Nie, Yun-Fei; Wang, Zhen-Jun; Peng, Li-Xia; Wu, Yan-Hong; Li, Qin

2016-01-01

Abstract An accurate understanding of the anatomy of the levator palpebrae superioris aponeurosis (LPSA) is critical for successful blepharoplasty of aponeurotic ptosis. We investigated the macroscopic and microscopic anatomy of the LPSA. This prospective live gross anatomy study enrolled 200 adult Chinese patients with bilateral mild ptosis undergoing elective blepharoplasty. Full-thick eyelid tissues and sagittal sections from the eyelid skin to the conjunctiva were examined with Masson trichrome staining or antismooth muscle actin (SMA) immunohistochemistry. Gross anatomy showed that the space between the superficial and deep layers of the LPSA could be accessed after incising the overlying superficial fascia, by retracting the white line. Adipose layers were clearly observed in 195 out of 200 patients with bilateral mild ptosis, among which 180 cases had the superficial layer connected to the uncoated adipose. Fifteen cases had the superficial layer connected to the smoothly coated layer, and 5 cases had the superficial layer directly connected to the deep loose fiber, almost without adipose. In previously untreated patients, the LPSA space was located beneath the intact orbital septum. In those with previous surgeries, it was beneath the superficial layer of the LPSA, underlying the destructed orbital septum. Cadaveric histology showed that the deep layer of the LPSA extended into the anterior layer of the tarsal plate and the superficial layer reflexed upward in continuity with the vertical orbital septum. An occult space existed between the 2 layers of the LPSA, with a smooth lining on the deep layer. The superficial layer of the LPSA was SMA-immunonegative but the deep layer was slightly immunopositive for SMA. An occult anatomic space exists between the superficial and deep layers of the LPSA, in proximity to the superior tarsal plate margin. Recognition of the more anatomically significant LPSA deep layer may help improve the aesthetic outcome of blepharoplasty. PMID:27495084

Visual, Physiological, and Aesthetic Factors and Pitfalls in Asian Blepharoplasty

PubMed Central

Chen, William Pai-Dei

2016-01-01

Double eyelid surgery to create an upper-lid crease in Asian patients is one of the more popular aesthetic surgeries among people of Asian descent. Much has been written about the myriad methods, but little has been written about the underlying factors that predispose a patient to complications and suboptimal results. This article touches on some of the possible errors in placement of crease height in upper blepharoplasty and the pitfalls that can be associated with permanent placement of nondissolvable sutures that encircle the complex layers of the upper eyelid, as well as the ideal eyelid crease wound closure and its biodynamics. One should consider these factors in any form of upper eyelid procedure, as they are not merely applicable to upper blepharoplasty. PMID:26673576

A new heterozygous mutation of the FOXL2 gene is associated with a large ovarian cyst and ovarian dysfunction in an adolescent girl with blepharophimosis/ptosis/epicanthus inversus syndrome.

PubMed

Raile, K; Stobbe, H; Tröbs, R B; Kiess, W; Pfäffle, R

2005-09-01

Blepharophimosis/ptosis/epicanthus inversus syndrome (BPES), an autosomal dominant syndrome in which eyelid malformation is associated with (type I BPES) or without premature ovarian failure (type II BPES). Mutations of a putative winged helix/forkhead transcription factor FOXL2 account for both types of BPES. We report on a 16-year-old adolescent girl with blepharophimosis and ptosis. Subsequently she developed oligomenorrhea, secondary amenorrhea for 6 months, and an extremely large cyst of one ovary. The cyst contained 8 l of cyst fluid and histopathology displayed a large corpus luteum cyst. Following laparotomy, gonadotropin levels were elevated (LH 17.2 U/l, FSH 29.4 U/l) and estradiol levels decreased (67 pmol/l). Because of clinical aspects of BPES and abnormal ovarian function we suspected a mutation of her FOXL2 gene and found a new in-frame mutation (904_939dup36) on one allele, leading to a 12 alanine expansion within the polyalanine domain. We conclude that the FOXL2 mutation 904_939dup36 may account not only for blepharophimosis and ptosis but also for ovarian dysfunction and growth of the large corpus luteum cyst. In contrast to known FOXL2 mutations with polyalanine expansions and association with BPES type II, clinical aspects of our girl may indicate some degree of ovarian dysfunction that might finally lead to BPES type I with premature ovarian failure.

[Treatment of eyelid retraction in Grave's disease by recession of the levator complex].

PubMed

Fichter, N; Schittkowski, M; Guthoff, R F

2004-11-01

The chronic stage in Grave's orbitopathy is characterised by fibrotic changes within the orbital soft tissues, especially the extraocular muscles. Retraction of the eyelids is a common clinical feature of this phenomenon. To solve this problem several techniques for lengthening the upper eyelid have been described with variable rates of success. In this report we describe our modified Harvey's technique for the correction of upper eyelid retraction which includes a complete recession of the Muller's muscle/levator complex from the tarsal plate without the interposition of a spacer. Finally only the skin and the superficial orbicularis muscle are sutured. We also report about our results with this procedure. 8 patients (1 male, 7 female) with lid retraction in Grave's ophthalmopathy were recorded who had undergone the modified lengthening technique by an external approach between 2001 and 2004. Four patients underwent a bilateral procedure and 1 patient showed a significant under-correction, necessitating reoperation. So a total of 13 procedures were included in this follow-up study. Beside the common ophthalmological examination, special interest was put in the difference of the two eyelid apertures in primary position pre- and postoperatively. Within a follow-up period of at least 3 months we recorded an averaged lengthening of the upper eyelid of 3.1 mm. The difference of the two eyelid apertures in primary position improved from 2.2 mm preoperatively to 1.0 mm postoperatively. Only 1 patient needed reoperation because of a significant under-correction. There were no late over-corrections observed. The modified Harvey's technique to lengthen the upper eyelid is a safe and effective method to reduce upper eyelid retraction in Grave's disease. An eventually required orbital decompression or extraocular muscle surgery has to be done before the lid surgery.

[Slipped superior rectus in Grave's orbitopathy. A case report].

PubMed

Spielmann, A C

2007-02-01

Superior rectus slippage after its surgical recession is characterized by short-term progressive overcorrection. Similarities with inferior rectus slippage are pronounced, especially a history of Grave's orbitopathy and the use of an adjustable suture. In the present clinical case, upper eyelid retraction and a history of upper eyelid elevator muscle surgery might be specific risk factors, due to the close anatomical links between the superior rectus and the upper eyelid elevator.

Management of the aging upper eyelid in the asian patient.

PubMed

Karam, Amir M; Lam, Samuel M

2010-08-01

Successful management of the aging upper eyelid region in the Asian patient requires a unique skill set and clinical experience. The surgeon must exhibit a thorough understanding of the unique anatomy of the Asian eyelid and its variations and of the cultural expectations of the patient and must possess a unique set of surgical skills such as de novo creation of the supratarsal crease as well as complementary procedures such as fat transfer used for volume augmentation of the periorbital region. The modern approach outlined here summarizes the key elements necessary to restore the youthful appearance of the upper eyelid region in a natural and ethnically consistent fashion.

Isolated upper eyelid retraction: a sign of idiopathic inflammatory orbital disease.

PubMed

Shome, Debraj; Toshniwal, Svetlana; Jain, Vandana; Natarajan, Sundaram; Vemuganti, Geeta K

2008-01-01

A 41-year-old woman was examined for left upper eyelid retraction. Remaining ocular and systemic examination was unremarkable. Orbital CT demonstrated an ill-defined, extraconal, superior orbital soft-tissue mass involving the levator palpebrae superioris muscle. Incisional biopsy with histopathology demonstrated idiopathic orbital inflammation. The patient was started on a gradually tapering dose of oral steroids, for 6 weeks. On follow-up, the eyelid retraction had resolved. We report this case to demonstrate that idiopathic inflammatory orbital disease, localized to the superior orbit, may cause isolated upper eyelid retraction without associated proptosis. This condition resolves with medical therapy, leading to symmetrical palpebral apertures.

Histopathological diagnosis of eyelid tumors in Chiang Mai University Hospital.

PubMed

Nithithanaphat, Chanut; Ausayakhun, Sakarin; Wiwatwongwana, Damrong; Mahanupab, Pongsak

2014-10-01

To report the histopathological diagnosis ofeyelid tumors and to study the prevalence of eyelid tumors in Chiang Mai University Hospital Chiang Mai, Thailand. A retrospective review of medical and pathological records ofpatients diagnosed as eyelid tumor that underwent histopathological biopsy between January 2007 and December 2013 in Chiang Mai University Hospital was done. Three hundred sixteen cases of eyelid tumors were reviewed. The mean age at diagnosis was 54.2 +/- 19.6 years (range 1 month-99 years), women were 59.5% (n = 188) and men 40.5% (n = 128). The tumor sites were left lower eyelid (27.5%), right upper eyelid (24.4%), right lower eyelid (21.2%), and left upper eyelid (18.7%). There were 204 (64.6%) benign tumors and 112 (35.4%) malignant tumors. Nevi were the most common in benign group (16.4%) and basal cell carcinoma was the most common eyelid malignancy (18.0%). The most common histopathological diagnosis for benign eyelid tumor was nevus, while the most common malignant eyelid tumor was basal cell carcinoma at Chiang Mai University Hospital.

Anterior lamellar recession, blepharoplasty, and supratarsal fixation for cicatricial upper eyelid entropion without lagophthalmos

PubMed Central

Aghai, G H; Gordiz, A; Falavarjani, K G; Kashkouli, M B

2016-01-01

Purpose To assess the results of anterior lamellar recession, blepharoplasty, and supratarsal fixation procedure in patients with upper eyelid cicatricial entropion without lagophthalmos. Methods In a prospective interventional case series, 52 eyelids (32 patients) were included (April 2009–December 2010). Excluded were patients with previous eyelid surgeries, lagophthalmos, and <12 months of follow-up. Using a microscope, after recessing anterior lamella 3–4 mm above the eyelid margin, it was fixed with 4–5 interrupted 6-0 vicryl sutures. Excess anterior lamella was then excised (blepharoplasty), supratarsal fixation sutures (6-0 vicryl) were put and the skin was closed with 6-0 nylon sutures. Success and failure defined based upon eyelash-globe touch on the last follow-up visit (at least 12 months), respectively. Results There were 21 females (65.6%) and 11 males (34.4%) with a mean age of 69.7 years (SD=6.9) and mean follow-up of 21.06 months (SD=8.26). Success was observed in 39 (75%) and failure in 13 (25%). Mean time of failure was 4.5 months (SD=3). Although re-treatment with radio-frequency electrolysis (eight eyelids) and re-anterior lamellar recession (two eyelids) resulted in success in 12 eyelids with failure, two patients (three eyelids) declined further procedure. Except for thickened eyelid margin, no complications were observed. Conclusion Anterior lamellar recession, blepharoplasty, and supratarsal fixation procedure is an effective and safe technique for the treatment of the upper eyelid cicatricial entropion without lagophthalmos. PMID:26869158

Congenital Upper Eyelid Coloboma: Clinical and Surgical Management

PubMed Central

Ortega Molina, José María; Mora Horna, Eduardo Ramón; Salgado Miranda, Andrés David; Rubio, Rosa; Solans Pérez de Larraya, Ana; Salcedo Casillas, Guillermo

2015-01-01

Purpose. The goal was to describe our experience in the surgical management and treatment of four patients with congenital upper eyelid colobomas. Methods. A descriptive, observational, retrospective study was performed including patients with congenital eyelid colobomas referred to Asociación para Evitar la Ceguera en México I.A.P. “Dr. Luis Sánchez Bulnes” between 2004 and 2014 and assessed by the Oculoplastics and Orbit Service. Results. The four cases required surgical treatment of the eyelid defects before one year of age and their evolution was monitored from the time of referral to the present day. One of the patients needed a second surgical procedure to repair the eyelid defect and correct the strabismus. Conclusions. Eyelid colobomas are a potential threat to vision at an early age, which requires close monitoring of the visual development of patients. PMID:26366313

Congenital Upper Eyelid Coloboma: Clinical and Surgical Management.

PubMed

Ortega Molina, José María; Mora Horna, Eduardo Ramón; Salgado Miranda, Andrés David; Rubio, Rosa; Solans Pérez de Larraya, Ana; Salcedo Casillas, Guillermo

2015-01-01

Purpose. The goal was to describe our experience in the surgical management and treatment of four patients with congenital upper eyelid colobomas. Methods. A descriptive, observational, retrospective study was performed including patients with congenital eyelid colobomas referred to Asociación para Evitar la Ceguera en México I.A.P. "Dr. Luis Sánchez Bulnes" between 2004 and 2014 and assessed by the Oculoplastics and Orbit Service. Results. The four cases required surgical treatment of the eyelid defects before one year of age and their evolution was monitored from the time of referral to the present day. One of the patients needed a second surgical procedure to repair the eyelid defect and correct the strabismus. Conclusions. Eyelid colobomas are a potential threat to vision at an early age, which requires close monitoring of the visual development of patients.

Linear scleroderma associated with ptosis and motility disorders.

PubMed Central

Suttorp-Schulten, M S; Koornneef, L

1990-01-01

A case is reported in which an 11-year-old girl developed progressive ptosis and a subsequent motility disorder of the right eye. The diagnosis linear scleroderma en coup de sabre was established. Atrophy of the upper levator palpebral and superior rectus muscle could be shown on CT scan. Images PMID:2223709

Upper eyelid abscess as a late complication of frontal sinus trauma

PubMed Central

Adriana, Iliescu Daniela; Cornel, Stefan; Mihaela, Timaru Cristina; Speranta, Schmitzer; Algerino, De Simone; Mehdi, Batras; Elena, Zeca Cristina; Bogdan, Maciuceanu-Zarnescu Mircea

2015-01-01

The authors report a case of upper eyelid abscess in a 30 year old male that presented in the ophthalmology department with complains of recurrent eyelid pyosis, hyperaemia and swelling that started 2 months earlier and that did not ease to repeated courses of antibiotic therapy. The reported history of the patient revealed frontal sinus trauma that occurred 5 years before and that required surgical treatment (fixation with titan plaque and screws) with total healing and giving no further complains over the next years. The present cranial CT imaging showed intraorbital fat infiltration with displacement of one orbital arcade screw. Clinical findings showed normal ocular mobility. Antibiotic treatment and screw extraction through eyelid fistula improved the outcome but did not resolve the fistulous communication. Final management involved surgical removal of orbital arcade plaque and remaining screw and excision of fistula tract. The postoperative outcome was very good and the fistula remained closed but left the patient with an upper eyelid retraction which will require oculoplastic surgery in the future. PMID:29450319

Changes in Sunken Eyes Combined with Blepharoptosis after Levator Resection.

PubMed

Mawatari, Yuki; Fukushima, Mikiko; Kawaji, Takahiro

2017-12-01

This study aims to report the changes in sunken eyes combined with blepharoptosis after levator resection. Analysis involved 60 eyes from 32 patients with sunken eyes combined with blepharoptosis. Advancement of the levator aponeurosis and the Müller's muscle complex (levator resection) was performed in these patients. Area of upper eyelid sulcus (AES) was defined as the area of the upper eyelid shadow. The digital images were converted to black and white using image-processing software (Adobe Photoshop), and the AES was calculated using ImageJ software. In addition, margin reflex distance, eyebrow height (EBH), and AES were measured before and 3 months after surgery to assess the changes in the eyelids. Preoperative AES was significantly correlated to age ( P < 0.0001; r = 0.8062). Sunken eyes were remarkably improved after levator resection in all patients. Mean margin reflex distance significantly increased, whereas mean EBH and mean AES significantly decreased at 3 months after surgery ( P < 0.0001). The AES change was significantly correlated to the EBH change ( P < 0.0001; r = 0.5184). The principal aim of levator resection is to improve upper eyelid height and visual fields; however, this technique can alter the location of the eyebrow and upper orbital fat. The effects fill the hollowness of the upper eyelid and can remarkably improve sunken eyes.

Breast ptosis: causes and cure.

PubMed

Rinker, Brian; Veneracion, Melissa; Walsh, Catherine P

2010-05-01

Breast ptosis is one of the most common conditions treated by plastic surgeons, but the causes are not clearly defined. A review was conducted of 132 consecutive patients presenting for breast augmentation or mastopexy. Information was obtained by chart review and telephone interview. Standardized photographs were examined to determine degree of ptosis by the Regnault classification. Of patients who had at least one pregnancy, 85% reported adverse changes in breast shape following pregnancy, 35% reported a reduction in breast size, and 30% reported an increase in size. Upon logistic regression, age, history of significant (>50 lbs) weight loss, higher body mass index, larger bra cup size, number of pregnancies, and smoking history were found to be significant risk factors for breast ptosis (P < 0.05). History of breast-feeding, weight gain during pregnancy, and lack of participation in regular upper body exercise were not found to be significant risk factors for ptosis.

Sticky eyelid syndrome.

PubMed

Kortvelesy, J Scott; Buerger, George F

2004-11-01

To report on patients seen with an unusual condition affecting the eyelids. The syndrome manifests as a temporary adhesion which forms between the upper and lower eyelid associated with laxity of the lower lid retractors. This results in a peculiar closure of the lids. Retrospective case reports. Charts of affected patients were reviewed for their clinical histories, examination findings, external photographs, and the results of treatment. Ten consecutive patients with the associated findings were reviewed. All cases were unilateral. Seven patients were Asian and three were Caucasian. Nine patients were symptomatic; of these, all were treated conservatively except for one who requested surgery. Two cases are described and photographs are shown. Lower eyelid retractor laxity combined with a temporary adhesion between the upper and lower lid results in the clinical findings of Sticky Eyelid Syndrome.

Free tarsomarginal graft for large congenital coloboma repair in patients with Tessier number 10 clefts.

PubMed

Fu, Yao; Shao, Chunyi; Lu, Wenjuan; Li, Jin; Fan, Xianqun

2016-08-01

The aim of this study was to evaluate the long-term outcome when a free tarsomarginal graft is used to repair a large congenital coloboma in patients with a Tessier number 10 cleft. This was a retrospective, interventional case series. The medical records were reviewed for five children (six eyes) diagnosed as having Tessier number 10 cleft with large upper eyelid defects and symblepharon. These children were referred to the Department of Ophthalmology of Shanghai Ninth People's Hospital, between May 2007 and December 2012. Reconstructive techniques included repair of the upper eyelid defect with a free tarsomarginal graft taken from the lower eyelid, and reconstruction of the conjunctival fornix by using a conjunctival autograft after symblepharon lysis. All the children were followed up for more than 2 years. Postoperative upper eyelid contour, viability and function for corneal protection, and recurrence of symblepharon were assessed. A one-stage reconstruction procedure was used in all children. All reconstructed eyelids achieved a surgical goal of providing corneal protection and improved cosmesis, with marked improvement of exposure keratopathy and no associated lagophthalmos. Adequate reconstruction of the upper fornix was obtained, and there was no obvious recurrence of symblepharon. A free tarsomarginal graft is beneficial and seems to be an adequate method for reconstruction of large eyelid defects in children with a Tessier number 10 cleft. Symblepharon lysis with a conjunctival autograft for reconstruction of the ocular surface can be performed at the same time as eyelid repair as a one-stage procedure. Copyright © 2016. Published by Elsevier Ltd.

Evaluation of homeopathic Arnica montana for ecchymosis after upper blepharoplasty: a placebo-controlled, randomized, double-blind study.

PubMed

Kotlus, Brett S; Heringer, Dustin M; Dryden, Robert M

2010-01-01

Ecchymosis is commonly encountered after upper eyelid blepharoplasty. The use of homeopathic preparations of Arnica montana, a flowering herb, has been advocated by physicians, patients, and manufacturers for reduction of postsurgical ecchymosis. The authors evaluate its efficacy after upper eyelid blepharoplasty. A prospective, placebo-controlled, double-blind study was performed in which patients were randomly assigned to the administration of homeopathic A. montana or placebo concurrent with unilateral upper eyelid blepharoplasty followed by contralateral treatment at least 1 month later. Ecchymosis was evaluated at days 3 and 7 by rank order of severity and measurement of surface area of observable ecchymosis. There was no statistically significant difference in area of ecchymosis or rank order of ecchymosis severity for days 3 and 7 after treatment with A. montana versus placebo. Additionally, there was no difference in ease of recovery per patient report, and there was no difference in the rate of ecchymosis resolution. The authors find no evidence that homeopathic A. montana, as used in this study, is beneficial in the reduction or the resolution of ecchymosis after upper eyelid blepharoplasty.

Outcomes of levator resection at tertiary eye care center in Iran: a 10-year experience.

PubMed

Abrishami, Alireza; Bagheri, Abbas; Salour, Hossein; Aletaha, Maryam; Yazdani, Shahin

2012-02-01

To assess outcomes of levator resection for the surgical correction of congenital and acquired upper lid ptosis in patients with fair to good levator function and evaluation of the relationship between demographic data and success of this operation. In a retrospective study, medical records of patients with blepharoptosis who had undergone levator resection over a 10-year period and were followed for at least 3 months were reviewed. Overall, 136 patients including 60 (44.1%) male and 76 (55.9%) female subjects with a mean age of 20 ± 13.8 years (range, 2 to 80 years) were evaluated, of whom 120 cases (88.2%) had congenital ptosis and the rest had acquired ptosis. The overall success rate after the first operation was 78.7%. The most common complication after the first operation was undercorrection in 26 cases (19.1%), which was more prevalent among young patients (p = 0.06). Lid fissure and margin reflex distance (MRD(1)) also increased after levator resection (p < 0.001). Age, sex, type of ptosis, amblyopia, levator function, MRD(1), lid fissure and spherical equivalent were not predictive of surgical outcomes of levator resection. Levator resection has a high rate of success and few complications in the surgical treatment of congenital and acquired upper lid ptosis with fair to good levator function. Reoperation can be effective in most cases in which levator resection has been performed.

Periocular mexametric melanin and erythema indexes in adult glaucoma patients treated with topical prostaglandin analogs.

PubMed

Duman, Nilay; Duman, Reşat; Yavaş, Güliz Fatma; Doğruk Kaçar, Seval; Özuğuz, Pınar; Çetinkaya, Ersan

2017-03-01

Although topical prostaglandin analogs (PGAs) have been previously associated with periocular skin hyperpigmentation, studies using objective clinical methods are lacking. Furthermore changes in periocular skin erythema indexes associated with topical PGAs have not been reported previously. The purpose of the present study was to evaluate periocular melanin and erythema indexes in patients treated with topical PGA using an objective clinical method - Mexameter. About 45 glaucoma patients treated with topical PGA therapy, and 30 age-, and sex-matched controls were enrolled in the study. Demographic data, medical history including duration of therapy, PGA type, involved eye (unilateral, bilateral) were noted, and skin phototypes were evaluated. Melanin and erythema indexes on medial and lateral upper and lower eyelids, and normal skin from the upper cheeks were measured using Mexameter MX-18. The index of difference for lower/upper eyelid was calculated. Reading results of patients and controls were compared. Melanin and erythema indexes of upper/lower eyelids, and the index of differences for upper/lower eyelids were significantly higher in patients despite similar clinical findings (p < 0.05). Duration of therapy and type of PGA were not associated with skin changes (p > 0.05). Both periocular melanin and erythema indexes increased in both upper and lower eyelids due to PGA therapy compared to controls, despite similar clinical findings. Mexametric evaluation is more sensitive than clinical evaluation, and may be used as an objective, sensitive clinical method to evaluate periocular skin changes, even smallest changes, in such patients.

[Ophthalmic complications and local anesthesia. Pathophysiology and types of eye complications after intraoral dental anesthesia, and clinical recommendations].

PubMed

von Arx, Thomas; Lozanoff, Scott; Zinkernagel, Martin

2014-01-01

The present article reviews the different types of ophthalmologic complications following administration of intraoral local anesthesia. Since the first report by Brain in 1936, case reports about that topic have been published regularly in the literature. However, clinical studies evaluating the incidence of ophthalmologic complications after intraoral local anesthesia are rarely available. Previous data point to a frequency ranging from 0.03% to 0.13%. The most frequently described ophthalmologic complications include diplopia (double vision), ptosis (drooping of upper eyelid), and mydriasis (dilatation of pupil). Disorders that rather affect periorbital structures than the eye directly include facial paralysis and periorbital blanching (angiospasm). Diverse pathophysiologic mechanisms and causes have been reported in the literature, with the inadvertent intravascular administration of the local anesthetic considered the primary reason. The agent as well as the vasopressor is transported retrogradely via arteries or veins to the orbit or to periorbital structures (such as the cavernous sinus) with subsequent anesthesia of nerves and paralysis of muscles distant from the oral cavity. In general the ophthalmologic complications begin shortly after administration of the local anesthesia, and disappear once the local anesthesia has subsided.

Nonallergic Eyelid Edema After Botulinum Toxin Type A Injection

PubMed Central

Chang, Yin-Shuo; Chang, Chang-Cheng; Shen, Jen-Hsiang; Chen, Yu-Tsung; Chan, Karen Kar-Wun

2015-01-01

Abstract Periocular botulinum toxin type A (BoNTA) injections are generally safe. Ptosis is the most common adverse effect, whereas eyelid edema is rarely reported. There is no consensus on the latter's incidence, clinical course, or treatment strategy. Here we managed a 59-year-old woman who received BoNTA injections to her forehead, glabella, and eye corner. At 3-day follow-up, she presented with painless, nonpruritic, bilateral periorbital edema, and erythema. Preliminary diagnosis was a local allergic reaction, and topical corticosteroid was administered, but upon lack of improvement, edema secondary to venous and lymphatic congestion was hypothesized, and she was advised to apply hot pads over her eyes, blink frequently, and massage the area. Her eyelid edema resolved 2 weeks later. At 4-month follow-up, the patient requested and received another course of BoNTA at half the dose. Frequent blinking was instructed, and the patient reported a satisfactory outcome with no adverse effects. In our literature review, incidence of BoNTA-induced eyelid edema was 1.4% and showed Asian tendency. Although rare, BoNTA-induced periorbital edema is self-limiting, and normally resolves in 2 to 4 weeks without medical treatment. Patients at risk for edema, including Asian ethnicity, dermatochalasis, and poor periocular muscle tone, are advised to receive injections at half the dosage. Examination of the function and tone of the orbicularis oculi and levator palpebrae superioris muscles before treatment is recommended, and application of hot pads over the eyes, frequent blinking in the morning, and self-massage of the affected area to increase venous return have demonstrated to improve outcome. PMID:26402825

Oriental upper blepharoplasty.

PubMed

Weng, Chau-Jin

2009-02-01

Aesthetic surgery of the upper eyelids is a very common procedure performed in cosmetic practices around the world. The word blepharoplasty, however, has a different meaning in Asia than it does elsewhere. Orientals have different periorbital anatomic characteristics, their motivations for seeking eyelid treatment are different, and operative techniques have been adapted consequently. There are also many eyelid shapes among Orientals, mostly with regard to the presence and location of the supratarsal fold and/or presence of an epicanthal fold. The surgeon must therefore master a range of surgical procedures to treat these variations adequately. It is critical to know the indications for each blepharoplasty technique as well as their complications to select the right surgery and avoid unfavorable results. Epicanthoplasty performed on the right patient can greatly improve aesthetic results while retaining ethnic characteristics. This article will discuss Oriental eyelid characteristics, preoperative patient assessment, commonly used corrective techniques for the "double-eyelid" creation, and complications and how to avoid them.

Hills and Valleys: Understanding the Under-Eye

PubMed Central

Naik, Milind N

2016-01-01

Soft tissue deflation and descent have long been implicated in the pathogenesis of facial aging. In the periorbital area, the upper orbital region is thought to change by descent of the eyebrow, as well as deflation of brow fat. While the understanding of the aging changes in the upper eyelid region are relatively simple, the lower eyelid poses a myriad of aging changes, each demanding a specific management plan. These can be best described in terms of elevations, or ‘Hills’ and hollows, or ‘Valleys’. This article simplifies the understanding of the lower eyelid in the light of anatomical knowledge, and available literature. It forms a basis of easy diagnosis and treatment of the soft tissue changes in the lower eyelid and malar region. PMID:27398004

Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft.

PubMed

Toft, Peter B

2016-01-01

To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery. This was a retrospective case-series of 8 patients who underwent reconstruction of the upper eyelid after tumour removal. The horizontal defect involved 50-75% of the lid (3 pts.), more than 75% (3 pts.), and more than 75% plus the lateral canthus (2 pts.). The posterior lamella was reconstructed with contralateral upper eyelid tarsal plate. The anterior lamella was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free skin graft. All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after excision to avoid eye discomfort. Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases.

Hidradenocarcinoma eccrinale syringomatodes of the eyelid--case of a rare malignancy.

PubMed

Karolina, Ziaja; Arkadiusz, Pogrzebielski; Jolanta, Orłowska-Heitzman; Bozena, Romanowska-Dixon

2010-01-01

Presentation of a case of very rare malignant tumor of eccrine sweat glands in the eyelid. A 44 years old man with a tumor of the upper left eyelid is presented. Sweat gland carcinomas are rare malignant tumors of the skin adnexa. Diagnosis of these carcinomas is difficult due to their infrequency.

The expression and comparison of healthy and ptotic upper eyelid contours using a polynomial mathematical function.

PubMed

Mocan, Mehmet C; Ilhan, Hacer; Gurcay, Hasmet; Dikmetas, Ozlem; Karabulut, Erdem; Erdener, Ugur; Irkec, Murat

2014-06-01

To derive a mathematical expression for the healthy upper eyelid (UE) contour and to use this expression to differentiate the normal UE curve from its abnormal configuration in the setting of blepharoptosis. The study was designed as a cross-sectional study. Fifty healthy subjects (26M/24F) and 50 patients with blepharoptosis (28M/22F) with a margin-reflex distance (MRD1) of ≤2.5 mm were recruited. A polynomial interpolation was used to approximate UE curve. The polynomial coefficients were calculated from digital eyelid images of all participants using a set of operator defined points along the UE curve. Coefficients up to the fourth-order polynomial, iris area covered by the UE, iris area covered by the lower eyelid and total iris area covered by both the upper and the lower eyelids were defined using the polynomial function and used in statistical comparisons. The t-test, Mann-Whitney U test and the Spearman's correlation test were used for statistical comparisons. The mathematical expression derived from the data of 50 healthy subjects aged 24.1 ± 2.6 years was defined as y = 22.0915 + (-1.3213)x + 0.0318x(2 )+ (-0.0005x)(3). The fifth and the consecutive coefficients were <0.00001 in all cases and were not included in the polynomial function. None of the first fourth-order coefficients of the equation were found to be significantly different in male versus female subjects. In normal subjects, the percentage of the iris area covered by upper and lower lids was 6.46 ± 5.17% and 0.66% ± 1.62%, respectively. All coefficients and mean iris area covered by the UE were significantly different between healthy and ptotic eyelids. The healthy and abnormal eyelid contour can be defined and differentiated using a polynomial mathematical function.

Nonallergic Eyelid Edema After Botulinum Toxin Type A Injection: Case Report and Review of Literature.

PubMed

Chang, Yin-Shuo; Chang, Chang-Cheng; Shen, Jen-Hsiang; Chen, Yu-Tsung; Chan, Karen Kar-Wun

2015-09-01

Periocular botulinum toxin type A (BoNTA) injections are generally safe. Ptosis is the most common adverse effect, whereas eyelid edema is rarely reported. There is no consensus on the latter's incidence, clinical course, or treatment strategy. Here we managed a 59-year-old woman who received BoNTA injections to her forehead, glabella, and eye corner. At 3-day follow-up, she presented with painless, nonpruritic, bilateral periorbital edema, and erythema. Preliminary diagnosis was a local allergic reaction, and topical corticosteroid was administered, but upon lack of improvement, edema secondary to venous and lymphatic congestion was hypothesized, and she was advised to apply hot pads over her eyes, blink frequently, and massage the area. Her eyelid edema resolved 2 weeks later. At 4-month follow-up, the patient requested and received another course of BoNTA at half the dose. Frequent blinking was instructed, and the patient reported a satisfactory outcome with no adverse effects. In our literature review, incidence of BoNTA-induced eyelid edema was 1.4% and showed Asian tendency. Although rare, BoNTA-induced periorbital edema is self-limiting, and normally resolves in 2 to 4 weeks without medical treatment. Patients at risk for edema, including Asian ethnicity, dermatochalasis, and poor periocular muscle tone, are advised to receive injections at half the dosage. Examination of the function and tone of the orbicularis oculi and levator palpebrae superioris muscles before treatment is recommended, and application of hot pads over the eyes, frequent blinking in the morning, and self-massage of the affected area to increase venous return have demonstrated to improve outcome.

Efficacy of adhesive strips to reduce postoperative periorbital edema and ecchymosis following rhinoplasty

PubMed

Tatar, Sedat; Bulam, Mehmet Hakan; Özmen, Selahattin

2018-02-23

Background/aim: Periorbital edema and ecchymosis may develop following rhinoplasty. The aim of this study was to assess the efficacy of adhesive strip application on the upper and lower eyelids to reduce postoperative edema and ecchymosis following rhinoplasty. Materials and methods: The eyelids of one side were randomly selected, and an adhesive strip of standard size and number was applied at the end of the operation. The strips were removed at postoperative day 3; photos of the eyes were taken at days 3 and 7. Edema and ecchymosis were graded on a scale from 1 to 4. The ecchymosis areas on the lower and upper eyelids were measured and compared in square centimeters. Results: The mean ecchymosis area of the lower eyelid on the side of the adhesive strip and on the side without the strip was 1.63 cm2 and 3.32 cm2 in the early period, respectively. It was 1.15 cm2 on the upper eyelid on the side of the adhesive strip, and 1.87 cm2 on the side without the strip. It was 0.224 cm2 on the side of the adhesive strip, and 0.498 cm2 on the side without the adhesive strip in the late period. Conclusion: Applying adhesive strips reduces periorbital edema and ecchymosis.

Temporary Medial Upper Eyelid Lagophthalmos after External Dacryocystorhinostomy.

PubMed

Haefliger, I O; Meienberg, O; Pimentel de Figueiredo, A R

2016-04-01

Background. Report of three cases of medial upper eyelid lagophthalmos as complication of external dacryocystorhinostomy. History and Signs. Shortly after dacryocystorhinostomy (skin incision on the side of the nose), three of ten consecutive patients (28 ± 4 years; mean ± standard deviation), presented with an ipsilateral lagophthalmos of 4 ± 1 mm in voluntary eyelid closure and 6 ± 1 mm in spontaneous blink. The lagophthalmos was due to a selective paresis of the medial part of the orbicularis oculi muscle of the upper eyelid. Patient 1 complained bitterly of dry eye symptoms and of her lagophthalmos. Patient 2 had mild symptoms but became very concerned after peers made her aware of her asymmetric blink. Patient 3 was asymptomatic and did not notice anything particular. Therapy and Outcome. Lagophthalmos resolved spontaneously within three months after surgery, first by improvement of voluntary eyelid closure and then of spontaneous blinking. Conclusions. Temporary lagophthalmos can occur as a complication of external dacryocystorhinostomy, most likely due to damage of the (only recently described) superficial buccal and/or zygomatic branches of the facial nerve that run upward to cross over the medial ligament and innervate the medial part of the orbicularis oculi muscle. Georg Thieme Verlag KG Stuttgart · New York.

Pediatric ptosis as a sign of treatable autonomic dysfunction.

PubMed

Phillips, Lara; Robertson, David; Melson, Mark R; Garland, Emily M; Joos, Karen M

2013-08-01

To report the ophthalmic findings in young patients with dopamine β-hydroxylase deficiency and to assess them in the context of other reports in an attempt to discern if ophthalmic criteria may assist in early detection of this debilitating, yet treatable, disorder. Prospective, observational case series. An ophthalmic examination, including measuring intraocular and systemic blood pressures while supine, sitting, and standing, and eyelid function and pupillary function testing, was completed on 3 young patients with recently documented dopamine β-hydroxylase deficiency at a single institution. Mean arterial blood pressures were 90.1 ± 18.5 mm Hg supine, 79.1 ± 25.7 mm Hg sitting, and 45.8 ± 11.6 mm Hg standing (P = .021). Mean intraocular pressures in these patients were 15.8 ± 1.0 mm Hg supine, 15.0 ± 3.6 mm Hg sitting, and 7.7 ± 2.3 mm Hg standing (P = .03). Mean palpebral fissure, levator function, and margin reflex distance were 8.2 ± 1.0 mm, 16.0 ± 0 mm, and 2.8 ± 0.6 mm, respectively. Measurable miosis was present in only 1 patient, and pupillary supersensitivity to 2.5% phenylephrine was not observed. The ophthalmologic findings of the patients in this case series documented mild ptosis and striking orthostatic reductions in intraocular pressure and mean arterial blood pressure, as might be expected with a lack of intrinsic sympathetic function. Orthostatic intraocular pressure and mean arterial blood pressure may be a helpful early screening tool for autonomic dysfunction in children undergoing a ptosis evaluation. Copyright © 2013 Elsevier Inc. All rights reserved.

Eyebrow ptosis after blowout fracture indicates impairment of trigeminal proprioceptive evocation that induces reflex contraction of the frontalis muscle.

PubMed

Ban, Ryokuya; Matsuo, Kiyoshi; Ban, Midori; Yuzuriha, Shunsuke

2013-01-01

The mixed levator and frontalis muscles lack the interior muscle spindles normally required to induce involuntary contraction of their slow-twitch fibers. To involuntarily move the eyelid and eyebrow, voluntary contraction of the levator nonskeletal fast-twitch muscle fibers stretches the mechanoreceptors in Müller's muscle to evoke trigeminal proprioception, which then induces reflex contraction of the levator and frontalis skeletal slow-twitch muscle fibers. The trigeminal proprioceptive nerve has a long intraorbital course from the mechanoreceptors in Müller's muscle to the superior orbital fissure. Since external force to the globe may cause impairment of trigeminal proprioceptive evocation, we confirmed how unilateral blowout fracture due to a hydraulic mechanism affects ipsilateral eyebrow movement as compared with unilateral zygomatic fracture. In 16 unilateral blowout fracture patients, eyebrow heights were measured on noninjured and injured sides in primary and 60° upward gaze and statistically compared. Eyebrow heights were also measured in primary gaze in 24 unilateral zygomatic fracture patients and statistically compared. In the blowout fracture patients, eyebrow heights on the injured side were significantly smaller than on the noninjured side in both gaze. In the zygomatic fracture patients, eyebrow heights on the injured side were significantly larger than on the noninjured side in primary gaze. Since 60° upward gaze did not recover the eyebrow ptosis observed in primary gaze in blowout fracture patients, such ptosis indicated impairment of trigeminal proprioceptive evocation and the presence of a hydraulic mechanism that may require ophthalmic examination.

Eyebrow Ptosis After Blowout Fracture Indicates Impairment of Trigeminal Proprioceptive Evocation That Induces Reflex Contraction of the Frontalis Muscle

PubMed Central

Ban, Ryokuya; Matsuo, Kiyoshi; Ban, Midori; Yuzuriha, Shunsuke

2013-01-01

Objective: The mixed levator and frontalis muscles lack the interior muscle spindles normally required to induce involuntary contraction of their slow-twitch fibers. To involuntarily move the eyelid and eyebrow, voluntary contraction of the levator nonskeletal fast-twitch muscle fibers stretches the mechanoreceptors in Müller's muscle to evoke trigeminal proprioception, which then induces reflex contraction of the levator and frontalis skeletal slow-twitch muscle fibers. The trigeminal proprioceptive nerve has a long intraorbital course from the mechanoreceptors in Müller's muscle to the superior orbital fissure. Since external force to the globe may cause impairment of trigeminal proprioceptive evocation, we confirmed how unilateral blowout fracture due to a hydraulic mechanism affects ipsilateral eyebrow movement as compared with unilateral zygomatic fracture. Methods: In 16 unilateral blowout fracture patients, eyebrow heights were measured on noninjured and injured sides in primary and 60° upward gaze and statistically compared. Eyebrow heights were also measured in primary gaze in 24 unilateral zygomatic fracture patients and statistically compared. Results: In the blowout fracture patients, eyebrow heights on the injured side were significantly smaller than on the noninjured side in both gaze. In the zygomatic fracture patients, eyebrow heights on the injured side were significantly larger than on the noninjured side in primary gaze. Conclusion: Since 60° upward gaze did not recover the eyebrow ptosis observed in primary gaze in blowout fracture patients, such ptosis indicated impairment of trigeminal proprioceptive evocation and the presence of a hydraulic mechanism that may require ophthalmic examination. PMID:23814636

[Therapeutic strategy for different types of epicanthus].

PubMed

Gaofeng, Li; Jun, Tan; Zihan, Wu; Wei, Ding; Huawei, Ouyang; Fan, Zhang; Mingcan, Luo

2015-11-01

To explore the reasonable therapeutic strategy for different types of epicanthus. Patients with epicanthus were classificated according to the shape, extent and inner canthal distance and treated with different methods appropriately. Modified asymmetric Z plasty with two curve method was used in lower eyelid type epicanthus, inner canthus type epicanthus and severe upper eyelid type epicanthus. Moderate upper epicanthus underwent '-' shape method. Mild Upper epicanthus in two conditions which underwent nasal augumentation and double eyelid formation with normal inner canthal distance need no correction surgery. The other mild epicanthus underwent '-' shape method. A total of 66 cases underwent the classification and the appropriate treatment. All wounds healed well. During 3 to 12 months follow-up period, all epicanthus were corrected completely with natural contour and unconspicuous scars. All patients were satisfied with the results. Classification of epicanthus hosed on the shape, extent and inner canthal distance and correction with appropriate methods is a reasonable therapeutic strategy.

Reversibility of Gland Dropout and Significance of Eyelid Hygiene Treatment in Meibomian Gland Dysfunction.

PubMed

Yin, Yue; Gong, Lan

2017-03-01

To observe reversibility of meibomian gland (MG) dropout and analyze correlated factors and to compare the treatment efficiency with and without eyelid hygiene in patients with meibomian gland dysfunction (MGD). Consecutive 78 eyes of 78 MGD (stage 2-3) patients who finished follow-up examination after 1-month of treatment were recruited in this retrospective study. All patients were treated with artificial lubricant and eyelid hygiene. Related ocular surface evaluation and meibomian gland assessment were examined. There were 26 (33%) patients (included in group 1) who ignored doctors' order for eyelid hygiene, and 52 (67%) patients (included in group 2) were compliant. There was no statistical difference between group 1 (age, 44.4 ± 12.2) and group 2 (age, 38.9 ± 16.6) in characteristics and pretreatment clinical indexes. However, after 1-month of treatment, only the ocular surface disease index of group 1 improved (P = 0.048), whereas all clinical indexes of group 2, except the Schirmer test result, improved (including expressibility, all P < 0.05). A 5% decrease in MG dropout of both upper (5.4%) and lower (4.6%) eyelids in group 2 was observed. Improvement in upper-eyelid dropout and expressibility were the predictors of lower-eyelid dropout improvement. The reversibility had no correlation with age, sex, pretreatment MGD stage, disease duration, and use of topical antiinflammation medication. With expressibility-improving treatment, MG dropout was reversible to some extent. Eyelid hygiene is an efficient treatment of MGD; however, there is a need for ophthalmologists to instruct patients on conduct and supervise patients' compliance.

Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures.

PubMed

Cruz, Antonio Augusto Velasco E; Akaishi, Patricia M S; Al-Dufaileej, Mohammed; Galindo-Ferreiro, Alicia

2015-01-01

To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men) were operated on, with an age range of 44-99 years [mean ± standard deviation (SD) = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months). Forty percent of the patients (24 lids) had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes) was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

Unilateral eyelid angioedema with congestion of the right bulbar conjunctiva due to loxoprofen sodium.

PubMed

Tsuruta, Daisuke; Oshimo, Tomoko; Sowa, Junko; Ishii, Masamitsu; Kobayashi, Hiromi

2011-01-01

Angioedema is a variant of urticaria that causes deep dermal and subcutaneous swelling. It frequently is a unilateral reaction and usually lasts for several hours but may persist for several days. We report 2 cases of angioedema that involved the right upper and lower eyelids and was associated with congestion of the right bulbar conjunctiva; the symptoms started approximately 1 to 2 hours after taking loxoprofen sodium. All of the symptoms subsided after oral corticosteroid therapy. In both cases, an oral challenge test with 60 mg of loxoprofen sodium (contained in a tablet) caused swelling of the right upper eyelid within several hours, followed by swelling of the right bulbar conjunctiva. We believe the drug reaction in both patients is angioedema.

Effect of double-fold surgery on spontaneous resolution of Graves' upper eyelid retraction.

PubMed

Kim, Dong Kyu; Choi, Moonjung; Yoon, Jin Sook

2015-02-01

To investigate the effect of previous incisional double-fold surgery on spontaneous resolution of eyelid retraction caused by Graves orbitopathy (GO) in Asian individuals. Retrospective review of medical records. Patients (N = 30; 39 eyes) with eyelid retraction associated with GO with symptom duration of less than 6 months. Patients who visited the Ophthalmology Department of Severance Hospital, Yonsei University, between January 2010 and December 2011, followed up for more than 6 months and in a euthyroid state with antithyroid drug treatment were included. Patients treated with steroids or who underwent surgery during follow-up were excluded. Upper scleral show was measured as the distance between the central upper lid margin and limbus at initial presentation and after 6 months. Comparative analysis was performed between the 2 groups delineated by history (n = 12; 16 eyes), or lack thereof (n = 18; 23 eyes), of incisional double-fold surgery before onset of GO symptoms and signs. Patient demographics and initial upper scleral show were not significantly different between groups. In both groups, upper scleral show significantly decreased at 6 months of follow-up (p < 0.001 in both groups); however, improvement of upper scleral show was significantly reduced in patients who had undergone previous double-fold surgery (0.8 ± 0.5 mm) than in nonsurgical patients (1.8 ± 0.5 mm; p < 0.001). Graves eyelid retraction resolves spontaneously over time, albeit not completely. Previous double-fold surgery hinders the degree of spontaneous resolution, probably because of the fibrosis and cicatrization between the skin, the subcutaneous layer, and the levator complex. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Full thickness skin grafts in periocular reconstructions: long-term outcomes.

PubMed

Rathore, Deepa S; Chickadasarahilli, Swaroop; Crossman, Richard; Mehta, Purnima; Ahluwalia, Harpreet Singh

2014-01-01

To evaluate the outcomes of eyelid reconstruction in patients who underwent full thickness skin grafts. A retrospective, noncomparative intervention study of patients who underwent periocular reconstruction with full thickness skin grafts between 2005 and 2011. One hundred consecutive Caucasian patients were included in the study, 54 women and 46 men. Mean follow up was 32 months. Indications for full thickness skin grafts were excision of eyelid tumors (98%) and cicatricial ectropion (2%). Site of lid defects were lower lid (60%), medial canthus (32%), upper lid (6%), and lateral canthus (2%). The skin graft donor sites were supraclavicular (44%), upper eyelid (24%), inner brachial (18%), and postauricular (14%).Early postoperative complications included lower eyelid graft contracture (1%) and partial failure (1%). Late sequelae included lower eyelid graft contracture (4%) and hypertrophic scarring (23%). Of the 23 patients with hypertrophic scar, 21 achieved good outcomes following massage with silicone gel and steroid ointment and 2 had persistent moderate lumpiness. No statistically significant association was found between graft hypertrophy and donor site or graft size. As high as 95% of all patients achieved good final eyelid position. Good color match was seen in 94% and graft hypopigmentation in 6%. An association between hypopigmentation and supraclavicular and inner brachial donor site was found to be statistically significant. Most patients (94%) achieved good eyelid position and color match. Majority (91%) of the early postoperative cicatricial sequelae can be reversed by massage, steroid ointment, and silicone gel application. Full thickness skin grafts have excellent graft survival rates and have minimal donor site morbidity.

Validity of Forced Eyelid Closure Test: A Novel Clinical Screening Test for Ocular Myasthenia Gravis.

PubMed

Apinyawasisuk, Supanut; Zhou, Xinkai; Tian, Jack J; Garcia, Giancarlo A; Karanjia, Rustum; Sadun, Alfredo A

2017-09-01

Forced eyelid closure test (FECT) is a clinical screening test developed from the original Cogan lid twitch (CLT) sign to assist in the diagnosis of ocular myasthenia gravis (OMG), We evaluated the sensitivity and specificity of FECT compared with CLT and benchmarked to standard diagnostic tests. This study was a retrospective chart review of 48 patients using electronic medical records of those that presented with ptosis and/or diplopia at Doheny Eye Institute, University of California, Los Angeles between February 2015 and April 2016. Patients without FECT testing were excluded. FECT and CLT results, and final diagnosis were recorded. To perform FECT, the patient was asked to squeeze his or her eyelids shut for 5-10 seconds then open quickly and fixate in primary position. The excessive upward overshoot of eyelids movement indicated a positive FECT. The test was performed by a neuro-ophthalmologist before establishing the diagnosis. Patients who had equivocal test results and/or inconclusive final diagnosis were excluded. Of the 48 patients studied, 18 patients (37.5%) had positive FECT; 15 of whom had a final diagnosis of OMG (83.3%). Of the 30 patients with negative FECT, 1 had OMG (3.3%). Of the 48 patients, 35 patients also had a documented CLT result (72.9%). CLT was positive in 11 of these 35 patients (31.4%), and 9 of these 11 had OMG (81.8%). Of the 24 patients with negative CLT, 2 of them had OMG (8.3%). Sensitivity and specificity of FECT were 94% and 91% (joint 95% confidence region: sensitivity × specificity = [0.70, 1] × [0.75, 1]). The relative true-positive fraction (rTPF) between FECT and CLT was 1.15; the relative false-positive fraction was 1.31. FECT is a simple clinical screening test with good sensitivity and specificity for OMG.

A Promising Modified Procedure for Upper Eyelid Retraction-Associated Graves' Ophthalmopathy: Transconjunctival Lateral Levator Aponeurectomy.

PubMed

Khatavi, Fatima; Nasrollahi, Kobra; Zandi, Alireza; Panahi, Maryam; Mortazavi, Mahshid; Pourazizi, Mohsen; Ranjbar-Omidi, Behzad

2017-01-01

Upper eyelid retraction is a characteristic feature of thyroid eye disease, including Graves' orbitopathy. In this study, a new surgical technique for correction of lid retraction secondary to Graves' orbitopathy is described. Sixteen eyelids of patients older than 18 years old underwent surgical correction for moderate to severe lid retraction secondary to Graves' orbitopathy. In this procedure, levator aponeurectomy was performed via a transconjunctival approach. Upper marginal reflex distance (MRD1) was measured before the surgery and at 1 week, 3 months, and 6 months after the surgery. MRD1 was reduced significantly from preoperatively (mean: 7.84 mm) to 1 week after the surgery (mean: 3.59 mm) (P < 0.001). Three and six months after surgery, mean MRD1 was 5.09 mm and 5.10 mm, respectively, showing that lid retraction was improved significantly (P < 0.001). Lateral levator aponeurectomy via the transconjunctival approach is a simple, scar-less, quick procedure that has optimal stable outcome.

[Microcirculatory blood and lymph flow examination in eyelid skin by laser Doppler flowmetry].

PubMed

Safonova, T N; Kintyukhina, N P; Sidorov, V V; Gladkova, O V; Reyn, E S

to study normal blood and lymph microcirculation of the upper and lower eyelids in different age groups. The study included 108 volunteers (216 eyes) aged from 20 to 80 years with no signs of changes in anterior segment structures, who were grouped by age ranges (20-30 years, 31-40 years, 41-50 years, 51-60 years, 61-70 years, and 71-80 years) into 6 groups equal in gender and quantitative composition. In all volunteers, microcirculation of the upper and lower eyelids was examined by laser Doppler flowmetry (LDF) ('LASMA MC-1' peripheral blood and lymph flow analyzer and 'LASMA MC' laser diagnostic complex, LASMA LLC). The average perfusion changes in blood and lymph flow as well as blood and lymph flow oscillations were analyzed. Blood and lymph flow in the microvasculature of the upper and lower eyelids is variable and depends on neither the age, nor gender of the test subject. On LDF-gram, every increase in amplitude of blood flow corresponds to a decrease in that of lymph flow. The non-invasive method of LDF expands our diagnostic capabilities as it enables assessment of not only blood, but also lymph flow. The data obtained can serve as a starting point for exploring microcirculation in different age groups in the presence of different pathological processes.

[Update on upper eyelid blepharoplasty].

PubMed

Klingenstein, A; Hintschich, C

2018-04-01

Upper eyelid blepharoplasty is among the most frequent oculoplastic surgical procedures. It is often performed as one of the first esthetic surgical interventions by surgeons of various disciplines. While there is a high probability of happy and satisfied patients postoperatively, there are important potential surgical complications that should be prevented. This requires a careful preoperative, perioperative and postoperative approach. This synopsis presents the basic considerations concerning upper eyelid blepharoplasty to serve as practical surgical guidelines. This is a compendium of important preoperative, perioperative and postoperative contemplations derived from the medical literature, expert opinions and the authors' personal experiences. Careful examination and documentation of eyelid and periorbital findings are required in order to identify additional pathologies to dermatochalasis and plan the surgical approach accordingly. There is a trend in the literature and in expert opinions away from large tissue resection and towards volume preserving and volume reconstructing surgical techniques. Correct placement of the skin fold as well as maintaining lid symmetry are crucial points in order to achieve a natural appearance and patient satisfaction. Careful and realistic patient information, state of the art surgery including cautious tissue resection and correct symmetrical formation of the skin fold as well as postoperative assistance and availability increase the likelihood of satisfied patients after blepharoplasty.

Periorbital edema as the initial presentation of T-cell prolymphocytic leukemia.

PubMed

Nusz, Kevin J; Pang, Noelene K; Woog, John J

2006-01-01

A 57-year-old woman presented with a history of progressive bilateral upper and lower eyelid edema. Laboratory tests revealed T-cell prolymphocytic leukemia. Despite systemic treatment, she died 2 weeks after presentation. This life-threatening disorder should be added to the differential diagnosis of eyelid edema.

Genome-Wide Association Study of Entropion Eyelid in Multiple Breeds of Sheep

USDA-ARS?s Scientific Manuscript database

Entropion is an inversion of the eyelid margin causing lashes or external hairs to rub against the ocular surface. If uncorrected, discomfort, ocular damage, increased eye infection rates, and potential blindness can occur. Entropion affects many mammalian species, can be expressed in both upper and...

Two-dimensional analysis of palpebral opening in blepharoptosis: visual iris-pupil complex percentage by digital photography.

PubMed

Choi, Yeop; Eo, SuRak

2014-04-01

The vertical dimension of the palpebral fissure and the marginal reflex distance are conventionally used to assess the amount or degree of blepharoptosis, and levator function is assessed by measuring total upper lid excursion between the extremes of down-gaze and up-gaze. However, these are 1-dimensional measures obtained with a ruler, and the results obtained are dependent on examiner skill. Digital photographs were obtained of 692 patients before and after upper blepharoplasty. Visual iris-pupil complex percentage (VIP) was measured in the 1,305 eyes by digital calculation using Adobe Photoshop CS3 (Adobe Systems, Inc). Perioperative eye images in primary gaze were evaluated independently by 2 surgeons, 2 nurses, and a graphic designer, and after excluding 50 eyes which were nonconcordant and 29 eyes which revealed retracted upper lids, the remaining 1,305 eyes were classified into 4 major groups, that is, into excellent (n = 415), good (n = 435), subclinical (n = 270), and prominent ptosis (n = 185) groups. In addition, eyes were subdivided into 5 types according to the iris-pupil complex position within the palpebral fissure. Visual iris-pupil complex percentages were from 85% to 94% in the excellent, from 78% to 84% in the good, from 70% to 77% in the subclinical ptosis, and below 70% in the prominent ptosis group. Patients in the subclinical or prominent ptosis eye group required surgery for blepharoptosis. Iris-pupil complex relation to the palpebral opening was classified into 5 eye types, namely, standard (n = 961), scleral (n = 266), sinking (n = 151), retracted (n = 3), and fish (n = 3). The authors devised a new prospective measurement method for assessing blepharoptosis in a clinical setting. Graphical comparisons between the devised method of measuring VIP and mathematical estimations showed that the devised method is easier, more practical, and more precise for measuring degree of blepharoptosis from general population trends, and that VIP also provides a useful objective index for evaluating the postoperative results of blepharoptosis.

The role of clinical pharmacology in molecular genetics

NASA Technical Reports Server (NTRS)

Robertson, D.

1997-01-01

PROBLEM: Discovering the causes of unusual phenotypes in human subjects is an important aspect of patient-oriented research. MATERIAL: The tools of clinical pharmacology are uniquely useful in addressing these problems. PATIENTS, SUBJECTS, OR CASE HISTORIES: We evaluated a 42-year-old patient with lifelong orthostatic hypotension and ptosis of the eyelids. He underwent a series of biochemical, physiological, and pharmacological tests outlined in this article. RESULTS: These studies indicated that sympathetic innervation was intact but that the sympathetic neurotransmitter was dopamine rather than norepinephrine. These results demonstrated that dopamine-beta-hydroxylase deficiency underlies the clinical abnormalities of this patient. CONCLUSION: In selected individuals with unusual phenotypes, the techniques of clinical chemistry and clinical pharmacology can define the nature of the defect at almost the resolution of the human genome.

Upper Arch Flap Combined with Extended Incision of Lower Eyelid: A Modified Epicanthoplasty in Correcting Epicanthus.

PubMed

Zhang, Song; Xue, Hongyu

2018-06-19

The epicanthus, a lengthways cambered skinfold around the inner canthus, is particularly common in Orientals. The purpose of this study was to evaluate the surgical outcomes for patients with epicanthus after the application of a new surgical technique. A total of 753 patients with epicanthus underwent epicanthoplasty in our hospital from October 2009 to March 2017 and were enrolled in this study. All patients were treated with upper arch flap combined with extended incision of the lower eyelid surgical method, and the effects of the surgery were assessed by photographic analysis and satisfaction surveys. After the surgery, the eyelids of patients were elongated, and their inner canthi diameter was shortened without recurrence in the epicanthus. For 3.32% of the patients, there was a nonuniform edge thickness of the lower eyelid incision; for 8.23% of the patients, there was a slightly lighter skin color in the rest of quondam arch flap. Six months after the surgery, the incision scar was not obvious for all patients, and most of the patients (90.31%) were satisfied with the effect of the surgery. The upper arch flap combined with extended incision of the lower eyelid surgical method, a simple and effective surgical correction method, obtained a good cosmetic result with more secluded scar and high satisfaction for patients with epiblepharon. 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 .

A new autosomal dominant syndrome of distinctive face showing ptosis and prominent eyes associated with cleft palate, ear anomalies, and learning disability.

PubMed

Tyshchenko, N; Neuhann, T M; Gerlach, E; Hahn, G; Heisch, K; Rump, A; Schrock, E; Tinschert, S; Hackmann, K

2011-09-01

We report on three patients from two families with apparently a novel clinical entity. The main features of which include unusual craniofacial dysmorphism with ptosis, prominent eyes, flat midface, Cupid's bow configuration of the upper lip, low-set, posteriorly rotated small ears, as well as conductive hearing loss, cleft palate, heart defect, and mild developmental delay. We suggest that this entity is an autosomal dominant disorder given the occurrence in a mother and daughter as well as in an unrelated boy. Copyright © 2011 Wiley-Liss, Inc.

The development of the eyelids. Part I. External features.

PubMed

Pearson, A A

1980-01-01

The sequence of developmental events leading to the formation of the eyelids is described in staged human embryos. By the end of the fourth week the optic vesicle lies close to the surface ectoderm. The surface ectoderm overlying the optic vesicle, in response to this contact, has thickened to form the lense placode (Stage 13). A few days later (about 32 days, Stage 14) the lens placode is indented by the lens pit. A day or two later (about 33 days, Stage 15) the lens pit is closed: however, the lens vesicle and optic cup lie close to the surface ectoderm and appear to press against the surface. Prior to the development of the eyelids, one small sulcus or groove forms above the eye (eyelid groove) and another below it (stage 16, 37 days). As these grooves deepen, in Stages 17--19, eyelid folds develop, first below, and then above, the eye. In Stages 19--22 the eyelid folds develop into the eyelids and cover more of the eye as the palpebral fissure takes shape. The upper and the lower eyelids meet at the outer canthus in Stage 19. The inner canthus is established a few days later in Stage 20. Closure of the eyelids is complete in Stage 23.

Effects of chalazia on corneal astigmatism : Large-sized chalazia in middle upper eyelids compress the cornea and induce the corneal astigmatism.

PubMed

Jin, Ki Won; Shin, Young Joo; Hyon, Joon Young

2017-03-31

A chalazion is a common eyelid disease that causes eye morbidity due to inflammation and cosmetic disfigurement. Corneal topographic changes are important factors in corneal refractive surgery, intraocular lens power calculations for cataract surgery, and visual acuity assessments. However, the effects of chalazia on corneal astigmatism have not been thoroughly investigated. The changes in corneal astigmatism according to chalazion size and location is necessary for better outcome of ocular surgery. The aim of this study is to evaluate changes in corneal astigmatism according to chalazion size and location. In this cross-sectional study, a total of 44 eyes from 33 patients were included in the chalazion group and 70 eyes from 46 patients comprised the control group. Chalazia were classified according to location and size. An autokeratorefractometer (KR8100, Topcon; Japan) and a Galilei™ dual-Scheimpflug analyzer (Ziemer Group; Port, Switzerland) were utilized to evaluate corneal changes. Oblique astigmatism was greater in the chalazion group compared with the control group (p < 0.05). Astigmatism by simulated keratometry (simK), steep K by simK, total root mean square, second order aberration, oblique astigmatism, and vertical astigmatism were significantly greater in the upper eyelid group (p < 0.05). Astigmatism by simK, second order aberration, oblique astigmatism, and vertical astigmatism were significantly greater in the large-sized chalazion group (p < 0.05). Corneal wavefront aberration was the greatest in the upper eyelid chalazion group, whole area group, and large-sized chalazion group (p < 0.05). Large-sized chalazia in the whole upper eyelid should be treated in the early phase because they induced the greatest change in corneal topography. Chalazion should be treated before corneal topography is performed preoperatively and before the diagnosis of corneal diseases.

Three Skin Zones in the Asian Upper Eyelid Pertaining to the Asian Blepharoplasty.

PubMed

Choi, Yeop; Kang, Hyun Gu; Nam, Yong Seok

2017-06-01

Natural looking double fold is an essential and aesthetically pleasing masterpiece in Asian blepharoplasty. This study aims to emphasize the 3 skin zone concept in the Asian upper blepharoplasty. The authors examined the anterior lamella of each skin zone microscopically by performing 31 double-eyelid surgeries and 11 infrabrow lifts. Characteristics of dermal components, subcutaneous tissue, and outer fascia of OOM (OFOOM) at each skin zone were documented. The authors evaluated the vertical scales of each skin zone in young and aged Asian patients who visited the first author's clinic for the primary or secondary upper blepharoplasty with ×3.5 magnifying surgical loupe. The thickness of OOM had no difference among zones 1, 2, and 3. The skin and subdermal tissue had varying characteristics according to its skin zone. At zone 1, it seemed that only thin skin was on the OOM. The anterior lamella of zone 2 seemed to consist of skin, white fascia (OFOOM) including a venous network, and OOM in a gross field. At zone 3, thick skin, thick subcutaneous fatty layer, and OOM were magnified. The OFOOM of zone 3 was not significantly identified due to a sticky adherence with OOM. At the point of vertical scales of skin zone, good eyelids have lower zone 3 ratio and higher zones 1 and 2 ratio with qualified topographic condition. The authors classified the Asian upper eyelid as with 3 skin zones. Based on its anatomical investigation, the authors can afford anthropometric data and supplemental theory for the creation of aesthetic folds.

Uneven Meibomian Gland Dropout Over the Tarsal Plate and its Correlation With Meibomian Gland Dysfunction.

PubMed

Yin, Yue; Gong, Lan

2015-10-01

To evaluate the distribution of meibomian gland dropout and analyze the correlation between dropout and meibomian gland dysfunction (MGD). A total of 161 eyes of 85 patients with MGD were recruited as the MGD group; 88 eyes of 46 health volunteers were enrolled as the control group (2:1 matched for age and sex). Examinations included the Schirmer I test, breakup time, symptom questionnaire, corneal fluorescein staining, meibum quality, meibomian gland expressibility, and meibomian gland dropout. (1) The incidences of chalazion and eyelid surgery were significantly higher in patients with MGD. (2) All clinical indexes were better in healthy volunteers (all P < 0.05). (3) The dropout in the upper eyelid was statistically lower (P < 0.01) in both groups. The nasal and/or temporal part had higher dropout than did the middle part, except in the lower eyelid of the control group. (4) The entire or partial dropout was positively related to MGD occurrence. Both additive dropout of the entire 2 eyelids and that of the 2 nasal parts had the strongest correlation (r = 0.792, P < 0.01). (5) In the MGD group, breakup time was most negatively related to upper nasal dropout (r = -0.229, P < 0.05). The corneal staining score was positively related only to the dropout of additive (r = 0.185, P < 0.05) and lower (r = 0.258, P < 0.05) middle parts. (1) Uneven dropouts exist in different or single eyelids. (2) Dropout evaluation is better when covering the entire area of both upper and lower meibomians. (3) Nasal part dropout plays a more essential role than the other dropouts in MGD occurrence.

Morgellons Disease Presenting As an Eyelid Lesion.

PubMed

Sandhu, Rasanamar K; Steele, Eric A

2016-01-01

Morgellons disease is characterized by complaints of uncomfortable skin sensations and fibers emanating from nonhealing skin lesions. Morgellons disease is well-known in the dermatology and psychiatry literature, where it is typically considered a subtype of delusional parasitosis, but it has not yet been described in the ophthalmology literature. A patient with self-reported Morgellons disease is presented, who was referred for evaluation of left lower eyelid ectropion. She reported that her skin was infested with fibers that were "trying to get down into the eyelid." On examination, she had ectropion of the left lower eyelid, broken cilia, and an ulcerated left upper eyelid lesion concerning for carcinoma. Biopsy of the lesion was consistent with excoriation. Treatment of her ectropion was deferred out of concern for wound dehiscence, given the patient's aggressive excoriation behavior. This case is presented to make the ophthalmologist aware of this disorder and to highlight the appropriate clinical management.

Primary conjunctival amyloidosis.

PubMed

Chakraborti, Chandana; Chaudhury, Krittika P; Biswas, Ranu Roy

2014-01-01

A 19-year-old previously healthy male presented with a 4 year history of painless drooping of right upper eyelid. On eversion of the right upper eyelid, a yellowish pink mass was seen in the tarsal region. Rest of the ocular examination was normal in both the eyes. Initial biopsy showed chronic inflammation. Subsequently, the entire mass was excised and histopathological examination showed the presence of amyloid in the subconjunctival stroma. At 3 months follow-up, similar lesion was detected in the right lower, left upper, and lower lid, which were treated with cryotherapy, with partial resolution. Patient has been followed up for more than 2 years without any complaints. To our knowledge, this is the first case report of an isolated primary conjunctival amyloidosis with involvement of both the upper and lower palpebral conjunctiva of either eye. It was treated successfully by excision and cryotherapy.

Tick Infestation of the Eyelid and Removal With Forceps and Punch Biopsy.

PubMed

Park, Jongyeop; Suh, Eoksoo

2016-11-01

Ocular tick infestation can occur in any age group or sex with exposure in an endemic setting. All parts of the ocular tissue have been reported to be susceptible to tick infestation. The authors present a rare patient with tick infestation of eyelid.An 88-year-old woman was referred for a yellowish lesion of the right upper eyelid. She had a history of sting 2 days before presentation, and developed eyelid swelling with mucopurulent discharge the next day. Slit lamp examination showed blepharitis and revealed that the lesion was the body of a hard tick, firmly attached to eyelid. First, blunt forceps were used for removal of the tick under a surgical microscope. However, attempted removal resulted in the disembodiement of the parasite and retention of the mouthparts in the skin. The retained tick parts were excised en bloc by skin punch biopsy. The tick was identified as Ixodes nipponensis. Subsequent treatment was given for blepharitis and skin lesion.This case introduces a rare patient with tick infestation of eyelid, and the proper management. Less than 20 documented patients with tick infestation of eyelid have been reported worldwide, and this is the first patient from South Korea in ophthalmological society.

Blepharoptosis surgery in patients with myasthenia gravis.

PubMed

Litwin, Andre S; Patel, Bhupendra; McNab, Alan A; McCann, John D; Leatherbarrow, Brian; Malhotra, Raman

2015-07-01

To review our approach of cautious surgical correction of blepharoptosis in patients with myasthenia gravis (MG) to minimise risk of exposure complications. Retrospective case note review of 30 patients with symptomatic eyelid concerns despite appropriate medical treatment, who underwent eyelid surgery. The mean age at diagnosis was 47 years. 13/30 patients had systemic MG, 14/30 ocular MG and 3/30 congenital MG. The main outcome measures were improvement in eyelid height and/or position, duration of a successful postoperative result, need for further surgical intervention, and intraoperative or postoperative complications. 38 blepharoptosis procedures were performed on 23 patients. Mean age at time of surgery was 62 years, with an average follow-up of 29 months. 10 patients (16 eyelids) underwent anterior approach levator advancement, 4 patients (5 eyelids) posterior approach surgery and 8 patients (15 eyelids) brow suspension. One patient (2 eyelids) had tarsal switch surgery. An average improvement in eyelid height of 1.9 mm was achieved. Postoperative symptoms or signs of exposure keratopathy occurred in 17% of patients. This necessitated lid lowering in one eyelid of one patient. During follow-up, 37% of eyelids required further surgical intervention to improve the upper eyelid height, after an average of 19 months (range 0.5-49 months). Over a third of patients in our series required repeat surgery, which would be expected when the initial aim was to under-correct this group. In contrast to previous commentaries, the amount of eyelid excursion was not the main factor used to guide the surgical approach. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Levator Muscle Enlargement in Thyroid Eye Disease-Related Upper Eyelid Retraction.

PubMed

Davies, Michael J; Dolman, Peter J

To identify levator palpebrae superioris enlargement in thyroid eye disease (TED)-related upper eyelid retraction (ULR). Retrospective case-control. Subjects included 50 consecutive patients with unilateral thyroid eye disease-related ULR ≥ 2 mm and no previous eyelid surgery. The contralateral side was used as control. Clinical information was recorded from charts. CT scans were assessed by investigators blinded to the clinical data. A prediction of retracted side was made based on CT scan appearance and on basis of measured levator palpebrae superioris cross-sectional area at 2 defined points. Statistical analysis determined correlation between levator palpebrae superioris size and presence of ULR. The study was approved by the institutional ethics committee. Side with ULR predicted from CT scan review in over 85% of cases. Mean cross-sectional area of levator palpebrae superioris on retracted side was significantly larger than nonretracted side at 2 separate sites. Levator palpebrae superioris area was larger on retracted side compared with nonretracted side in over 85% of subjects. More than 30% of subjects had no enlargement of other extraocular muscles. Only 6% of patients had enlargement of the ipsilateral inferior rectus muscle. Levator palpebrae superioris enlargement from inflammation or scar is a factor in thyroid eye disease-related ULR. Upper eyelid retraction can be predicted from CT scan appearance in over 85% of cases. Ipsilateral inferior rectus enlargement is rare. Levator palpebrae superioris is the most commonly targeted muscle in thyroid eye disease.

Acetylcholine receptor antibody-positive myasthenia gravis associated with small-cell lung cancer

PubMed Central

Yamasaki, Masahiro; Funaishi, Kunihiko; Saito, Naomi; Yonekawa, Tomomi; Yamawaki, Takemori; Ihara, Daisuke; Daido, Wakako; Ishiyama, Sayaka; Deguchi, Naoko; Taniwaki, Masaya; Hattori, Noboru

2018-01-01

Abstract Rationale: Only few cases of myasthenia gravis (MG) associated with small-cell lung cancer (SCLC) have been reported, and cases positive for acetylcholine receptor antibody (AChR-ab) are even rarer. The efficacy of standard MG treatment, such as cholinesterase inhibitor therapy, immunosuppressive therapy using steroids and immunosuppressive drugs, plasma exchange, and intravenous immune globulin (IVIg), for these cases is unclear. Patient concerns and diagnoses: A 71-year-old man complained of bilateral eyelid ptosis. He also presented with dysphagia and masticatory muscle fatigue after chewing. The edrophonium test was positive, and the serum AChR-ab level was increased; therefore, the patient was diagnosed with MG. Computed tomography scan showed a nodule on the left upper lobe of the lung and mediastinal lymphadenopathy. Further examination revealed the lesion as SCLC. Finally, he was diagnosed with AChR-ab-positive MG associated with SCLC. Interventions and outcomes: Oral pyridostigmine and tacrolimus were administered to treat MG; however, his symptoms worsened. Therefore, methylprednisolone and IVIg were administrated, which temporarily improved his symptoms. However, they remained uncontrolled. Meanwhile, chemotherapy with carboplatin and etoposide was administered to treat his SCLC. The lesions shrunk, and the MG symptoms and serum AChR-ab level also improved. Lessons: AChR-ab-positive MG may develop as a comorbidity of SCLC. In such cases, management might require treatment for SCLC in addition to the standard MG treatment to stabilize the MG symptoms. PMID:29703032

The development of the eyelids. Part I. External features.

PubMed Central

Pearson, A A

1980-01-01

The sequence of developmental events leading to the formation of the eyelids is described in staged human embryos. By the end of the fourth week the optic vesicle lies close to the surface ectoderm. The surface ectoderm overlying the optic vesicle, in response to this contact, has thickened to form the lense placode (Stage 13). A few days later (about 32 days, Stage 14) the lens placode is indented by the lens pit. A day or two later (about 33 days, Stage 15) the lens pit is closed: however, the lens vesicle and optic cup lie close to the surface ectoderm and appear to press against the surface. Prior to the development of the eyelids, one small sulcus or groove forms above the eye (eyelid groove) and another below it (stage 16, 37 days). As these grooves deepen, in Stages 17--19, eyelid folds develop, first below, and then above, the eye. In Stages 19--22 the eyelid folds develop into the eyelids and cover more of the eye as the palpebral fissure takes shape. The upper and the lower eyelids meet at the outer canthus in Stage 19. The inner canthus is established a few days later in Stage 20. Closure of the eyelids is complete in Stage 23. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 PMID:7364662

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

PubMed

Martin, Matthew; Shah, Christopher T; Attawala, Payal; Neaman, Keith; Meldrum, Melissa; Hassan, Adam S

2016-01-01

As the ptotic brow drops below the supraorbital rim, it can exacerbate dermatochalasis by pushing the adjacent skin of the upper lid further down. 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. 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. 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). 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.

Reconstruction of periorbital soft tissue defects.

PubMed

Berli, Jens U; Merbs, Shannath L; Grant, Michael P

2014-10-01

Because of the complex anatomy and fine mechanics of the periorbital soft tissues, the reconstruction of this region can be particularly daunting. Through a structured assessment of the defect, based on subunit analysis and thorough understanding of the surgical layers, we believe to allow the reconstructive surgeon to develop an algorithmic approach to these complex problems. The sequela of a suboptimal reconstruction do not only result in an inferior aesthetic result, but also have the potential for long-term functional problems such as epiphora, dry eye, ptosis, eyelid retraction, and thus requiring secondary surgery. There is no better time to aim for a perfect reconstruction than at the time of the initial surgery. In this chapter, we hope to encourage the reader to strengthen and recapitulate these analytical skills and present the most commonly used and studied techniques to help achieve a reproducible functional and aesthetically appealing result. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Cross-Sectional Survey of the Association between Bilateral Topical Prostaglandin Analogue Use and Ocular Adnexal Features

PubMed Central

Shah, Mamta; Lee, Grace; Lefebvre, Daniel R.; Kronberg, Benjamin; Loomis, Stephanie; Brauner, Stacey C.; Turalba, Angela; Rhee, Douglas J.; Freitag, Suzanne K.; Pasquale, Louis R.

2013-01-01

We studied the relation between prostaglandin analogue use and ocular adnexal features. We used a prospective, cross-sectional study involving 157 current, 15 past, and 171 never users of prostaglandin analogues. Patients 50 years of age or older and without conditions affecting ocular adnexal anatomy underwent glaucoma medication use history, external digital photography and systematic external adnexal exam. Two masked readers assessed the digital photos for upper lid dermatochalasis and lower lid steatoblepharon using a validated grading scheme. Another masked clinical examiner also assessed upper lid ptosis, levator muscle function, and inferior scleral show. We performed ordinal logistic regression analysis accounting for multiple covariates to assess the relation between prostaglandin analogue use and adnexal features. Multivariable analyses indicated there was a 230-fold increased risk of incremental involution of dermatochalasis (odds ratio (OR)  =  2.30; 95% confidence interval (CI) 1.43–3.69; p = 5.44E-04) and a 249-fold increased risk of incremental loss of lower lid steatoblepharon (OR  =  2.49; 95% CI, 1.54–4.03; p =  1.98E-04) associated with current prostaglandin analogue use (bimatoprost 0.03%, travoprost 0.005%, or latanoprost 0.004%) versus prostaglandin analogue never or past users. Upper lid ptosis (OR  =  4.04; 95% CI, 2.43–6.72; p = 7.37E-08), levator dysfunction (OR =  7.51; 95% CI, 3.39–16.65; p = 6.74E-07) and lower lid retraction (OR = 2.60; 95% CI, 1.58–4.28; p = 1.72E-04) were highly associated with current prostaglandin analogue use versus prostaglandin analogue never or past users. The associations between prostaglandin analogue use and deepening of the upper lid sulci and between prostaglandin analogue use and loss of inferior periorbital fat are confirmed in this multivariable analysis. The associations between prostaglandin analogue use and levator muscle dysfunction and between prostaglandin analogue use and upper lid ptosis represent significant side effects that could impact visual function in glaucoma patients. PMID:23650502

Metastatic carcinoma of the breast: a case with the unusual presentation of unilateral periorbital edema.

PubMed

Kuo, Shu-Chen; Hsiao, Shih-Chuan; Chiou, Chien-Chun; Chen, Fen-Fen; Huang, Kuo-Chan

2008-01-01

Metastasis of mammary cancer involving the orbit is common, and it typically presents with enophthalmos and restrictions of ocular motility. We report a case of mammary cancer with the unusual presentation of unilateral periorbital edema only. The possible mechanisms of unilateral periorbital swelling are discussed. Metastasis of breast cancer involving unilateral eyelid edema was diagnosed in a 66-year-old woman. A biopsy was performed to confirm the etiology after vague neuroimaging findings. The diagnosis was based on the histopathologic features of carcinomatous cells in the excised specimen. Insidious, progressive unilateral upper and lower eyelid swelling of the right eye disappeared after one cycle of palliative chemotherapy. Neither restriction nor proptosis developed in the whole course. Possible metastasis should be considered as a possible etiology of unilateral eyelid edema, even without a palpable mass or limitation of ocular motility. A biopsy should be performed in cases of unexplained eyelid edema.

Infrared thermography in the evaluation of meibomian gland dysfunction.

PubMed

Su, Tai-Yuan; Ho, Wei-Ting; Chiang, Shu-Chiung; Lu, Chien-Yi; Chiang, Huihua Kenny; Chang, Shu-Wen

2017-07-01

To evaluate meibomian gland dysfunction (MGD) by infrared thermography. An observational study was conducted at the Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan. Participants included 89 MGD patients (30 in Grade 1, 49 in Grade 2, and 10 in Grade 3) and 65 controls. The close-eye thermographic images of the eyelid were obtained noninvasively by infrared thermography. Temperatures at 8 regions of interest (ROIs) of the eyelid margin and a reference temperature at the center of the upper eyelid were measured. The temperature ratio was defined as the temperature of ROI divided by the reference temperature. Eyelid margin temperature measured by infrared thermography increased from temporal side (ROI 1) to the nasal side (ROI 8) of the eye in both MGD patients and control groups. The temperature ratios were significantly higher in MGD participants than in controls, especially at ROI 8. The eyelid margin temperature measured by infrared thermography was higher in MGD participants. Further development of this infrared thermography system may become a rapid and non-invasive tool for MGD screening. Copyright © 2016. Published by Elsevier B.V.

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

PubMed Central

Martin, Matthew; Shah, Christopher T; Attawala, Payal; Neaman, Keith; Meldrum, Melissa; Hassan, Adam S

2016-01-01

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. PMID:27398009

Changing the facial features of patients with Treacher Collins syndrome: protocol for 3-stage treatment of hard and soft tissue hypoplasia in the upper half of the face.

PubMed

Mitsukawa, Nobuyuki; Saiga, Atsuomi; Satoh, Kaneshige

2014-07-01

Treacher Collins syndrome is a disorder characterized by various congenital soft tissue anomalies involving hypoplasia of the zygoma, maxilla, and mandible. A variety of treatments have been reported to date. These treatments can be classified into 2 major types. The first type involves osteotomy for hard tissue such as the zygoma and mandible. The second type involves plastic surgery using bone grafting in the malar region and soft tissue repair of eyelid deformities. We devised a new treatment to comprehensively correct hard and soft tissue deformities in the upper half of the face of Treacher Collins patients. The aim was to "change facial features and make it difficult to tell that the patients have this disorder." This innovative treatment strategy consists of 3 stages: (1) placement of dermal fat graft from the lower eyelid to the malar subcutaneous area, (2) custom-made synthetic zygomatic bone grafting, and (3) Z-plasty flap transposition from the upper to the lower eyelid and superior repositioning and fixation of the lateral canthal tendon using a Mitek anchor system. This method was used on 4 patients with Treacher Collins syndrome who had moderate to severe hypoplasia of the zygomas and the lower eyelids. Facial features of these patients were markedly improved and very good results were obtained. There were no major complications intraoperatively or postoperatively in any of the patients during the series of treatments. In synthetic bone grafting in the second stage, the implant in some patients was in the way of the infraorbital nerve. Thus, the nerve was detached and then sutured under the microscope. Postoperatively, patients had almost full restoration of sensory nerve torpor within 5 to 6 months. We devised a 3-stage treatment to "change facial features" of patients with hypoplasia of the upper half of the face due to Treacher Collins syndrome. The treatment protocol provided a very effective way to treat deformities of the upper half of the face in patients with Treacher Collins syndrome.

[Inveterate squamous cell carcinoma of the upper eyelid: a case report].

PubMed

Rinaldi, S; Marcasciano, M; Pacitti, F; Toscani, M; Tarallo, M; Fino, P; Scuderi, G L

2013-01-01

Squamous cell carcinoma (SCC) is a malignant tumor of epithelium that shows squamous cell differentiation. It is the second most common cancer of the skin and usually occurs in areas exposed to the sun but it can rarely arise within the conjunctival epithelium with a deep component. We describe a woman with a history of chronic blepharoconjunctivitis unresponsive to topical medications. Examination disclosed a hyperaemic translucent patch with blurred margins of the upper palpebral conjunctiva. Tarsoconjunctival biopsy revealed intraepithelial squamous cell carcinoma. Management consisted of complete tumor excision with removal of the entire posterior lamella of the left upper eyelid and reconstruction. Histopathologic analysis confirmed primary squamous cell carcinoma arising from conjunctival epithelium, involving the underlying tarsus. Patients with unexplained chronic unilateral blepharoconjunctivitis or papillary hypertrophy of the palpebral conjunctiva should be considered for biopsy to rule out neoplasia, even when there is no sign of an evident mass.

[Multiple ocular coloboma (MOC) with persistent pupillary membrane in the snow leopard (Panthera uncia)].

PubMed

Schäffer, E; Wiesner, H; von Hegel, G

1988-01-01

In a litter of three snow leopards, bilateral colobomata of the upper temporal eyelids, bilateral persistent pupillary membranes and a unilateral coloboma of the optic nerve entrance are described as "Multiple Ocular Colobomata" (MOC). The causal pathogenesis of each of the colobomata is discussed comparatively. The colobomata of the eyelids, essential feature of the MOC syndrome in snow leopards, are most probably not of hereditary, but rather of intrauterine infectious viral origin.

Ophthalmological manifestations in patients with Leigh syndrome.

PubMed

Han, Jinu; Lee, Young-Mock; Kim, Sang Myung; Han, So Young; Lee, Jong Bok; Han, Sueng-Han

2015-04-01

To describe the ophthalmological manifestations in patients with childhood onset Leigh syndrome (LS) and investigate the correlation between genotypes and phenotypes in patients with LS. Childhood onset LS was clinically and enzymatically confirmed in a total of 63 patients. Among them, 44 patients who underwent ophthalmologic consultation were included in this study. Patients with LS underwent genotyping for the whole genome of mitochondrial DNA and SURF1 mutations. The clinical demographic and ophthalmologic phenotypes were compared between the good prognosis group and the poor prognosis group. Strabismus (40.9%) was the most frequently observed ophthalmologic manifestation, followed by pigmentary retinopathy (22.5%), optic atrophy (22.5%), ptosis (15.9%), and nystagmus (13.6%). Thirteen patients were exotropes and five patients were esotropes. The mean exodeviation was 29.6±12.5 prism dioptres (PD) and the mean esodeviation was 24.0±8.9 PD. All patients with esotropia reported disease onset at <1 year old. Among 26 patients older than 4 years, eight (30.8%) patients had better than 0.4 in the best eye was noted. Eyelid ptosis was a main presenting sign in four patients (9.1%). Among these patients, two patients had m.13513G>A mutation in the MT-ND5 gene. Age at onset was 2.47±2.06 years in the good prognosis group and 0.92±0.98 years in the poor prognosis group (p=0.002). Serum lactate peak concentration was 3.23±1.36 mmol/L in the good prognosis group and 4.54±2.31 mmol/L in the poor prognosis group (p=0.051). LS is a group of mitochondrial disorders with variable ophthalmologic manifestations, the most frequent being strabismus in this study. Ptosis could be an initial sign in patients with LS and these patients can be easily misdiagnosed as having juvenile myasthenia gravis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Blepharoplasty techniques in the management of orbito-temporal neurofibromatosis.

PubMed

Li, Jin; Lin, Ming; Shao, Chunyi; Ge, Shengfang; Fan, Xianqun

2014-11-01

We aimed to present blepharoplasty techniques we used for severe orbito-temporal neurofibromatosis (NF). A retrospective noncomparative single-center case study was undertaken on patients with orbito-temporal NF. Twenty-two patients with orbito-temporal NF treated at the Department of Ophthalmology of Shanghai Ninth People's Hospital between 2007 and 2011 participated in the study. They underwent a standard ophthalmologic assessment for orbito-temporal NF involving both the orbito-temporal soft tissue and bony orbits. The orbits were examined with three-dimensional computed tomography (CT) and all 22 patients underwent tumor debulking, blepharoplasty, and orbital reconstruction. We modified the conventional procedures. Our reconstructive techniques included eyelid reduction; lateral canthal reattachment; for patients with collapse of the lateral orbital margin, reconstruction of the orbital margin to be performed before reattaching the lateral canthus to the implanted titanium mesh; anterior levator resection; and frontalis suspension according to preoperative levator muscle function. Visual acuity, tumor recurrence, and postoperative palpebral fissure and orbital appearance were evaluated to assess outcomes. Acceptable cosmetic results were obtained in 22 patients after debulking of the orbito-temporal NF and surgical reconstruction. There was no loss of vision or visual impairment postoperatively. All patients did not display recrudescence after a follow-up period of >1 year. Three patients with residual ptosis were successfully treated with a second ptosis repair. We believe that the blepharoplasty techniques described in the treatment of orbito-palpebral NF may provide both functional and esthetic benefits. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Developed lower-positioned transverse ligament restricts eyelid opening and folding and determines Japanese as being with or without visible superior palpebral crease.

PubMed

Ban, Midori; Matsuo, Kiyoshi; Ban, Ryokuya; Yuzuriha, Shunsuke; Kaneko, Ai

2013-01-01

We have reported that a developed lower-positioned transverse ligament between the superior-medial orbital rim and the lateral orbital rim on the lateral horn in the lower orbital fat space antagonizes eyelid opening and folding in certain Japanese to produce narrow eye, no visible superior palpebral crease, and full eyelid. In this study, we confirmed relationship between development of the lower-positioned transverse ligament and presence of the superior palpebral crease. We evaluated whether (1) digital immobilization of eyebrow movement during eyelid opening and (2) a developed lower-positioned transverse ligament could classify Japanese subjects as being with or without visible superior palpebral crease. Digital immobilization of eyebrow movement restricted eyelid opening in all subjects without visible superior palpebral crease but did not restrict in any subject with visible superior palpebral crease. Macroscopic and microscopic evidence revealed that the lower-positioned transverse ligament behind the lower orbital septum in subjects without visible superior palpebral crease was significantly more developed than that in subjects with visible superior palpebral crease. Since a developed lower-positioned transverse ligament antagonizes opening and folding of the anterior lamella of the upper eyelid in subjects without visible superior palpebral crease, these individuals open their eyelids by lifting the eyebrow with the anterior lamella and the lower-positioned transverse ligament owing to increased tonic contraction of the frontalis muscle, in addition to the retractile force of the levator aponeurotic expansions. In subjects with visible superior palpebral crease, the undeveloped lower-positioned transverse ligament does not antagonize opening and folding of the anterior lamella, and so they open their eyelids by folding the anterior lamella on the superior palpebral crease via the retractile force of the levator aponeurotic expansions.

Developed Lower-Positioned Transverse Ligament Restricts Eyelid Opening and Folding and Determines Japanese as Being With or Without Visible Superior Palpebral Crease

PubMed Central

Ban, Midori; Matsuo, Kiyoshi; Ban, Ryokuya; Yuzuriha, Shunsuke; Kaneko, Ai

2013-01-01

Introduction: We have reported that a developed lower-positioned transverse ligament between the superior-medial orbital rim and the lateral orbital rim on the lateral horn in the lower orbital fat space antagonizes eyelid opening and folding in certain Japanese to produce narrow eye, no visible superior palpebral crease, and full eyelid. In this study, we confirmed relationship between development of the lower-positioned transverse ligament and presence of the superior palpebral crease. Methods: We evaluated whether (1) digital immobilization of eyebrow movement during eyelid opening and (2) a developed lower-positioned transverse ligament could classify Japanese subjects as being with or without visible superior palpebral crease. Results: Digital immobilization of eyebrow movement restricted eyelid opening in all subjects without visible superior palpebral crease but did not restrict in any subject with visible superior palpebral crease. Macroscopic and microscopic evidence revealed that the lower-positioned transverse ligament behind the lower orbital septum in subjects without visible superior palpebral crease was significantly more developed than that in subjects with visible superior palpebral crease. Conclusions: Since a developed lower-positioned transverse ligament antagonizes opening and folding of the anterior lamella of the upper eyelid in subjects without visible superior palpebral crease, these individuals open their eyelids by lifting the eyebrow with the anterior lamella and the lower-positioned transverse ligament owing to increased tonic contraction of the frontalis muscle, in addition to the retractile force of the levator aponeurotic expansions. In subjects with visible superior palpebral crease, the undeveloped lower-positioned transverse ligament does not antagonize opening and folding of the anterior lamella, and so they open their eyelids by folding the anterior lamella on the superior palpebral crease via the retractile force of the levator aponeurotic expansions. PMID:23943676

Acquired hemochromatosis with pronounced pigment deposition of the upper eyelids.

PubMed

Chacon, Anna H; Morrison, Brian; Hu, Shasa

2013-10-01

primary (hereditary) or secondary (acquired). The acquired type most commonly occurs after massive intake of iron supplements or blood transfusions and is also known as transfusional iron overload. In the past, hemochromatosis was usually recognized at an advanced stage by the classic triad of hyperpigmentation, diabetes mellitus ("bronze diabetes"), and hepatic cirrhosis. Cutaneous hyperpigmentation is present in 70 percent of patients due to two different mechanisms: (1) hemosiderin deposition resulting in diffuse, slate-gray darkening and (2) increased production of melanin in the epidermis. A 47-year-old woman who receives regular transfusions due to low iron and chronic, unresolving anemia and who subsequently developed pronounced hyperpigmentation of the upper eyelids is described. The presentation, diagnosis, pathogenesis, and treatment options of hyperpigmentation due to secondary hemochromatosis are discussed.

Periorbital hemangiomas.

PubMed

Goldberg, N S; Rosanova, M A

1992-10-01

1. Any hemangioma that involves the upper or lower lid and leads to partial closure in infancy may interfere with or prevent development of normal binocular vision in a matter of days to weeks. 2. Hemangiomas least likely to interfere with vision are lower lid lesions occupying one third of the lid margin or less, not extending beyond the eyelid region, and resolving early. 3. Hemangiomas associated with deprivation amblyopia (with or without anisometropia) are lesions occupying more than one half of the lid margin, extending beyond the eyelid region, resolving late, and obstructing the visual axis. 4. Hemangiomas associated with isolated anisometropic amblyopia are local but bulky lesions that are usually but not always restricted to the upper lid, closing the eye partly and resolving late. 5. The treatment of choice for periorbital hemangiomas is corticosteroids, either systemic or intralesional.

Soft tissue management of orbitotemporal neurofibromatosis.

PubMed

Singhal, Dhruv; Chen, Yi-Chieh; Chen, Yu-Ray; Chen, Philip Kuo-Ting; Tsai, Yueh-Ju

2013-01-01

The aim of this study was to provide an overview of a single-institution, 30-year surgical experience with the soft tissue management of orbitotemporal neurofibromatosis. Lessons learned are highlighted in case presentations. From 1981 to 2011, all patients who presented to the Chang Gung Memorial Hospital Craniofacial Center with craniofacial neurofibromatosis and orbitotemporal involvement were retrospectively reviewed. The medical records of those patients who underwent surgical correction were reviewed for age, extent of involvement, procedures performed, histologic confirmation, and acute complications. All patients were grouped according to the Jackson Classification. The electronic photobank was queried to evaluate results. Thirty-five patients presented to our center with orbitotemporal neurofibromatosis during the study period. Thirty-one patients underwent surgical management of their disease. The average age was 25 years (range 4 to 57 years). Over half of our patients (n = 18) presented with concomitant disease of the cheek. The 2 most common procedures performed were lateral canthopexy (n = 24) and upper eyelid excision (n = 24). The only acute complication recorded was a postoperative hematoma on the fourth postoperative day following simultaneous lateral canthopexy and upper eyelid excision which required operative evacuation. In orbitotemporal neurofibromatosis, tissue hyperextensibility and tumor weight adversely affect outcomes. Treatment of concomitant disease of the cheek should be prioritized in order to provide periorbital support prior to addressing the delicate structures of the eyelids. Preservation of the lateral canthal unit and levator muscle, despite neurofibroma infiltration, is critical to maximize outcomes following debulking procedures of the eyelid and orbit.

Dropped-head in recessive oculopharyngeal muscular dystrophy.

PubMed

Garibaldi, Matteo; Pennisi, Elena Maria; Bruttini, Mirella; Bizzarri, Veronica; Bucci, Elisabetta; Morino, Stefania; Talerico, Caterina; Stoppacciaro, Antonella; Renieri, Alessandra; Antonini, Giovanni

2015-11-01

A 69-year-old woman presented a dropped head, caused by severe neck extensor weakness that had started two years before. She had also developed a mild degree of dysphagia, rhinolalia, eyelid ptosis and proximal limb weakness during the last months. EMG revealed myopathic changes. Muscle MRI detected fatty infiltration in the posterior neck muscles and tongue. Muscle biopsy revealed fiber size variations, sporadic rimmed vacuoles, small scattered angulated fibers and a patchy myofibrillar network. Genetic analysis revealed homozygous (GCN)11 expansions in the PABPN1 gene that were consistent with recessive oculopharyngeal muscular dystrophy (OPMD). There are a few reports of the recessive form, which has a later disease onset with milder symptoms and higher clinical variability than the typical dominantly inherited form. This patient, who is the first Italian and the eighth worldwide reported case of recessive OPMD, is also the first case of OPMD with dropped-head syndrome, which thus expands the clinical phenotype of recessive OPMD. Copyright © 2015 Elsevier B.V. All rights reserved.

Forehead lift

MedlinePlus

... both sides even. If you have already had plastic surgery to lift your upper eyelids, a forehead ... brow lifting. In: Rubin JP, Neligan PC, eds. Plastic Surgery: Volume 2: Aesthetic Surgery . 4th ed. Philadelphia, ...

Surgical anatomy and histology of the levator palpebrae superioris muscle for blepharoptosis correction.

PubMed

Djordjević, Boban; Novaković, Marijan; Milisavljević, Milan; Milićević, Sasa; Maliković, Aleksandar

2013-12-01

The detailed knowledge of the architecture of the upper eyelid is very important in numerous upper eyelid corrective surgeries. The article deals with the detailed anatomy of the major components of the upper lid, which are commonly seen in surgical practice. This study was conducted on 19 human cadavers (12 adults and 7 infants) without pathologic changes in the orbital region and eyelids. Anatomic microdissection of the contents of the orbita was performed bilaterally on 12 orbits from 6 unfixed cadavers (3 male and 3 female). Micromorphologic investigations of the orbital tissue were performed on 8 en bloc excised and formalin-fixed orbits of infant cadavers. Specimens were fixed according to the Duvernoy method. An intra-arterial injection of 5% mixture of melt formalin and black ink was administered into the carotid arterial system. Using routine fixation, decalcination, dehydration, illumination, impregnation and molding procedures in paraplast, specimens were prepared for cross-sections. The measurement of the muscle length and diameter in situ in 6 nonfixed cadavers (12 orbits) showed an average length of the levator palpbrae superioris (LPS) muscle body of the 42.0 +/- 1.41 mm on the right, and 40.3 +/- 1.63 mm on the left side. In all the cases, the LPS had blood supply from 4 different arterial systems: the lacrimal, supratrochlear, and supraorbital artery and muscle branches of the ophthalmic artery. The LPS muscle in all the specimens was supplied by the superior medial branch of the oculomotor nerve. The connective tissue associated with the LPS muscle contains two transverse ligaments: the superior (Whitnall's) and intermuscular transverse ligaments (ITL). The orbital septum in all the specimens originated from the arcus marginalis of the frontal bone, and consisted of two layers--the superficial and the inner layer. In addition, a detailed histological analysis revealed that the upper eyelid's crease was formed by the conjoined fascia including the fascia of the orbicularis muscle, the superficial layer of the orbital septum, and the aponeurosis of the LPS muscle, as well as the pretarsal fascia. The conducted study provided a valuable morphological basis for biomechanical and clinical considerations regarding blepharoptosis surgery.

Ophthalmic branch radiofrequency thermocoagulation for atypical trigeminal neuralgia:a case report.

PubMed

Du, Shibin; Ma, Xiaoliang; Li, Xiaoqin; Yuan, Hongjie

2015-01-01

Trigeminal neuralgia is an intense neuralgia involving facial areas supplied by trigeminal nerve. The pain is characterized by sudden onset, short persistence, sharp or lancinating. Trigeminal neuralgia commonly affects frontal areas, infraorbital or paranasal areas, mandibular areas and teeth. While Trigeminal neuralgia affecting merely the upper eyelid is rare. Here we report a case of atypical Trigeminal neuralgia confined to the upper eyelid. The patient was pain free during the follow-up period of 6 months after unusual ophthalmic branch radiofrequency thermocoagulation. A 55-year-old female patient was diagnosed as primary trigeminal neuralgia involving the right upper eyelid. As the pain could not be controlled by drug therapy, peripheral nerve branch radiofrequency thermocoagulation was recommended. A combination of infratrochlear, supratrochlear and lacrimal radiofrequency thermocoagulation was implemented in this case. The point where the bridge of the nose abuts the supraorbital ridge and the point slightly above the lateral canthus along outer border of the orbit were selected respectively as the puncture sites. After positive diagnostic test, radiofrequency thermocoagulation of the above-mentioned nerve branches was performed respectively. The patient was pain free immediately after the treatment and during the follow-up period of 6 months. Trigeminal neuralgia is a common severe and chronic facial neuralgia which requires accurate diagnosis and effective therapy. With typical clinical symptoms, normal neurological signs, normal CT and MRI findings, the patient was diagnosed as classic trigeminal neuralgia. As the patient was drug resistant, some invasive treatments were considered. Peripheral branch neurolysis was chosen for its minimal invasiveness, convenience, low risk and not affecting further invasive treatments. According to the anatomic data and the diagnostic test results, infratrochlear, supratrochlear and lacrimal nerve were responsible, therefore, an unusual combination of infratrochlear, supratrochlear, and lacrimal radiofrequency thermocoagulation was implemented for this patient. Radiofrequency thermocoagulation is an effective treatment option for trigeminal neuralgia. Peripheral branch radiofrequency thermocoagulation for trigeminal neuralgia should be considered preferentially due to its minimal invasiveness and convenience. Furthermore, as the sensory innervation of the upper eyelid is complex, the knowledge of peripheral distribution of trigeminal nerve is essential.

Analysis of the causes of recurrence after frontalis suspension using silicone rods for congenital ptosis

PubMed Central

Kim, Chang Yeom; Son, Byeong Jae; Son, Jangyup; Hong, Jongill; Lee, Sang Yeul

2017-01-01

Background Silicone rod is a commonly used synthetic suspension material in frontalis suspension surgery to correct blepharoptosis. The most challenging problem and a decisive drawback of the use of silicone rod is a considerable rate of ptosis recurrence after surgery. We examined patients with recurred ptosis and assessed the physical and micromorphological properties of implanted silicone rods to determine the causative mechanisms of recurred ptosis after frontalis suspension using silicone rod. Methods This is a prospective observational case series of 22 pediatric patients with recurred ptosis after frontalis suspension using silicone rods for congenital ptosis. Implanted silicone rods were observed and removed during the operation for correction of recurred ptosis. The removed silicone rods were physically and micromorphologically evaluated to determine the cause of recurrence. Results Pretarsal fixation positions migrated upward, whereas suprabrow fixation positions migrated downward during ptosis recurrence. The breaking strength of implanted silicone rods was reduced by approximately 50% during 3 years. Cracks, debris, and loss of homogenous structure with disintegration were observed on scanning electron micrographs of implanted silicone rods in patients with recurred ptosis. Preoperative severe degree of ptosis also contributed to recurred ptosis. Conclusions Recurrence of ptosis after frontalis suspension using silicone rod was associated with physical changes of implanted silicone rods, including positional migration, weakened tensile strength, and micromorphological changes in combination with patients’ characteristics. PMID:28207846

Acquired Hemochromatosis with Pronounced Pigment Deposition of the Upper Eyelids

PubMed Central

Morrison, Brian; Hu, Shasa

2013-01-01

Hemochromatosis may be classified into two groups: primary (hereditary) or secondary (acquired). The acquired type most commonly occurs after massive intake of iron supplements or blood transfusions and is also known as transfusional iron overload. In the past, hemochromatosis was usually recognized at an advanced stage by the classic triad of hyperpigmentation, diabetes mellitus (“bronze diabetes”), and hepatic cirrhosis. Cutaneous hyperpigmentation is present in 70 percent of patients due to two different mechanisms: (1) hemosiderin deposition resulting in diffuse, slate-gray darkening and (2) increased production of melanin in the epidermis. A 47-year-old woman who receives regular transfusions due to low iron and chronic, unresolving anemia and who subsequently developed pronounced hyperpigmentation of the upper eyelids is described. The presentation, diagnosis, pathogenesis, and treatment options of hyperpigmentation due to secondary hemochromatosis are discussed. PMID:24155994

Eyelid reconstruction: the state of the art.

PubMed

Verity, David H; Collin, J Richard O

2004-08-01

The goals of eyelid reconstruction are corneal protection, restoration of the integrity of the lid lamellae, and improvement of facial symmetry. Inadequate reconstruction may lead to corneal exposure and sight-threatening keratopathy; in the younger patient, visual deprivation and amblyopia may also follow. The purpose of this review is to describe new materials and approaches used in reconstructing the damaged eyelid. Although the surgical principles of lid reconstruction remain unchallenged, new materials and techniques have emerged. These include the use of both autogenous and cadaveric acellular dermis in the management of lower eyelid retraction, and amniotic membrane transplantation in the management of tarsal conjunctival disease. Recent work on upper facial nerve branch reinnervation in the animal model may also offer hope for eyelid reanimation after facial palsy. The lid surgeon requires a sound knowledge of the principles involved in reconstructing the respective lamellae of the lid. Anterior lamellar reconstruction carries a significant risk of ectropion, and large defects may require several interposition flaps for optimum skin texture and color reconstruction. New materials (autogenous and cadaveric) for posterior lid reconstruction may reduce donor site morbidity and surgical time, but they may contract significantly after surgery. Recent experience with amniotic membrane transplantation may improve the prognosis for patients with entropion and symblepharon caused by conjunctival cicatricial changes.

Regional Differences in Tear Film Stability and Meibomian Glands in Patients With Aqueous-Deficient Dry Eye.

PubMed

Koh, Shizuka; Ikeda, Chikako; Fujimoto, Hisataka; Oie, Yoshinori; Soma, Takeshi; Maeda, Naoyuki; Nishida, Kohji

2016-07-01

To noninvasively investigate regional differences in tear film stability and meibomian glands in patients with aqueous-deficient dry eye. Forty-nine dry eyes and 31 normal eyes were analyzed. A corneal topographer with a tear film scanning function was used for noninvasive tear film break-up time (NI-TFBUT) measurements and meibomian gland observations. The NI-TFBUT values and location of the first tear film break-up point were recorded in four quadrants. Meibomian gland loss was graded for each eyelid using meiboscores. Lid margin abnormality was scored from zero to four according to the number of existing abnormalities. The NI-TFBUT values and meiboscores were compared between two groups, and regional differences in NI-TFBUT values and meiboscores were analyzed. Also, the correlation between the NI-TFBUT and ocular surface examination results were investigated. The NI-TFBUT values and meiboscores were significantly lower and higher, respectively, for the dry eye group than for the normal group. In the dry eye group, the occurrence rate for first tear film break-up was the highest in the inferior nasal quadrant, and the mean meiboscore was significantly higher for the upper eyelids than for the lower eyelids. The NI-TFBUT and lid margin abnormality scores showed a weak negative correlation, and the NI-TFBUT values and meiboscores showed no correlation. Compared to normal eyes, aqueous-deficient dry eyes show significant regional differences in tear film stability and meibomian glands. Considering these regional differences, the overall observation of the ocular surface, including both upper and lower eyelids, will aid clinicians in understanding this condition better.

The value of color Doppler imaging and intralesional steroid injection in pediatric orbital capillary hemangioma.

PubMed

Ke, Yifeng; Hao, Rui; He, Yanjin; Tam, Eric S; Li, Xiaorong

2014-05-01

To evaluate color Doppler imaging (CDI) as the primary imaging modality in the diagnosis of pediatric orbital capillary hemangioma. This is a retrospective study of 36 consecutive cases of orbital capillary hemangiomas between January 2006 and July 2011. Data on demographic details, clinical findings, gray-scale ultrasonography, CDI characteristics, treatment, and follow-up period were reviewed. The mean age of onset was 7 weeks. Twenty-nine (81%) lesions presented as eyelid masses, whereas seven (19%) presented as exophthalmos. Nineteen (53%) tumors were located on the upper eyelid, seven (19%) on the lower eyelid, six (17%) in the medial canthus, and one on both upper and lower eyelids. Ultrasonography depicted a heterogeneous, well-defined, irregular tumor with a low or moderate echogenicity. All lesions presented with abundant color blood flow on CDI. The intralesional blood flow had a mean peak systolic velocity of 37.5 ± 24.5 cm/second, and a mean resistance index of 0.69 ± 0.16, representing a shift in the pulse Doppler toward high velocity and high resistance. After a single intratumoral injection of betamethasone, 18 cases (50%) resolved. Additionally, 15 (42%) and four (11%) cases resolved after two injections and three injections, respectively. Only three (8%) masses persisted after three injections within the follow-up period. The blood flow characteristics of CDI play a vital role in the differentiation of orbital capillary hemangiomas from other orbital lesions. The availability and lack of adverse effects of CDI enable its utilization in the early clinical diagnosis of pediatric orbital capillary hemangioma. Copyright © 2014. Published by Elsevier B.V.

Viability of full-thickness skin grafts used for correction of cicatricial ectropion of lower eyelid in previously irradiated field in the periocular region

PubMed Central

Kim, Hee Joon; Hayek, Brent; Nasser, Qasiem; Esmaeli, Bita

2013-01-01

Purpose To evaluate the viability of skin grafts used for correction of cicatricial ectropion resulting from previous ablative surgery and radiotherapy for head and neck cancer and to report overall outcomes of cicatricial ectropion repair. Methods This is a retrospective, non-comparative case series of all consecutive head and neck cancer patients who had been exposed to high-dose radiation therapy in their periocular region and had surgical correction of their lower eyelid cicatricial ectropion through placement of a full-thickness skin graft and a lower eyelid tightening procedure by the same surgeon. The primary outcome measure was skin graft viability. Secondary outcome measures comprised of post-operative complications, the overall outcome of ectropion repair as judged by improvement in symptoms of exposure keratopathy and dependence on lubricating eye drops and ointments, as well as cosmetic improvement measured through a grading scale determined based on the degree of inferior scleral show and/or tarsal conjunctival eversion. Results 25 patients were eligible for the study. 19 men and 6 women had a median age of 63 years (range: 20–84 years). All 25 patients had high-dose radiation therapy for their head and neck cancer. All but 1 patient had major cancer ablative surgery performed prior to radiation therapy. Thirteen of 25 patients also received chemotherapy. There was 100% viability of the skin grafts used for the repair of lower eyelid cicatricial ectropion. There were a few post-operative complications including the need for revision surgery to correct residual ectropion in the lower eyelid in 2 patients and a third patient required a revision surgery due to upper lid retraction and lagophthalmos after harvest of skin graft from the upper eyelid. Improvement was noted in the subjective symptoms in 22 of 25 patients (88%) while 17 patients (68%) were noted to have improvement in their clinical findings on slit lamp examination. All 20 patients for whom good quality photos were available had improvement in the degree of cicatrical lower eyelid ectropion as measured by the amount of inferior scleral show and tarsal conjunctival eversion, although 11 patients had some residual ectropion. All 20 had either good or excellent result in the appearance of their skin grafts. Conclusions Our findings suggest that full thickness skin grafts are a nice option for correction of cicatricial lower eyelid ectropion in a previously radiated field; 100% of the grafts survived. The majority of patients had improvement of ocular surface damage and symptoms, with a decreased dependence on topical lubricants. All evaluable patients had improvement in the degree of cicatrical lower eyelid ectropion, although close to one-half of patients had some mild residual ectropion. The majority of patients had excellent appearance of the skin graft. PMID:22287483

Microscopic and ultrastructural changes of Müller's muscle in patients with simple congenital ptosis.

PubMed

Alshehri, Mohammed D; Al-Fakey, Yasser H; Alkhalidi, Hisham M; Mubark, Mohamed A; Alsuhaibani, Adel H

2014-01-01

To study microscopic and ultrastructural changes of Müller's muscle in patients with isolated congenital ptosis. In this prospective, observational case-control study, Müller's muscle specimens were collected during ptosis surgical correction for 18 consecutive patients. Each specimen was divided into 2 parts. One part was embedded in formalin for light microscopy, and the other one was fixed in 3% glutaraldehyde for electron microscopy. A neuropathologist, serving as a masked evaluator, blindly reviewed all the different features for every case and counted the number of myocytes showing distinct myofilaments in the whole grid for every case. Statistical analysis using compare means and correlation tests was conducted to investigate potential associations and/or differences within and across groups. Twelve Müller's muscle specimens from patients with simple congenital ptosis of various severities and 6 specimens from patients with aponeurotic ptosis (controls) were collected and studied. Under light microscopy, congenital ptosis slides showed a small number of dispersed myocytes in a fibrotic background, whereas acquired ptosis slides showed a greater number of well-defined myocytes. Under electron microscopy, all congenital ptosis specimens had only a very small number of myocytes with clear, distinct myofilaments. Most myocytes in the aponeurotic ptosis group showed clear, distinct myofilaments, indicating a well-preserved muscle. No relationship existed between the number of clear, distinct myofilaments observed in the congenital ptosis group by transmission electron microscopy and patient age or ptosis severity. Substantial Müller's muscle atrophy was observed in patients with different severities of isolated congenital ptosis.

An agonist–antagonist cerebellar nuclear system controlling eyelid kinematics during motor learning

PubMed Central

Sánchez-Campusano, Raudel; Gruart, Agnès; Fernández-Mas, Rodrigo; Delgado-García, José M.

2012-01-01

The presence of two antagonistic groups of deep cerebellar nuclei neurons has been reported as necessary for a proper dynamic control of learned motor responses. Most models of cerebellar function seem to ignore the biomechanical need for a double activation–deactivation system controlling eyelid kinematics, since most of them accept that, for closing the eyelid, only the activation of the orbicularis oculi (OO) muscle (via the red nucleus to the facial motor nucleus) is necessary, without a simultaneous deactivation of levator palpebrae motoneurons (via unknown pathways projecting to the perioculomotor area). We have analyzed the kinetic neural commands of two antagonistic types of cerebellar posterior interpositus neuron (IPn) (types A and B), the electromyographic (EMG) activity of the OO muscle, and eyelid kinematic variables in alert behaving cats during classical eyeblink conditioning, using a delay paradigm. We addressed the hypothesis that the interpositus nucleus can be considered an agonist–antagonist system controlling eyelid kinematics during motor learning. To carry out a comparative study of the kinetic–kinematic relationships, we applied timing and dispersion pattern analyses. We concluded that, in accordance with a dominant role of cerebellar circuits for the facilitation of flexor responses, type A neurons fire during active eyelid downward displacements—i.e., during the active contraction of the OO muscle. In contrast, type B neurons present a high tonic rate when the eyelids are wide open, and stop firing during any active downward displacement of the upper eyelid. From a functional point of view, it could be suggested that type B neurons play a facilitative role for the antagonistic action of the levator palpebrae muscle. From an anatomical point of view, the possibility that cerebellar nuclear type B neurons project to the perioculomotor area—i.e., more or less directly onto levator palpebrae motoneurons—is highly appealing. PMID:22435053

Propeller flaps in eyelid reconstruction.

PubMed

Rajak, Saul N; Huilgol, Shyamala C; Murakami, Masahiro; Selva, Dinesh

2018-03-14

Propeller flaps are island flaps that reach the recipient site through an axial rotation. The flap has a subcutaneous pedicle on which it pivots, thereby resembling a helicopter propeller. We present our series of propeller flaps for the reconstruction of large eyelid defects. This is a retrospective review of the clinical case notes of eight patients that underwent tumour excision with reconstruction with a cutaneous propeller flap supplied by a non-perforator orbicularis pedicle between July and December 2016. Propeller flaps were used in the reconstruction of five lower lid defects (size range 19 × 5 mm to 25 × 8 mm), one medial canthus defect (13 mm diameter), one complete upper lid defect (42 × 19 mm diameter) and one lid sparing extenteration defect. The flaps were recruited from nasolabial, lateral canthal, temple or medial upper cheek skin. Post-operatively one case had 'trapdooring' which required flap revision at 4 months and one had persistent oedema that settled without intervention. The reconstruction of large eyelid defects is challenging in part because of the paucity of locally available skin. Propeller flaps are a paradigm shift in periocular reconstruction in which the subcutaneous pedicle enables the recruitment of large and highly mobile skin flaps from a wide area of regional tissue.

Lip and Lower Lid Supporting Prosthetic Appliance: A Unique Approach of Treating Unilateral Facial Paralysis

PubMed Central

Pawah, Salil; Sikri, Arpit; Rexwal, Pushpanjali; Aggarwal, Prachi

2017-01-01

Along with function, aesthetics plays an important role in treating partially or completely edentulous patients. Ageing, trauma, tooth loss and neuromuscular disorders have a high impact on tonicity of facial musculature, elasticity of skin as well as function of muscles. Patients affected with Bell’s palsy face functional, aesthetic as well as psychological impairment. Common problems are the partial closure of upper eyelid, sagging of lower eyelid and drooping of angle of mouth leading to facial asymmetry, along with difficulty in eating, drinking and speaking. The key to aesthetic restoration is to support and harmonize the collapsed facial musculature with the help of various prosthodontic treatment approaches. This case report attempts to focus on treating completely edentulous patient affected with Bell’s palsy with special prosthesis supporting angle of mouth and lower eyelid using novel technique. PMID:28658922

A Proposal for a Prevalence Study of the Use of Alcohol among Women Attending Selected United States Air Force Prenatal Clinics.

DTIC Science & Technology

1985-06-01

and ptosis 7. epicanthal folds 8. cleft lip or cleft palate 9. hirsuitism APPENDIX 2 PROCESSION PLAN Stage Activit Time Required Phase I step 1 Select...thin upper lip , and/or flattening of the maxillary area II. FETAL ALCOHOL EFFECTS: Any congenital abnormality seen in children as a result of maternal

Anthropometry of eyelid and orbit in four southern Thailand ethnic groups.

PubMed

Preechawai, Passorn

2011-02-01

To study the basic eyelid and orbital measurement in the four main ethnic groups of southern Thailand. The basic eyelid and orbital surface anatomy of 101 normal subjects aged 20-40 years old were measured in the four ethnic groups of which the majority of people in southern Thailand belong to: Thai, Chinese, Thai-Malay, and Thai-Chinese. Of the 101 subjects, 51 were male and 50 were female. Each ethnic group had at least 12 normal subjects. Male-female data were analyzed separately and compared between groups. The palpebral fissure heights in Thai, Chinese, Thai-Malay, and Thai-Chinese males were 9.5, 9.0, 10.2 and 9.6 mm respectively, which demonstrated statistically significant differences between Thai-Malay versus Thai, and Thai-Malay versus Chinese. The palpebral fissure lengths were 30.4, 29.8, 30.5 and 30.5 mm, but without statistically significant differences. The marginal reflex distances were 3.2, 2.8, 3.7 and 3.1 mm respectively with a statistically significant difference only between Thai-Malay versus Chinese. The levator functions were 15.2, 15.2, 15.3 and 15.2 mm. The upper lid creases were 7.1, 4.0, 6.6, and 4.4 mm, statistically significantly different in Thai versus Chinese, Thai versus Thai-Chinese and Chinese versus Thai-Malay. The Hertel exophthalmometer measurements were 15.4, 16.3, 16.6 and 15.9 mm without statistically significant differences. The female measurements were overall similar to the male measurements, with some parallel differences between the groups. The eyebrow position in this age group was mostly at and above the orbital rim in both genders and all ethnic groups. An absence of upper lid crease and an epicanthal fold were found in significantly greater numbers in the Chinese group compared to the others, while parallel lid crease was significantly found in greater numbers in the Thai-Malay group than in the others. Different eyelid characteristics in diferent ethnic groups are an important feature to note when planning for eyelid surgery. As there is a wide range of ethnic groups in Asia, with many differences in eyelid characteristics, it is important for the ophthalmologist to be aware of and understanding these anatomical variations in clinical assessment and treatment in Asians.

21 CFR 886.5600 - Ptosis crutch.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ptosis crutch. 886.5600 Section 886.5600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Therapeutic Devices § 886.5600 Ptosis crutch. (a) Identification. A ptosis crutch is a...

Double breast contour in primary aesthetic breast augmentation: incidence, prevention and treatment.

PubMed

Médard de Chardon, Victor; Balaguer, Thierry; Chignon-Sicard, Bérengère; Lebreton, Elisabeth

2010-04-01

The goal of this study was to define the incidence of double breast contour in primary aesthetic breast augmentation and to analyze its risk factors. An independent plastic surgeon analyzed the data of 200 patients who had a primary aesthetic breast augmentation with silicone gel implant and with a minimum 12-month follow-up. All patients had pre and postoperative standardized photography. Mastopexy-augmentations, breast reconstructions, breast malformations (tuberous breasts and Poland syndrome), and patients with incomplete data were excluded from the study. Assessment was achieved using an original standardized evaluation form (preoperative breast morphology, surgical options, postoperative aesthetic results). Patients were also asked to complete an exhaustive satisfaction form. A double breast contour was assessed clinically using Massiha's classification. The mean follow-up was 36 months. The double breast contour incidence was 7%. All of them were type I (the so called waterfall deformity). There was no type II (double inframammary crease). They were minor for 6.5% and major for 0.5%. They were related to a preoperative breast ptosis, subpectoral placement, and implant upper malposition. The rate of the type I was 10.5% of submuscular augmentation and 15% of preoperative breast ptosis. A double breast contour was primitive for 6% and secondary for 1% (pregnancy and breast-feeding postaugmentation). It was bilateral for 4.5% (3 cases of upper malposition, 1 case of medial malposition, 2 cases of pregnancy with breast-feeding postaugmentation and 1 patient refused a mastopexy-augmentation). It was unilateral for 2.5% related to a preoperative breast asymmetry with ptosis asymmetry and skin quality asymmetry. The satisfaction rate in the group "double contour" (14 patients) was 85.7% (vs. 91.9%). One patient had revision surgery (upper malposition). These types of deformities are fundamentally different with consideration on their clinical aspects, physiopathogeny, prevention and treatment. Type I major risk factor is subpectoral augmentation of ptotic breasts (with medium to bad skin quality and loses muscle to gland attachments). The muscle at the inferior pole of the breast is a "brake" preventing implant to fill the envelope. This risk is increased with implant malposition, constitutional ptosis asymmetry with symmetrical implant placement and selection of an insufficient implant projection or dimensions. This deformity can be avoided with selection of a subglandular or dual plane (type II or III) placement, a sufficient implant volume or projection and anatomic prosthesis. Type II is related to a lowering of a well-defined submammary fold more commonly in constricted and dens glandular breasts. This deformity can be avoided with respecting the inframammary fold, radial incisions on the gland's posterior surface, and selection of anatomic implants.

A Proposed Method for Upper Eyelid and Infrabrow Tightening Using a Transcutaneous Temperature Controlled Radiofrequency Device With Opaque Plastic Eye Shields.

PubMed

Key, Douglas J; Boudreaux, Lauren

2016-11-01

Laxity of the eyelid and periorbital area, a common manifestation of aging, is usually addressed via blepharoplasty and/ or fat transfer. Given the trend toward safer, less invasive treatments preferred by those patients reticent to undergo more invasive procedures, viable alternatives have been sought. Transcutaneous temperature controlled radiofrequency (TTCRF) integrates non- invasive super cial RF treatment with automatic temperature feedback control of energy deposition, as a stimulator of overall collagen remodeling; however, the globe of the eye is particularly sensitive to RF energy. The purpose of the study was to propose a method by which TTCRF and other non-ablative modalities could be used to treat eyelid and infrabrow laxity, with autoclavable opaque black haptic scleral contact lenses protecting the globe of the eye. Subjects (n=40, 36 women and 4 men, age range, 33-72) with mild to moderate laxity of the eyelid and infrabrow were treated with TTCRF using black plastic eye shields (Oculoplastik, Montreal, Quebec, Canada) to protect the globe of the eye from heat and RF energy. With the shields in place subjects were treated with the 10 mm small monopolar emitter of the ThermiSmooth device (Thermi, Irving, Tex.), using small circular looping motions to safely elevate the temperature of target tissue to the therapeutically rel- evant range for approximately 6 minutes; tissue temperature was measured in real time using the device's forward-looking infrared imaging. No major adverse events were recorded. Treatment was safe and tolerable for all subjects. The use of autoclavable opaque black plastic eye shields provides a safe method of treating the upper eye lid and infrabrow using TTCRF. J Drugs Dermatol. 2016;15(11):1302-1305..

Ocular adnexal asymmetry in models: a magazine photograph analysis.

PubMed

Ing, Edsel; Safarpour, Azien; Ing, Tom; Ing, Sabrina

2006-04-01

Symmetry of facial features often correlates with a perception of physical attractiveness, and ophthalmologists are sometimes consulted by patients for eyelid, eyebrow, or orbital asymmetry. Our objective was to determine the prevalence of ocular adnexal asymmetry among people generally regarded as attractive. The mean width of the horizontal palpebral fissure (MHPF) for both men and women was determined in 40 adult volunteers. Then unobscured, head-on photographs of models looking in the primary position were digitally scanned from popular magazines. Eyelid height, eyelid folds, eyebrow height, medial canthus to midline distance, pupil to midline distance, and orbital dystopia measurements were made. After the measurements from the models were scaled to size by factoring with the MHPF obtained from the volunteers, the results were analyzed by paired samples t test for right-left asymmetry of the ocular adnexal measurements. We also examined for antimongoloid slant in the models. The MHPF of the volunteers was 27+/-1.3 mm for women and 29.6+/-2.0 mm for men. Of 102 magazine photographs analyzed, 55 were women and 47 men. As a group, the models showed a statistically significant asymmetry (p<0.05) in the horizontal fissure width, upper central lid fold, upper temporal lid fold, central eyebrow height, temporal eyebrow height, medial canthal to midline distance, pupil to midline distance, and orbital dystopia. The female models had more eyebrow asymmetry. The male models had more asymmetry at the horizontal fissure and with orbital dystopia. Two male models also had a unilateral antimongoloid slant. Small to moderate amounts of eyelid, eyebrow, and orbital asymmetry were observed in faces generally perceived as attractive. This fact should be considered during preoperative discussions with patients considering oculoplastic surgery.

FOXL2 modulates cartilage, skeletal development and IGF1-dependent growth in mice.

PubMed

Marongiu, Mara; Marcia, Loredana; Pelosi, Emanuele; Lovicu, Mario; Deiana, Manila; Zhang, Yonqing; Puddu, Alessandro; Loi, Angela; Uda, Manuela; Forabosco, Antonino; Schlessinger, David; Crisponi, Laura

2015-07-02

Haploinsufficiency of the FOXL2 transcription factor in humans causes Blepharophimosis/Ptosis/Epicanthus Inversus syndrome (BPES), characterized by eyelid anomalies and premature ovarian failure. Mice lacking Foxl2 recapitulate human eyelid/forehead defects and undergo female gonadal dysgenesis. We report here that mice lacking Foxl2 also show defects in postnatal growth and embryonic bone and cartilage formation. Foxl2 (-/-) male mice at different stages of development have been characterized and compared to wild type. Body length and weight were measured and growth curves were created. Skeletons were stained with alcian blue and/or alizarin red. Bone and cartilage formation was analyzed by Von Kossa staining and immunofluorescence using anti-FOXL2 and anti-SOX9 antibodies followed by confocal microscopy. Genes differentially expressed in skull vaults were evaluated by microarray analysis. Analysis of the GH/IGF1 pathway was done evaluating the expression of several hypothalamic-pituitary-bone axis markers by RT-qPCR. Compared to wild-type, Foxl2 null mice are smaller and show skeletal abnormalities and defects in cartilage and bone mineralization, with down-regulation of the GH/IGF1 axis. Consistent with these effects, we find FOXL2 expressed in embryos at 9.5 dpc in neural tube epithelium, in head mesenchyme near the neural tube, and within the first branchial arch; then, starting at 12.5 dpc, expressed in cartilaginous tissue; and at PO and P7, in hypothalamus. Our results support FOXL2 as a master transcription factor in a spectrum of developmental processes, including growth, cartilage and bone formation. Its action overlaps that of SOX9, though they are antagonistic in female vs male gonadal sex determination but conjoint in cartilage and skeletal development.

Mitochondrial myopathies.

PubMed

DiMauro, Salvatore

2006-11-01

Our understanding of mitochondrial diseases (defined restrictively as defects of the mitochondrial respiratory chain) is expanding rapidly. In this review, I will give the latest information on disorders affecting predominantly or exclusively skeletal muscle. The most recently described mitochondrial myopathies are due to defects in nuclear DNA, including coenzyme Q10 deficiency and mutations in genes controlling mitochondrial DNA abundance and structure, such as POLG, TK2, and MPV17. Barth syndrome, an X-linked recessive mitochondrial myopathy/cardiopathy, is associated with decreased amount and altered structure of cardiolipin, the main phospholipid of the inner mitochondrial membrane, but a secondary impairment of respiratory chain function is plausible. The role of mutations in protein-coding genes of mitochondrial DNA in causing isolated myopathies has been confirmed. Mutations in tRNA genes of mitochondrial DNA can also cause predominantly myopathic syndromes and--contrary to conventional wisdom--these mutations can be homoplasmic. Defects in the mitochondrial respiratory chain impair energy production and almost invariably involve skeletal muscle, causing exercise intolerance, cramps, recurrent myoglobinuria, or fixed weakness, which often affects extraocular muscles and results in droopy eyelids (ptosis) and progressive external ophthalmoplegia.

Early onset bilateral juvenile myasthenia gravis masquerading as simple congenital ptosis.

PubMed

Alam, Md Shahid; Devi Nivean, Pratheeba

2017-01-01

Myasthenia gravis is an autoimmune disorder affecting the neuromuscular junction. Ocular myasthenia gravis presents as ptosis with extraocular motility restriction and is prone to be misdiagnosed as third nerve palsy or congenital or aponeurotic ptosis. Juvenile ocular myasthenia gravis in very young children is difficult to diagnose and can be easily labeled as a case of congenital ptosis, the more so when the condition is bilateral. We present a case of a two-year-old child who presented with bilateral ptosis and was diagnosed as a case of simple congenital ptosis elsewhere with the advice to undergo tarsofrontalis sling surgery. The child was diagnosed with juvenile myasthenia gravis on thorough history, examination, and systemic evaluation and was started on anti-myasthenic treatment.

Churg-Strauss syndrome presenting with conjunctival and eyelid masses: a case report.

PubMed

Ameli, F; Phang, K S; Masir, N

2011-12-01

Churg-Strauss syndrome, a small and medium vessel vasculitis, was first described by Churg and Strauss in 1951. It is characterised by the presence of asthma, prominent tissue and blood eosinophilia, systemic vasculitis, and pulmonary and systemic necrotising allergic granulomas. Involvement of the skin, heart and gastrointestinal tract is well documented, but ocular presentation is unusual. We describe a 40-year-old lady who presented with recurrent upper eyelid swelling due to conjunctival lesions. Although she has chronic asthma, Churg-Strauss syndrome was never suspected. The diagnosis of Churg-Strauss syndrome was only made following histological examination of the conjunctival lesions.

Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System.

PubMed

Waltho, Daniel; Hatchell, Alexandra; Thoma, Achilleas

2017-03-01

Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several classification systems for gynecomastia have been proposed. A systematic review was performed to (1) identify all classification systems for the surgical management of gynecomastia, and (2) determine the adequacy of these classification systems to appropriately categorize the condition for surgical decision-making. The search yielded 1012 articles, and 11 articles were included in the review. Eleven classification systems in total were ascertained, and a total of 10 unique features were identified: (1) breast size, (2) skin redundancy, (3) breast ptosis, (4) tissue predominance, (5) upper abdominal laxity, (6) breast tuberosity, (7) nipple malposition, (8) chest shape, (9) absence of sternal notch, and (10) breast skin elasticity. On average, classification systems included two or three of these features. Breast size and ptosis were the most commonly included features. Based on their review of the current classification systems, the authors believe the ideal classification system should be universal and cater to all causes of gynecomastia; be surgically useful and easy to use; and should include a comprehensive set of clinically appropriate patient-related features, such as breast size, breast ptosis, tissue predominance, and skin redundancy. None of the current classification systems appears to fulfill these criteria.

Baby Shampoo Versus Povidone-Iodine or Isopropyl Alcohol in Reducing Eyelid Skin Bacterial Load.

PubMed

Garcia, Giancarlo A; Nguyen, Christine V; Yonkers, Marc A; Tao, Jeremiah P

Baby shampoo is used as an alternative surgical skin preparation, but the evidence supporting its use is scarce with no descriptions of efficacy in the periocular region. The authors compare the efficacy of baby shampoo, povidone-iodine (PI, Betadine) and isopropyl alcohol (IA) in reducing eyelid skin bacterial load. Prospective, randomized, comparative, and interventional trial. Bacterial load on adult, human eyelid skin was quantitated before and after cleansing with 1) dilute baby shampoo, 2) 10% PI, or 3) 70% IA. Paired skin swabs were collected from a 1 cm area of the upper eyelid of subjects before and after a standardized surgical scrub technique. Samples were cultured on 5% sheep blood agar for 24 hours. The number of colony forming units (CFU) was assessed and bacterial load per square centimeter of eyelid skin was quantified. Baseline and postcleansing samples were assessed from 42 eyelids of 42 subjects (n = 14 for each of baby shampoo, PI, and IA). Before cleansing, similar amounts of bacterial flora were grown from all specimens (median log CFU/cm = 2.04 before baby shampoo, 2.01 before PI, 2.11 before IA; p > 0.05). All 3 cleansing agents significantly reduced the bacterial load (p < 0.01 for each). There was no statistically significant difference in postcleansing bacterial load between the 3 cleansing agents (median log CFU/cm = 0.48 after baby shampoo, 0.39 after PI, 0.59 after IA; p > 0.05). Change from baseline in bacterial load was statistically similar for all 3 agents (median reduction in log CFU/cm = 1.28 with baby shampoo, 1.57 with PI, 1.40 with IA; p > 0.05). These corresponded to bacterial load reductions of 96.3%, 96.6%, and 98.4% for baby shampoo, PI, and IA, respectively. Baby shampoo achieved comparable diminution in eyelid skin bacterial load to PI or IA. These data suggest baby shampoo may be an effective preoperative cleansing agent.

Surgical management and outcome of tessier number 10 clefts.

PubMed

Fan, Xianqun; Shao, Chunyi; Fu, Yao; Zhou, Huifang; Lin, Ming; Zhu, Huimin

2008-12-01

To present the clinical manifestations and outcome of the surgical management of subjects with Tessier number 10 clefts. Retrospective, interventional case series. Twelve patients with Tessier number 10 clefts treated at the Department of Ophthalmology of Shanghai Ninth People's Hospital between January of 2002 and December of 2005. All 12 patients (15 eyes) underwent a standard ophthalmologic assessment, and the orbits were examined by a 3-dimensional computed tomography scan. Reconstructive techniques included eyebrow reconstruction with a frontal hairline transposition flap, eyelid reconstruction with a hard palate mucosa-lined sliding myocutaneous flap, and conjunctival fornix reconfiguration using a mucous membrane graft. In patients requiring enucleation, hydroxyapatite implant was used, followed by fitting of ocular prosthesis. Postoperative upper eyelid and eyebrow contour and viability, recurrence of symblepharon, and ability to hold prosthesis. All reconstructed eyelids achieved the surgical goal of providing corneal coverage and the ability to hold a cosmetic contact lens or an ocular prosthesis. Eyebrow reconstruction was performed in 4 patients. The reconstructed eyebrow was symmetrical with the opposite side. There was no recurrence of symblepharon. Three patients wore cosmetic contact lenses, and their eyelid function appeared adequate. Two patients underwent enucleation along with insertion of a hydroxyapatite implant, followed by fitting of ocular prosthesis. The surgical approach described in our series of cases seems to be effective in repairing Tessier number 10 clefts. Eyebrow reconstruction with a frontal hairline transposition flap followed by eyelid repair with a hard palate mucosa-lined sliding myocutaneous flap is a suitable technique for correcting eyebrow and eyelid malformations in adults. The authors have no proprietary or commercial interest in any materials discussed in this article.

Use of 2-octyl cyanoacrylate for wound closure in a modified Roberts-Bistner procedure for eyelid agenesis in five cats (nine eyes).

PubMed

Reed, Zoe; Doering, Clinton J; Barrett, Paul M

2018-01-15

CASE DESCRIPTION 5 cats (9 eyes) were evaluated for surgical correction of bilateral eyelid agenesis. CLINICAL FINDINGS All eyes lacked > 25% of the temporal upper eyelid, and all cats had clinical signs attributable to chronic ocular exposure. Abnormalities were limited to the ocular surface in the 4 female cats, whereas the sole male cat had additional abnormalities consistent with anterior segment dysgenesis. TREATMENT AND OUTCOME A modified Roberts-Bistner procedure involving 2-octyl cyanoacrylate (2OCA) was performed on 9 eyes; 1 eye was enucleated. Surgical wounds in the initial 3 eyes were closed with 2OCA plus sutures, and flaps were lined with conjunctiva. The technique was optimized for remaining eyes by use of a single suture for flap apposition, no conjunctival lining of flaps, and 2OCA alone for wound closure. Median duration of surgery was 35 minutes/eye for the initial 3 eyes versus 16 minutes/eye for the subsequent 6 eyes treated with the optimized procedure. After surgery, all cats had complete palpebral reflexes and resolution of clinical signs of ocular irritation. Minor complications in the early postoperative period included eyelid swelling (n = 9), poor cosmesis (7), and persistent epiphora (3). By the second recheck examination, swelling had resolved and cosmesis was considered excellent. Two eyes with epiphora had been treated with the initial modified procedure and required cryoepilation for resolution of epiphora. CLINICAL RELEVANCE The modified Roberts-Bistner procedure for eyelid agenesis involving 2OCA for wound closure provided functional, cosmetic eyelids that improved comfort and provided protection of the ocular surface in affected cats.

Ptosis induced by topical steroid eye drops: Two cases reports.

PubMed

Zhu, Yanan; Sun, Chaohui; Zhang, Xin; Shentu, Xingchao

2017-12-01

Ptosis is a rare complication of periocular steroid use. Studies report that local injections of steroids produce ptosis. We describe the first 2 cases of ptosis because of long-term treatment with topical steroid eye drops. Two cases admitted to our hospital because of ptosis of their right eye after long-term treatment with topical steroid eye drops. Both of them had uncontrolled Posner-Schlossman syndrome. Two cases were diagnosed as steroid-related ptosis. Regulatory anti-inflammation therapy was prescribed for case 1, and after inflammation control, phacoemulsification was done for her. Six months after steroid withdrawal, the levator resection of the right eye was performed. Case 2 refused our advice of steroid reduction and ptosis surgery. After surgery, case 1 retained a symmetrical appearance during a 1-year follow-up. In the surgery, we found thin levator muscles and slack levator palpebrae superioris aponeurosis (LPSA) in the affected eye. Postoperative transmission electron microscopy revealed typical signs of apoptosis in levator muscle cells. We suggest topical application of steroids induces levator muscle apoptosis and LPSA weakness, and results in ptosis. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

External ophthalmomyiasis due to Dermatobia hominis. A case report.

PubMed

Serra Moltó, A; Molina Martín, J C; Mengual Verdú, E; Hueso Abancens, J R

2018-03-23

A 46-year-old woman with no relevant medical history, native of Honduras and resident in Spain for one and a half months. The patient went to the Emergency Department due to inflammation of the upper eyelid of the right eye, with an area that simulated an abscess. This was drained (obtaining hardly any purulent content). Treatment was prescribed with oral and topical antibiotics, as well as an anti-inflammatory drug. One week later the patient returned, with improvement of the inflammatory signs, but with discomfort and corneal erosions. After eversion of the upper eyelid, a «worm» type parasite emerged from the tarsus. The extraction was completed with a clamp, and was later identified as Dermatobia hominis (Dh) by examination of a fresh specimen. The subsequent outcome of the patient was favourable. Preseptal cellulitis in patients from tropical and sub-tropical areas can be caused by Dh. Copyright © 2018 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Type IV Hypersensitivity to Gold Weight Upper-Eyelid Implant: Case Report and Review of the Literature.

PubMed

Kilduff, Caroline L S; Casswell, Edward J; Imonikhe, Richard; Marjanovic, Branka

2017-05-04

Complications associated with gold-weight insertion for lagophthalmos are uncommon, recent reports have provided evidence to suggest that type IV hypersensitivity to gold can cause a persistent inflammatory reaction. We present a case of a 46-year-old man who experienced persistent post-operative inflammation, and summarize previously documented cases. This patient underwent uncomplicated insertion of an upper eyelid gold weight for right-sided facial nerve palsy. He had no allergies or implanted metalwork. Post-operatively erythema was noted at seven-weeks and did not resolve. The weight was removed after six-months. The histopathological findings were in keeping with type IV hypersensitivity and similar to previous cases. Although infrequent, this complication has poor outcomes. The definitive management is removal of the weight. Information regarding implanted gold, and previous reactions should be elicited pre-operatively. Type IV hypersensitivity should be considered in patients with persistent inflammation that do not respond to antibiotic or steroid therapy.

Characterization of Upper Eyelid Tarsus and Lid Wiper Dimensions.

PubMed

Navascues-Cornago, Maria; Maldonado-Codina, Carole; Gupta, Ruchi; Morgan, Philip B

2016-09-01

To measure various dimensions of the upper tarsal plate and the area of upper lid wiper staining. The repeatability of the method of measurement was investigated. Thirty-five healthy non-contact lens wearers were enrolled. The following parameters were measured from digital images of the upper eyelid captured with a slitlamp camera: length, height, and total area of the tarsal plate and area of lid wiper staining (lissamine green). Measurements were performed in a randomized and masked fashion on two separate occasions by the same investigator using ImageJ (National Institutes of Health). Coefficients of repeatability (COR) were calculated. The dimensions (mean±SD) of the tarsal plate were 20.6±1.9 mm length, 7.9±0.8 mm height, and 103.3±18.8 mm total area. The area of lid wiper staining was 2.7±2.0 mm. No association was found between tarsal dimensions and lid wiper staining (all P>0.05). Image analysis COR values were 0.6 mm tarsal length, 0.1 mm tarsal height, 1.2 mm tarsal area, and 0.4 mm lid wiper staining. There was no significant difference between repeated measurements for any parameter (all P>0.05). Limits of agreement were narrow for all parameters, indicating good agreement between repeated measurements. This work has demonstrated that there is a wide range in the dimensions of the upper tarsal plate in an urban UK population. No association was found between the upper tarsal dimensions and lid wiper staining. ImageJ was shown to be a repeatable method to measure the dimensions of the upper tarsal plate and upper lid wiper staining.

Comparison of Periorbital Anthropometry Between Beauty Pageant Contestants and Ordinary Young Women with Korean Ethnicity: A Three-Dimensional Photogrammetric Analysis.

PubMed

Kim, Young Chul; Kwon, Jin Geun; Kim, Sung Chan; Huh, Chang Hun; Kim, Hee Jin; Oh, Tae Suk; Koh, Kyung S; Choi, Jong Woo; Jeong, Woo Shik

2018-04-01

The purpose of this study is to investigate the differences in the periorbital anthropometry between national Beauty Pageant Contestants and Ordinary Young Women with Korean ethnicity. Forty-three Beauty Pageant Contestants who were elected for the national beauty contest and forty-eight Ordinary Young Women underwent 3D photography. The authors analyzed 3D photogrammetric measures regarding periorbital soft tissue. The palpebral fissure width was significantly higher in the Beauty Pageant Contestants than the Ordinary Young Women (27.7 ± 1.2 vs. 26.3 ± 1.6 mm) (p < 0.001). The palpebral fissure height was also significantly higher in the Beauty Pageant Contestants (11.5. ± 1.0 vs. 9.1 ± 1.2 mm) (p < 0.001). The intercanthal width and upper eyelid height were smaller for the Beauty Pageant Contestants (intercanthal width, 34.3 ± 1.86 mm vs. 36.7 ± 3.1 mm; upper eyelid height, 11.5 ± 1.4 mm vs. 13.4 ± 2.3 mm) (p < 0.05). The nasal width and midfacial width were significantly smaller in the Beauty Pageant Contestants (nasal width, 38.0 ± 1.8 vs. 39.5 ± 2.2 mm; midfacial width 144.5 ± 3.9 vs. 146.9 ± 5.2 mm) (p < 0.05). The eyebrow showed significantly different features between the two groups in terms of vertical position in the upper face and the shape of the brow apex. The interpupillary distance, binocular distance, slant of palpebral fissure and width of pretarsal crease showed no significant difference between the two groups. Periorbital features in Beauty Pageant Contestants are wide-set eyes, larger palpebral fissure in width and height, relatively small upper eyelid height and intercanthal width, and relatively small nose and facial width compared to normal women. Our anthropometric results can be referable values for Asian eyelid surgery and help surgeons to establish individualized surgical planning. 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 .

Arnica Ointment 10% Does Not Improve Upper Blepharoplasty Outcome: A Randomized, Placebo-Controlled Trial.

PubMed

van Exsel, Denise C E; Pool, Shariselle M W; van Uchelen, Jeroen H; Edens, Mireille A; van der Lei, Berend; Melenhorst, Wynand B W H

2016-07-01

It has been suggested that arnica can reduce postoperative edema and ecchymosis associated with cosmetic surgical procedures and improve outcome. Despite a high incidence of arnica use among upper blepharoplasty patients, evidence to support its treatment effect is lacking. The authors performed a randomized, double-blind, placebo-controlled trial to investigate the efficacy of arnica ointment after upper blepharoplasty. One hundred thirty-six bilateral upper blepharoplasty patients were randomized between arnica ointment 10% and placebo ointment. In both study arms, one periorbital area was designated as the treatment side (either arnica or placebo ointment), and the contralateral side served as an untreated (no ointment) internal control. As the primary endpoint, the overall periorbital appearance as based on light photography and judged by a medical and nonmedical panel, was assessed after 3 days, 7 days, and 6 weeks. Secondary endpoints were swelling, ecchymosis, erythema, pain, and patient satisfaction with recovery and outcome. There was no significant difference between arnica and placebo in overall judgment of periorbital appearance 3 days, 7 days, and 6 weeks after surgery. Furthermore, swelling, ecchymosis, erythema, pain, and patient satisfaction with recovery and outcome did not differ between arnica and placebo. Postoperative outcome in untreated eyelids was not different from eyelids treated with either arnica or placebo on any of the studied outcome measures. The authors' study demonstrates that topical arnica ointment after upper blepharoplasty does not improve postoperative outcome. Therapeutic, II.

The eye in sleep apnea syndrome.

PubMed

Abdal, Helen; Pizzimenti, Joseph J; Purvis, Cheryl C

2006-03-01

Sleep apnea syndrome (SAS) is a disease characterized by recurrent complete or partial upper airway obstructions during sleep. The majority of patients with SAS demonstrate this obstruction either at the nasopharynx or the oropharynx. Risk factors for SAS include obesity, male gender, upper airway abnormalities, alcohol use, snoring, and neck girth of more than 17 in. in men or 16 in. in women. Reported ophthalmic findings in patients with SAS include floppy eyelid syndrome (FES), glaucoma, and non-arteritic anterior ischemic optic neuropathy (NAION).

Apremilast Use in a Case of Cicatricial Ectropion Secondary to Severe Lamellar Ichthyosis.

PubMed

Abboud, Jean-Paul J; Whittington, Alexander; Ahmed, Masih; Himebaugh, Jesse T; Wiley, Lee A; Haffar, Ahmad; Nguyen, John

Ichthyosis is a cutaneous disorder characterized by excessive amounts of dry thickened skin surface scales. Ocular manifestations of ichthyosis include cicatricial ectropion, which may cause exposure keratoconjunctivitis and rarely corneal perforation. Topical emollients, anti-inflammatory ointments, and systemic retinoids have been used to control the disease process, while surgical correction with donor graft has been reserved for severe cases involving corneal exposure. The authors report a case of a Caucasian male with lamellar ichthyosis with severe bilateral upper and lower eyelid cicatricial ectropion and corneal ulceration requiring surgical correction. Treatment with apremilast, a novel phosphodiesterase-4 inhibitor, for the treatment of a concomitant plaque psoriasis achieved good control of his skin diseases and minimized the recurrence of eyelid ectropion.

Ocular myasthenia gravis accompanied by anosmia.

PubMed

Chen, Ying; Wang, Li; Zhou, Li; Gao, Ying

2016-02-01

We report a case of ocular myasthenia gravis (MG) accompanied by anosmia. A 76-year-old man had idiopathic anosmia of 2-year duration. Four months before consultation, he began to have drooping in the right upper eyelid along with muscle soreness, distension, and pain in the nape. His tongue was dark-red with a thin and white coating; his pulse was wiry and slippery. According to Traditional Chinese Medicine, eyelid drooping and anosmia are the main signs of liver constraint and spleen deficiency. In Western Medicine, the diagnosis was ocular MG and idiopathic anosmia. Our patient, along with the literature, suggests that anosmia may be an early symptom before MG. MG accompanied by anosmia could be a special subtype of MG according to antibody production and symptoms.

Spitz nevus arising in the eyelid of a teenager.

PubMed

Shields, Patrick W; Jakobiec, Frederick A; Stagner, Anna M; Yoon, Michael K

2016-01-01

A 16-year-old boy developed over a 2-month interval a lightly pigmented left upper eyelid lesion measuring 1.5 mm in greatest diameter that, when excised, microscopically was hypercellular and composed almost exclusively of nonpigmented epithelioid cells that created florid, large intraepidermal junctional nests and sheets and nests of subepidermal cells. The diagnosis was a Spitz nevus. HMB-45, MART-1, and microphthalmia-associated transcription factor were all positive and established the melanocytic nature of the benign tumor. The Ki-67 proliferation index (5%) and 2 mitoses/mm(2) were both low; p16 protein was immunohistochemically identified in the nevoid cells. We review the clinical, histopathologic, and other immunohistochemical features of this entity and provide a brief differential diagnosis (including separation from a Spitzoid melanoma). This is only the third eyelid Spitz nevus reported in the literature and is the most fully characterized immunohistochemically. At their present stage of development, contemporary immunohistochemical biomarkers, while providing supplemental information, nonetheless remain less than definitive in terms of reliably distinguishing benign from malignant Spitz lesions. Copyright © 2016 Elsevier Inc. All rights reserved.

The lateral tarsal strip revisited. The enhanced tarsal strip.

PubMed

Jordan, D R; Anderson, R L

1989-04-01

The lateral tarsal strip procedure was originally designed for the treatment of upper and lower eyelid laxity, or lateral canthal tendon laxity or malposition. Despite the excellent results with a standard tarsal strip procedure for those eyelids with laxity and excess skin, we have encountered a number of patients with lower eyelid or canthal malpositions or both who would benefit from a tarsal strip, but who do not have lax tissues (especially skin), and may in fact have a shortage of skin. These include cases of lower lid retraction or canthal malposition following trauma, blepharoplasty, or other operations, and patients with tendency toward or having cicatricial ectropion. Any anterior lamella removal in such patients would aggravate the lid malposition and weaken the lateral canthal tissues to be sutured. We suggest a modification of the tarsal strip (developed by one of us [R.L.A.]) to treat many such patients without requiring additional anterior lamella (skin graft) or more formidable procedures. We refer to this technique as the "enhanced tarsal strip" technique, and we use this technique more frequently than the original tarsal strip procedure.

[Congenital "kissing" lesions: Nevus or "café au lait" spot?

PubMed

Durazzo, A; Boccara, O; Fraitag, S; Fusade, T; Picard, A; Kadlub, N

2016-12-01

"Café au lait" spots (CLS) are pigmented skin lesions principally located at the trunk and the limbs. Histologically, CLSs consist in an excessive pigmentation of the epidermis, with no risk of malignant transformation. The "kissing" nevus is a rare pigmented congenital nevus affecting both lower and upper eyelids in a mirror layout. As other nevi, it presents a theoretical risk of malignant transformation. These two pigmented lesions are responsible for aesthetic discomfort when affecting the face. Three patients presenting with a congenital pigmented lesion affecting the two eyelids in a mirror layout are presented. In two cases, the lesions, initially considered as "kissing" nevi, were classified as CLSs. The diagnosis of CLS was made on a biopsy in one patient and after surgery in the other one. Pigmented mirror layout lesions, called "kissing" lesions, are exclusively described for the nevi. We describe two cases of CLSs affecting the eyelids in a mirror layout. Difficulties in diagnostic are exposed and the possible treatments are discussed. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The expanding phenotype of mitochondrial myopathy.

PubMed

DiMauro, Salvatore; Gurgel-Giannetti, Juliana

2005-10-01

Our understanding of mitochondrial diseases (defined restrictively as defects in the mitochondrial respiratory chain) continues to progress apace. In this review we provide an update of information regarding disorders that predominantly or exclusively affect skeletal muscle. Most recently described mitochondrial myopathies are due to defects in nuclear DNA, including coenzyme Q10 deficiency, and mutations in genes that control mitochondrial DNA (mtDNA) abundance and structure such as POLG and TK2. Barth syndrome, an X-linked recessive mitochondrial myopathy/cardiopathy, is associated with altered lipid composition of the inner mitochondrial membrane, but a putative secondary impairment of the respiratory chain remains to be documented. Concerning the 'other genome', the role played by mutations in protein encoding genes of mtDNA in causing isolated myopathies has been confirmed. It has also been confirmed that mutations in tRNA genes of mtDNA can cause predominantly myopathic syndromes and - contrary to conventional wisdom - these mutations can be homoplasmic. Defects in the mitochondrial respiratory chain impair energy production and almost invariably involve skeletal muscle, causing exercise intolerance, myalgia, cramps, or fixed weakness, which often affects extraocular muscles and results in droopy eyelids (ptosis) and progressive external ophthalmoplegia.

Myasthenia gravis in a patient affected by glycogen storage disease type Ib: a further manifestation of an increased risk for autoimmune disorders?

PubMed

Melis, D; Balivo, F; Della Casa, R; Romano, A; Taurisano, R; Capaldo, B; Riccardi, G; Monsurrò, M R; Parenti, G; Andria, G

2008-12-01

Glycogen storage disease type Ib (GSD Ib, OMIM 232220) is an inborn disorder of glucose metabolism, caused by mutations in the G6PT gene, encoding a glucose 6-phosphate transporter (G6PT). GSD Ib is mainly associated with fasting hypoglycaemia and hepatomegaly. Most GSD Ib patients also show neutropenia and neutrophil dysfunction and therefore are at risk of developing severe infections and inflammatory bowel disease (IBD). An increased risk for autoimmune disorders, such as thyroid autoimmunity and Crohn-like disease, has also been demonstrated, but no systematic study on the prevalence of autoimmune disorders in GSD Ib patients has ever been performed. We describe a 25-year-old patient affected by GSD Ib who developed 'seronegative' myasthenia gravis (MG), presenting with bilateral eyelid ptosis, diplopia, dysarthria, severe dysphagia, dyspnoea and fatigue. The repetitive stimulation of peripheral nerves test showed signs of exhaustion of neuromuscular transmission, particularly evident in the cranial area. Even in the absence of identifiable anti-acetylcholine receptor antibodies, seronegative MG is considered an autoimmune disorder and may be related to the disturbed immune function observed in GSD Ib patients.

Posterior reversible encephalopathy as the first manifestation of Bickerstaff's brainstem encephalitis.

PubMed

Chen, Pei-Ru; Chen, Shih-Pin

2016-11-08

Posterior reversible encephalopathy syndrome (PRES) has been associated with Guillain-Barre syndrome in rare cases. Here we report a patient in whom PRES was the presenting manifestation of Bickerstaff's brainstem encephalitis. A 75-year-old woman presented with acute onset of hypertension, headache, blurred vision, and left eyelid drooping. Magnetic resonance imaging of the brain showed characteristic PRES lesions involving the parietal and occipital lobes bilaterally. On the 6th day after symptom onset, the patient developed complete ptosis and external ophthalmoplegia of both eyes, progressive ataxia, and bilateral lower limb weakness. Cerebrospinal fluid analyses revealed albuminocytological dissociation (protein: 66.6 mg/dL, WBC: 0/μl), and nerve conduction studies showed demyelinating sensorimotor polyneuropathy. The patient developed somnolence and a left extensor plantar response on the 8th day. A diagnosis of Bickerstaff's brainstem encephalitis was made. Treatment with plasmapheresis led to a rapid improvement of clinical symptoms. To date, only five similar cases have been reported, but this is the only case in which PRES developed prior to treatment. PRES can be a comorbid condition with Bickerstaff's brainstem encephalitis, either preceding or following treatment; caution should be used in patients with either syndrome who exhibit atypical presentations.

Ophthalmoplegic migraine.

PubMed

Bek, Semai; Genc, Gencer; Demirkaya, Seref; Eroglu, Erdal; Odabasi, Zeki

2009-05-01

According to the International Headache Society, ophthalmoplegic migraine is recurrent attacks of headache with migrainous characteristics associated with paresis of one or more ocular cranial nerves (commonly the third nerve) in the absence of any demonstrable intracranial lesion. We report a patient with typical clinical features of ophthalmoplegic migraine. A 21-year-old man had right frontal throbbing headaches recurring twice a year. His headache lasted for 1 to 5 days and was followed by slight drooping of his eyelid and double vision that lasted for approximately 3 months. On examination he had ptosis and adduction paralysis of the right eye. Brain MRI revealed a thickened, enhancing right oculomotor nerve. He was treated with methylprednisolone 1000 mg/d IV for 5 days. Only 2 weeks later, clinical improvement was observed and 3 months later the oculomotor nerve enhancement resolved. Ophthalmoplegic migraine has been considered to have a microvascular, ischemic etiology, but more recently it has been reclassified as a demyelinating condition affecting the oculomotor. To our knowledge, this is the first ophthalmoplegic migraine case presented pretreatment and post-treatment with clinical photographic documentation and an MRI showing enduring thickening of the oculomotor nerve although symptoms and contrast enhancement resolved.

Objective image analysis of the meibomian gland area.

PubMed

Arita, Reiko; Suehiro, Jun; Haraguchi, Tsuyoshi; Shirakawa, Rika; Tokoro, Hideaki; Amano, Shiro

2014-06-01

To evaluate objectively the meibomian gland area using newly developed software for non-invasive meibography. Eighty eyelids of 42 patients without meibomian gland loss (meiboscore=0), 105 eyelids of 57 patients with loss of less than one-third total meibomian gland area (meiboscore=1), 13 eyelids of 11 patients with between one-third and two-thirds loss of meibomian gland area (meiboscore=2) and 20 eyelids of 14 patients with two-thirds loss of meibomian gland area (meiboscore=3) were studied. Lid borders were automatically determined. The software evaluated the distribution of the luminance and, by enhancing the contrast and reducing image noise, the meibomian gland area was automatically discriminated. The software calculated the ratio of the total meibomian gland area relative to the total analysis area in all subjects. Repeatability of the software was also evaluated. The mean ratio of the meibomian gland area to the total analysis area in the upper/lower eyelids was 51.9±5.7%/54.7±5.4% in subjects with a meiboscore of 0, 47.7±6.0%/51.5±5.4% in those with a meiboscore of 1, 32.0±4.4%/37.2±3.5% in those with a meiboscore of 2 and 16.7±6.4%/19.5±5.8% in subjects with a meiboscore of 3. The meibomian gland area was objectively evaluated using the developed software. This system could be useful for objectively evaluating the effect of treatment on meibomian gland dysfunction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Blepharophimosis, ptosis, polythelia and brachydactyly (BPPB): a new autosomal dominant syndrome?

PubMed

Wittebol-Post, D; Hennekam, R C

1993-10-01

A father and two sons with blepharophimosis, ptosis, polythelia and brachydactyly are presented, apparently without other abnormalities. The features do not fit into any previously described syndrome. This condition may represent a hitherto undescribed syndrome, although resemblance with the blepharophimosis-ptosis-epicanthus inversus syndrome exists. Inheritance is probably autosomal dominant.

Changes to upper eyelid orbital fat from use of topical bimatoprost, travoprost, and latanoprost.

PubMed

Park, Juwan; Cho, Hyun Kyung; Moon, Jung-Il

2011-01-01

To confirm the possible mechanism by which topical prostaglandin antiglaucoma drugs cause a deep superior sulcus. Among patients who used bimatoprost (Lumigan), latanoprost (Xalatan), or travoprost (Travatan) and who developed a deep upper lid sulcus, 18 eyes of 11 patients (mean age, 58.2 ± 8.9 years) were studied. Seven patients were binocular users of one of the eye drops and four were monocular users. Preaponeurotic orbital fat was obtained, and the mean adipocyte density compared. In the four monocular users, mean adipocyte density of treated eyes was 1758.21 ± 158.15 cells/mm(2), and that of untreated eyes was 1258.73 ± 127.54 cells/mm(2). This difference was statistically significant (P = 0.04), suggesting that the adipocytes were atrophied in the treated eyes. The mean adipocyte density of the bimatoprost group was 2073.35 ± 184.89 cells/mm(2), that of the travoprost group was 1623.46 ± 218.99 cells/mm(2), and that of the latanoprost group was 1468.20 ± 113.44 cells/mm(2). The densities of the bimatoprost and travoprost groups, but not of the latanoprost group (P = 0.75), were significantly different from that of the untreated group (P < 0.001). Fat atrophy can be considered a mechanism of upper eyelid sulcus deepening in patients using topical prostaglandin analogs. © Japanese Ophthalmological Society 2011.

Causes and Surgical Outcomes of Lower Eyelid Retraction

PubMed Central

Kim, Kun Hae; Baek, Ji Sun; Lee, Saem; Lee, Jung Hye; Choi, Hye Sun; Kim, Sung Joo

2017-01-01

Purpose To investigate the causes of lower eyelid retraction and evaluate the outcomes of various surgical procedures. Methods We conducted a retrospective medical record review of patients who underwent lower eyelid retraction surgery performed by a single surgeon at Kim's Eye Hospital between 2006 and 2013. We investigated the causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperative and postoperative margin reflex distance 2 and inferior scleral show were measured for each eyelid. Success was defined as a positive eyelid elevation and a decrease in inferior scleral show. Results A total of 19 lower eyelids were treated in 14 patients with lower eyelid retraction. For cosmetic reasons, surgical correction for congenital lower eyelid retraction was performed on seven eyelids (36.8%). Ten eyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affected by facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selective approach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was the most commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was used to horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) also received an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lower eyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactory in all cases. Conclusions To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severity of lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction is severe and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from below are required. PMID:28682021

Causes and Surgical Outcomes of Lower Eyelid Retraction.

PubMed

Kim, Kun Hae; Baek, Ji Sun; Lee, Saem; Lee, Jung Hye; Choi, Hye Sun; Kim, Sung Joo; Jang, Jae Woo

2017-08-01

To investigate the causes of lower eyelid retraction and evaluate the outcomes of various surgical procedures. We conducted a retrospective medical record review of patients who underwent lower eyelid retraction surgery performed by a single surgeon at Kim's Eye Hospital between 2006 and 2013. We investigated the causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperative and postoperative margin reflex distance 2 and inferior scleral show were measured for each eyelid. Success was defined as a positive eyelid elevation and a decrease in inferior scleral show. A total of 19 lower eyelids were treated in 14 patients with lower eyelid retraction. For cosmetic reasons, surgical correction for congenital lower eyelid retraction was performed on seven eyelids (36.8%). Ten eyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affected by facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selective approach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was the most commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was used to horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) also received an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lower eyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactory in all cases. To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severity of lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction is severe and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from below are required. © 2017 The Korean Ophthalmological Society

[Tumour of the right lung vertex that produced a Pancoast syndrome: description of a case].

PubMed

Hermida Péreza, J A; Bermejo Hernández, A; Hernández Guerra, J S; Arroyo Diaz, R

2012-03-01

We describe a clinical case of an 80 year-old woman, with a history of Alzheimer's disease, who presented with right shoulder pain, numbness and decreased strength in the right arm, with right eye ptosis, cough and dysphagia. The chest X-Ray and thoracic-abdominal computed tomography scan showed a large mass in the upper lobe and apex of the right lung, supraclavicular metastatic lymph nodes. In the fine needle aspiration biopsy: poorly differentiated non-small cell carcinoma. She was referred to Oncology to start chemotherapy treatment.

Ptosis, extraocular motility disorder, and myopia as features of pompe disease.

PubMed

Slingerland, Niki W R; Polling, Jan Roelof; van Gelder, Catharina M; van der Ploeg, Ans T; Bleyen, Isabel

2011-03-01

The assets of this report are a thorough description of new clinical findings, namely the combination of ptosis, extraocular motility disorder and myopia, in consequence of prolonged survival in classic infantile-onset Pompe disease through enzyme therapy. Single case description. This manuscript describes a combination of ptosis, extraocular motility disorder and myopia in a 4.5-year-old patient with classic infantile-onset Pompe disease, who survived through enzyme therapy. This patient was treated with a bilateral frontalis suspension (modified Crawford technique) using prolene 3-0 sutures. The combination of ptosis, extraocular motility disorder and myopia, is a new clinical finding in children with classic infantile-onset Pompe disease.

The Classification and Prognosis of Periocular Complications Related to Blindness following Cosmetic Filler Injection.

PubMed

Myung, Yujin; Yim, Sangjun; Jeong, Jae Hoon; Kim, Baek-Kyu; Heo, Chan-Yeong; Baek, Rong-Min; Pak, Chang-Sik

2017-07-01

Common side effects during hyaluronic acid filler injections are typically mild and reversible, but several reports of blindness have received attention. The present study focused on orbital symptoms combined with blindness, aiming to classify affected patients and predict their disease course and prognosis. From September of 2012 to August of 2015, nine patients with vision loss after filler injection were retrospectively reviewed. Ptosis, ophthalmoplegia, and enophthalmos were recorded over a 6-month follow-up, and patients were classified into four types according to periocular symptom manifestation. Two patients were categorized as type I (blindness without ptosis or ophthalmoplegia), two patients as type II (blindness and ptosis without ophthalmoplegia), two patients as type III (blindness and ophthalmoplegia without ptosis), and three patients as type IV (blindness with ptosis and ophthalmoplegia). The present study includes previously unpublished information about orbital symptom manifestations and prognosis combined with blindness caused by retinal artery occlusion after cosmetic filler injection. Therapeutic, V.

Morphological Evaluation of Meibomian Glands in Children and Adolescents Using Noncontact Infrared Meibography.

PubMed

Wu, Yuan; Li, Haili; Tang, Yun; Yan, Xiaoming

2017-03-01

To compare, in vivo, differences in meibomian gland morphology between children and adolescents. Sixty-nine patients were included in this study and divided into two groups: children (n = 31; age range: 3 to 11 years) and adolescents (n = 39; age range: 12 to 18 years). Images of meibomian glands were obtained by infrared meibography and analyzed using ImageJ software (developed by the National Institutes of Health; available at http://rsb.info.nih.gov/ij/download.html). Meibomian gland loss, the number of meibomian gland ducts, the relative width of the meibomian gland ducts, and the percent area of the meibomian gland acini were compared between the two groups. Meibomian gland loss was found in both groups, but the meiboscore was not significantly different between the two groups (0.35 ± 0.6 vs 0.41 ± 0.8, t = -0.314, P > .05). The number of meibomian gland ducts (25.85 ± 3.25 vs 23.23 ± 3.06, t = -3.437, P < .05), relative width of the meibomian gland ducts (69.62% ± 5% vs 66.1% ± 7%, t = -2.454, P < .05), and percent area of the meibomian gland acini (57.7% ± 4% vs 55.5% ± 4%, t = 2.571, P < .05) in the upper eyelid were significantly greater in adolescents than in children. However, no significant differences were found in the lower eyelid between the two groups. Meibography is useful for the assessment of ocular surface conditions in children and adolescents. Meibomian gland loss occurs in both children and adolescents. The meibomian glands of the upper eyelid exhibit more morphological changes in adolescents than in children. [J Pediatr Ophthalmol Strabismus. 2017;54(2):78-83.]. Copyright 2017, SLACK Incorporated.

MR relaxometry for the facial ageing assessment: the preliminary study of the age dependency in the MR relaxometry parameters within the facial soft tissue.

PubMed

Watanabe, M; Buch, K; Fujita, A; Christiansen, C L; Jara, H; Sakai, O

2015-01-01

To investigate the location-specific tissue properties and age-related changes of the facial fat and facial muscles using quantitative MRI (qMRI) analysis of longitudinal magnetization (T1) and transverse magnetization (T2) values. 38 subjects (20 males and 18 females, 0.5-87 years old) were imaged with a mixed turbo-spin echo sequence at 1.5 T. T1 and T2 measurements were obtained within regions of interest in six facial fat regions including the buccal fat and subcutaneous cheek fat, four eyelid fat regions (lateral upper, medial upper, lateral lower and medial lower) and five facial muscles including the orbicularis oculi, orbicularis oris, buccinator, zygomaticus major and masseter muscles bilaterally. Within the zygomaticus major muscle, age-associated T1 decreases in females and T1 increases in males were observed in later life with an increase in T2 values with age. The orbicularis oculi muscles showed lower T1 and higher T2 values compared to the masseter, orbicularis oris and buccinator muscles, which demonstrated small age-related changes. The dramatic age-related changes were also observed in the eyelid fat regions, particularly within the lower eyelid fat; negative correlations with age in T1 values (p<0.0001 for age) and prominent positive correlation in T2 values in male subjects (p<0.0001 for male×age). Age-related changes were not observed in T2 values within the subcutaneous cheek fat. This study demonstrates proof of concept using T1 and T2 values to assess age-related changes of the facial soft tissues, demonstrating tissue-specific qMRI measurements and non-uniform ageing patterns within different regions of facial soft tissues.

Temperatures of the Ocular Surface, Lid, and Periorbital Regions of Sjögren's, Evaporative, and Aqueous-Deficient Dry Eyes Relative to Normals.

PubMed

Abreau, Kerstin; Callan, Christine; Kottaiyan, Ranjini; Zhang, Aizhong; Yoon, Geunyoung; Aquavella, James V; Zavislan, James; Hindman, Holly B

2016-01-01

To compare the temperatures of the ocular surface, eyelid, and periorbital skin in normal eyes with Sjögren's syndrome (SS) eyes, evaporative dry eyes (EDE), and aqueous deficient dry eyes (ADDE). 10 eyes were analyzed in each age-matched group (normal, SS, EDE, and ADDE). A noninvasive infrared thermal camera captured two-dimensional images in three regions of interest (ROI) in each of three areas: the ocular surface, the upper eyelid, and the periorbital skin within a controlled environmental chamber. Mean temperatures in each ROI were calculated from the videos. Ocular surface time-segmented cooling rates were calculated over a 5-s blink interval. Relative to normal eyes, dry eyes had lower initial central OSTs (SS -0.71°C, EDE -0.55°C, ADDE -0.95°C, KW P<.0001) and lower central upper lid temperatures (SS -0.24°C, ADDE -0.51°C, and EDE -0.54°C, KW P<.0001). ADDE eyes had the lowest initial central OST (P<.0001), while EDE eyes had the lowest central lid temperature and lower periorbital temperatures (P<.0001). Over the 5-s interblink interval, the greatest rate of temperature loss occurred following eyelid opening, but varied by group (normals -0.52, SS -0.73, EDE -0.63, and ADDE -0.75°C/s). The ADDE group also had the most substantial heat loss over the 5-s interblink interval (-0.97°C). Differences in OST may be related to thermal differences in lids and periorbita along with an altered tear film. Thermography of the ocular surface, lids, and surrounding tissues may help to differentiate between different etiologies of dry eye. Copyright © 2016 Elsevier Inc. All rights reserved.

Infratrochlear neuralgia.

PubMed

Pareja, Juan A; Casanova, Ignacio; Arbex, Andrea; Cuadrado, María L

2015-11-01

The infratrochlear nerve supplies the medial aspect of the upper eyelid, the superolateral aspect of the nose and the lacrimal caruncle. This nerve may contribute to the pain stemming from the trochlea, but infratrochlear neuralgia has not been identified as a specific cause of pain. Over a 10-year period we have been recruiting patients with pain in the internal angle of the orbit that did not show features of trochlear pain. Seven patients (six female, one male; mean age, 46.1 ± 18.9) presented with pain in the territory of the infratrochlear nerve. The pain appeared in the internal angle of the orbit and upper eyelid (n = 3), the superolateral aspect of the nose (n = 3), or the lacrimal caruncle (n = 1). All patients had a paroxysmal pain, with the attacks lasting five to 30 seconds. Pain attacks were mostly spontaneous, but two patients had triggers. Between attacks, all patients had local allodynia. Pain did not increase with vertical eye movements. Six patients were treated with gabapentin with complete response, and one patient experienced long-lasting relief with an anesthetic blockade of the infratrochlear nerve. Infratrochlear neuralgia should be considered as a possible cause of pain in the internal angle of the orbit. © International Headache Society 2015.

[Laser-assisted blepharoplasty].

PubMed

Thiesmann, R

2018-04-01

Blepharoplasty is one of the most frequently performed plastic cosmetic interventions. For this purpose the CO 2 laser is an instrument that can be used as a laser scalpel to cut as well as in its ablative function to remove skin irregularities, such as scars and tumors and also to treat changes of the skin due to aging. Fractionated laser irradiation reduces the duration of skin redness and the postoperative rehabilitation time after a resurfacing. The advantages of the CO 2 laser are a gentle intraoperative preparation and less postoperative swelling due to an additional cauterization of blood vessels. Disadvantages are an increased occurrence of wound dehiscence and the high cost of instrumentation. Before performing a blepharoplasty an exact analysis of changes of the eyelid and also the wishes of the patients are necessary to establish the most suitable surgical procedure and the correct dosage. In addition to skin and fat resection, depending on the original situation it is possible to tighten slack skin with a resurfacing, to shift the fat compartments, to change the position of the eyebrows, to correct a ptosis and also to modulate the tension of the lid. The frequency of complications can be reduced by good planning of the surgical intervention. In the case of occurrence of complications, suitable treatment strategies should be available.

Breast carcinoma metastasis to the lacrimal gland: Two case reports

PubMed Central

NICKELSEN, MARIE N.; VON HOLSTEIN, SARAH; HANSEN, ALASTAIR B.; PRAUSE, JAN U.; HEEGAARD, STEFFEN

2015-01-01

A 77-year-old female, with proptosis, reduced eye motility and diplopia which had developed over two to three months and a 69-year-old female with proptosis, oedema of the eyelid, reduced motility and ptosis, which had developed over three weeks, are presented in the present study. Computed tomography scans revealed irregular lacrimal gland tumours in the two patients. The two patients had history of breast cancer. The first breast cancer metastasis in the lacrimal gland demonstrated a cribriform growth pattern containing ductal elements. The epithelial tumour cells stained positive for cytokeratin (1–8, 10, 14–16, 18 and 19), oestrogen receptor, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA) and gross cystic disease fluid protein 15 (GCDFP-15). The second metastatic tumour was positive for EMA and estrogen receptor, but variably positive for CEA and GCDFP-15. The metastasis in the lacrimal gland was a pleomorphic tumour. The tumour cells were positive for EMA and variably positive for oestrogen and CEA. Metastases to the lacrimal gland are extremely rare, and metastases to the lacrimal gland should be considered in the diagnoses of lacrimal gland tumours. The present study aimed to describe two such cases and draw attention to breast carcinomas as a differential diagnosis and the most frequent cause of lacrimal gland metastasis. PMID:26622620

Blood Perfusion in Human Eyelid Skin Flaps Examined by Laser Speckle Contrast Imaging-Importance of Flap Length and the Use of Diathermy.

PubMed

Nguyen, Cu Dinh; Hult, Jenny; Sheikh, Rafi; Tenland, Kajsa; Dahlstrand, Ulf; Lindstedt, Sandra; Malmsjö, Malin

2017-10-11

It is well known that blood perfusion is important for the survival of skin flaps. As no study has been conducted to investigate how the blood perfusion in human eyelid skin flaps is affected by the flap length and diathermy, the present study was carried out to investigate these in patients. Fifteen upper eyelids were dissected as part of a blepharoplastic procedure, releasing a 30-mm long piece of skin, while allowing the 5 mm wide distal part of the skin to remain attached, to mimic a skin flap (hereafter called a "skin flap"). Blood perfusion was measured before and after repeated diathermy, using laser speckle contrast imaging. Blood perfusion decreased from the base to the tip of the flap: 5 mm from the base, the perfusion was 69%, at 10 mm it was 40%, at 15 mm it was 20%, and at 20 mm it was only 13% of baseline values. Diathermy further decreased blood perfusion (measured 15 mm from the base) to 13% after applying diathermy for the first time, to 6% after the second and to 4% after the third applications of diathermy. Blood perfusion falls rapidly with distance from the base of skin flaps on the human eyelid, and diathermy reduces blood perfusion even further. Clinically, it may be advised that flaps with a width of 5 mm be no longer than 15 mm (i.e., a width:length ratio of 1:3), and that the use of diathermy should be carefully considered.

Changes in fibroblast mechanostat set point and mechanosensitivity: an adaptive response to mechanical stress in floppy eyelid syndrome.

PubMed

Ezra, Daniel G; Ellis, James S; Beaconsfield, Michèle; Collin, Richard; Bailly, Maryse

2010-08-01

Floppy eyelid syndrome (FES) is an acquired hyperelasticity disorder affecting the upper eyelid. The tarsal plate becomes hyperelastic with a loss of intrinsic rigidity. As a result, the eyelid is subjected to cyclic mechanical stress. This condition was used as a model to investigate changes in dynamic fibroblast contractility in the context of chronic cyclic mechanical stress. Contractile efficiency was investigated in a free-floating, three-dimensional collagen matrix model. Intrinsic cellular force measurements and responses to changes in gel tension were explored using a tensioning culture force monitor (t-CFM). Gene expression differences between cell lines exhibiting differences in contractile phenotype were explored with a genome level microarray platform and RT-PCR. FES tarsal plate fibroblasts (TFs) showed an increased contractile efficiency compared with the control, and t-CFM measurements confirmed a higher intrinsic cellular force at plateau levels. Cyclic stretch/relaxation experiments determined that TFs in FES maintained a functional tensional homeostasis response but with an altered sensitivity, operating around a higher mechanostat set point. Gene expression array and RT-PCR analysis identified V-CAM1 and PPP1R3C as being upregulated in FES TFs. These changes may represent an adaptive response that allows tensional homeostasis to be maintained at the high levels of tissue stress experienced in FES. Gene expression studies point to a role for V-CAM1 and PPP1R3C in mediating changes in the dynamic range of mechanosensitivity of TFs. This work identifies FES as a useful model for the study of adaptive physiological responses to mechanical stress.

A Contractile Network of Interstitial Cells of Cajal in the Supratarsal Mueller's Smooth Muscle Fibers With Sparse Sympathetic Innervation

PubMed Central

Yuzuriha, Shunsuke; Matsuo, Kiyoshi; Ban, Ryokuya; Yano, Shiharu; Moriizumi, Tetsuji

2012-01-01

Background: We previously reported that the supratarsal Mueller's muscle is innervated by both sympathetic efferent fibers and trigeminal proprioceptive afferent fibers, which function as mechanoreceptors-inducing reflexive contractions of both the levator and frontalis muscles. Controversy still persists regarding the role of the mechanoreceptors in Mueller's muscle; therefore, we clinically and histologically investigated Mueller's muscle. Methods: We evaluated the role of phenylephrine administration into the upper fornix in contraction of Mueller's smooth muscle fibers and how intraoperative stretching of Mueller's muscle alters the degree of eyelid retraction in 20 patients with aponeurotic blepharoptosis. In addition, we stained Mueller's muscle in 7 cadavers with antibodies against α-smooth muscle actin, S100, tyrosine hydroxylase, c-kit, and connexin 43. Results: Maximal eyelid retraction occurred approximately 3.8 minutes after administration of phenylephrine and prolonged eyelid retraction for at least 20 minutes after administration. Intraoperative stretching of Mueller's muscle increased eyelid retraction due to its reflexive contraction. The tyrosine hydroxylase antibody sparsely stained postganglionic sympathetic nerve fibers, whereas the S100 and c-kit antibodies densely stained the interstitial cells of Cajal (ICCs) among Mueller's smooth muscle fibers. A connexin 43 antibody failed to stain Mueller's muscle. Conclusions: A contractile network of ICCs may mediate neurotransmission within Mueller's multiunit smooth muscle fibers that are sparsely innervated by postganglionic sympathetic fibers. Interstitial cells of Cajal may also serve as mechanoreceptors that reflexively contract Mueller's smooth muscle fibers, forming intimate associations with intramuscular trigeminal proprioceptive fibers to induce reflexive contraction of the levator and frontalis muscles. PMID:22359687

Lower Eyelid Retraction Surgery Without Internal Spacer Graft.

PubMed

Taban, Mehryar Ray

2017-02-01

Internal eyelid spacer graft is routinely placed during lower eyelid retraction surgery, which may be unnecessary. To evaluate the efficacy of lower eyelid retraction surgery without internal graft in select cases. Retrospective analysis of patients undergoing reconstructive lower eyelid retraction surgery without internal graft, by one surgeon from 2013 to 2015. Surgical technique included transconjunctival lower eyelid retractor lysis, canthoplasty, and temporary tarsorrhaphy, with or without subperiosteal midface-sub oribularis oculi fat (SOOF) lifting and scar lysis. Eyelids with true lower eyelid middle-lamella shortage were excluded. Analysis included 17 surgeries (11 patients). Eight of 11 patients had undergone at least one previous lower eyelid surgery with resultant lower eyelid retraction and sclera show. Preoperative and postoperative photographs at longest follow-up visit were analyzed with standardized measurements. Patient satisfaction was recorded using questionnaire. Etiologies of lower eyelid retraction included prior lower blepharoplasty, thyroid eye disease, and chronic facial palsy. All 11 patients (17 procedures) demonstrated improvement of lower eyelid position. The mean improvement of marginal reflex distance was 2.2 mm (range, 1.6-2.8 mm). There was one case of mild overcorrection. The average follow-up was 7 months (range, 6 months-2 years). Midface lift was performed for 14 of 17 eyelids. This study demonstrates improvement of lower lid position after lower eyelid retraction surgery without internal eyelid spacer graft in select patients. Most patients in our study had undergone previous lower eyelid blepharoplasty and required midface-SOOF lifting. The author proposes that "routine" placement of lower eyelid internal spacer/graft may not be necessary during lower eyelid retraction surgery. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

A Hyalinized Trichilemmoma of the Eyelid in a Teenager.

PubMed

Jakobiec, Frederick A; Stagner, Anna M; Sassoon, Jodi; Goldstein, Scott; Mihm, Martin C

2016-01-01

A 16-year-old African American male, the youngest patient to date, presented with a well-circumscribed upper eyelid lesion. On excision, the dermal nodule was contiguous with the epidermis, displayed trichohyalin-like bodies in an expanded outer root sheath, and was composed chiefly of small cellular clusters separated by a prominent network of periodic acid Schiff -positive hyaline bands of basement membrane material. The tumor cells were positive for high molecular weight cytokeratins (CK) 5/6, CK14, and CK34βE12 and were negative for CK7, carcinoembryonic antigen and epithelial membrane antigen. Negative S100, glial fibrillary acidic protein, and smooth muscle actin immunoreactions ruled out a myoepithelial lesion. The Ki-67 proliferation index was <10%. The diagnosis was a hyalinized trichilemmoma, contrasting with the more common lobular type. As an isolated lesion, trichilemmoma does not portend Cowden syndrome.

Severe periorbital edema secondary to STI571 (Gleevec).

PubMed

Esmaeli, Bita; Prieto, Victor G; Butler, Charles E; Kim, Stella K; Ahmadi, M Amir; Kantarjian, Hagop M; Talpaz, Moshe

2002-08-15

STI571 (imatinib mesylate; Gleevec) is a selective inhibitor of the bcr-abl, c-kit, and platelet-derived growth factor receptor tyrosine kinases. Mild periorbital edema has been noted as a common side effect in Phase I and II trials of this drug for the treatment of patients with chronic myelogenous leukemia and gastrointestinal stromal tumors. The authors report the case of male patient age 63 years who developed severe periorbital edema after treatment with STI571 for chronic myelogenous leukemia. His edema was severe enough to cause visual obstruction due to lower eyelid festoons that ultimately required surgical debulking. Histopathologic analysis of specimens of the excised upper and lower eyelid tissue revealed dermal dendrocytes that expressed the platelet-derived growth factor receptor and c-kit tyrosine kinases, suggesting a possible role for dermal dendrocytes in the development of this toxic effect. Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10729

Rehabilitation of orbital cavity after orbital exenteration using polymethyl methacrylate orbital prosthesis.

PubMed

Jain, Sumeet; Jain, Parul

2016-01-01

Squamous cell carcinoma of the eyelid is the second most common malignant neoplasm of the eye with the incidence of 0.09 and 2.42 cases/100 000 people. Orbital invasion is a rare complication but, if recognized early, can be treated effectively with exenteration. Although with advancements in technology such as computer-aided design and computer-aided manufacturing, material science, and retentive methods like implants, orbital prosthesis with stock ocular prosthesis made of methyl methacrylate retained by anatomic undercuts is quiet effective and should not be overlooked and forgotten. This clinical report describes prosthetic rehabilitation of two male patients with polymethyl methacrylate resin orbital prosthesis after orbital exenteration, for squamous cell carcinoma of the upper eyelid. The orbital prosthesis was sufficiently retained by hard and soft tissue undercuts without any complications. The patients using the prosthesis are quite satisfied with the cosmetic results and felt comfortable attending the social events.

The Hot Orbit: Orbital Cellulitis

PubMed Central

Chaudhry, Imtiaz A.; Al-Rashed, Waleed; Arat, Yonca O.

2012-01-01

Orbital cellulitis is an uncommon condition previously associated with severe complications. If untreated, orbital cellulitis can be potentially sight and life threatening. It can affect both adults and children but has a greater tendency to occur in the pediatric age group. The infection most commonly originates from sinuses, eyelids or face, retained foreign bodies, or distant soources by hematogenous spread. It is characterized by eyelid edema, erythema, chemosis, proptosis, blurred vision, fever, headache, and double vision. A history of upper respiratory tract infection prior to the onset is very common especially in children. In the era prior to antibiotics, vision loss from orbital cellulitis was a dreaded complication. Currently, imaging studies for detection of orbital abcess, the use of antibiotics and early drainage have mitigated visual morbidity significantly. The purpose of this review is to describe current investigative strategies and management options in the treatment of orbital cellulitis, establish their effectiveness and possible complications due to late intervention. PMID:22346113

The suspension (Frost) suture: experience and applications.

PubMed

Connolly, Karen L; Albertini, John G; Miller, Christopher J; Ozog, David M

2015-03-01

The Frost suture is a well-known surgical technique for providing upward tension on the lower lid to prevent or correct ectropion after surgical interventions in the periorbital area. Despite its relatively common use, comprehensive information on executing this technique is not readily available. To review eyelid anatomy, indications, and proper technique for performing the Frost suture, as well as potential complications. A review of the literature on Frost sutures was performed. Cadaveric dissection was performed to demonstrate placement of the Frost suture. The Frost suture is a useful method to reduce the risk of ectropion after surgery near the lower eyelid. Downward pull on the lid can occur with normal wound contracture even if ectropion is not present with the initial repair, reinforcing the need for preventive measures. Potential complications of this technique include superficial skin erosion of the upper lid, corneal abrasion, and blockage of the field of vision while the suture is in place.

Intraoperative modification of Pitanguy technique of reduction mammaplasty for elevation of the nipple-areola complex in case of severe breast ptosis.

PubMed

Foustanos, Andreas; Panagiotopoulos, Konstantinos; Skouras, George

2011-02-01

The Pitanguy method of reduction mammaplasty has been shown to be an anatomically safe technique in the management of the ptotic breast. However, the technique, as first described, cannot be applied in gigantomastia or severe breast ptosis cases or cases of dense parenchyma of the breast. The senior surgeon suggested an intraoperative modification of the Pitanguy method of reduction mammaplasty to make it applicable for such cases. A retrospective study of 122 patients with severe breast ptosis (70), gigantomastia (45), or dense breast parenchyma (7) who underwent a modification of the Pitanguy method was performed. The current procedure involves all the operating steps of the superior pedicle technique as described by Pitanguy, from the marking technique to the keel resection of the breast. If the nipple-areola complex is elevated inadequately, the surgeon can use the senior surgeon's modification to elevate the complex to the desired height. This modification consists of dissecting the upper pole of the breast vertically to the fascia of the pectoralis major muscle and laterally to the nipple-areola complex. The medial flap is then advanced superiorly, rotated 90°, and sutured to point A, while the lateral flap is placed below the medial one. This maneuver maximizes elevation of the nipple-areola complex to the desired height. The mean change in nipple position was 14 cm (range = 10-16 cm). The mean weight reduction of each breast was 900 g (range = 700-1300 g). The follow-up included 119 patients and the follow-up period ranged from 1 to 3 years (mean follow-up = 2 years). Three patients were operated on less than 3 months ago and were not involved in this study. All patients gained natural shaped breasts and they were pleased with the results. Serious complications, including flap necrosis, were avoided since caution was used to preserve the internal mammary perforators while performing this method. This technique provides a versatile, well-vascularized pedicle that allows elevation of the nipple-areola complex at the desired height in cases of severe breast ptosis, gigantomastia, or dense breast parenchyma.

Computation of breast ptosis from 3D surface scans of the female torso

PubMed Central

Li, Danni; Cheong, Audrey; Reece, Gregory P.; Crosby, Melissa A.; Fingeret, Michelle C.; Merchant, Fatima A.

2016-01-01

Stereophotography is now finding a niche in clinical breast surgery, and several methods for quantitatively measuring breast morphology from 3D surface images have been developed. Breast ptosis (sagging of the breast), which refers to the extent by which the nipple is lower than the inframammary fold (the contour along which the inferior part of the breast attaches to the chest wall), is an important morphological parameter that is frequently used for assessing the outcome of breast surgery. This study presents a novel algorithm that utilizes three-dimensional (3D) features such as surface curvature and orientation for the assessment of breast ptosis from 3D scans of the female torso. The performance of the computational approach proposed was compared against the consensus of manual ptosis ratings by nine plastic surgeons, and that of current 2D photogrammetric methods. Compared to the 2D methods, the average accuracy for 3D features was ~13% higher, with an increase in precision, recall, and F-score of 37%, 29%, and 33%, respectively. The computational approach proposed provides an improved and unbiased objective method for rating ptosis when compared to qualitative visualization by observers, and distance based 2D photogrammetry approaches. PMID:27643463

A computer analysis of reflex eyelid motion in normal subjects and in facial neuropathy.

PubMed

Somia, N N; Rash, G S; Epstein, E E; Wachowiak, M; Sundine, M J; Stremel, R W; Barker, J H; Gossman, D

2000-12-01

To demonstrate how computerized eyelid motion analysis can quantify the human reflex blink. Seventeen normal subjects and 10 patients with unilateral facial nerve paralysis were analyzed. Eyelid closure is currently evaluated by systems primarily designed to assess lower/midfacial movements. The methods are subjective, difficult to reproduce, and measure only volitional closure. Reflex closure is responsible for eye hydration, and its evaluation demands dynamic analysis. A 60Hz video camera incorporated into a helmet was used to analyze blinking. Reflective markers on the forehead and eyelids allowed for the dynamic measurement of the reflex blink. Eyelid displacement, velocity and acceleration were calculated. The degree of synchrony between bilateral blinks was also determined. This study demonstrates that video motion analysis can describe normal and altered eyelid motions in a quantifiable manner. To our knowledge, this is the first study to measure dynamic reflex blinks. Eyelid closure may now be evaluated in kinematic terms. This technique could increase understanding of eyelid motion and permit more accurate evaluation of eyelid function. Dynamic eyelid evaluation has immediate applications in the treatment of facial palsy affecting the reflex blink. Relevance No method has been developed that objectively quantifies dynamic eyelid closure. Methods currently in use evaluate only volitional eyelid closure, and are based on direct and indirect observer assessments. These methods are subjective and are incapable of analyzing dynamic eyelid movements, which are critical to maintenance of corneal hydration and comfort. A system that quantifies eyelid kinematics can provide a functional analysis of blink disorders and an objective evaluation of their treatment(s).

Breast shape (ptosis) as a marker of a woman's breast attractiveness and age: Evidence from Poland and Papua.

PubMed

Groyecka, Agata; Żelaźniewicz, Agnieszka; Misiak, Michał; Karwowski, Maciej; Sorokowski, Piotr

2017-07-08

A women's breast is a sex-specific and aesthetic bodily attribute. It is suggested that breast morphology signals maturity, health, and fecundity. The perception of a woman's attractiveness and age depends on various cues, such as breast size or areola pigmentation. Conducted in Poland and Papua, the current study investigated how breast attractiveness, and the further estimate of a woman's age based on her breast's appearance, is affected by the occurrence of breast ptosis (ie, sagginess, droopiness). In the Polish sample, 57 women and 50 men (N = 107) were presented with sketches of breasts manipulated to represent different stages of ptosis based on two different breast ptosis classifications. The participants were asked to rate the breast attractiveness and age of the woman whose breasts were depicted in each sketch. In Papua, 45 men aged 20 to 75 years took part in the study, which was conducted using only one of the classifications of breast ptosis. Regardless of the classification used, the results showed that the assessed attractiveness of the breasts decreased as the estimated age increased with respect to the more ptotic breasts depicted in the sketches. The results for Papuan raters were the same as for the Polish sample. Breast ptosis may be yet another physical trait that affects the perception and preferences of a potential sexual partner. The consistency in ratings between Polish and Papuan raters suggests that the tendency to assess ptotic breasts with aging and a loss of attractiveness is cross-culturally universal. © 2017 Wiley Periodicals, Inc.

[Eyelid retraction of neurologic origin: Report of three cases].

PubMed

Cartier R, Luis; Guzmán S, Jorge; Pasquali F, Renzo

2017-02-01

Eyelid retraction, has received limited attention and it has passively been interpreted as the result of an overactive levator palpebrae superioris muscle secondary to midbrain injury. However, eyelid retractions can occur in other neurological diseases, not directly related with the midbrain. We report three patients who developed eyelid retraction. One patient had a bilateral eyelid retraction, related with Creutzfeldt-Jakob disease (CJD). Another patient had a unilateral right eyelid retraction associated with a thalamic-mesencephalic infarct. The third patient had a bilateral pontine infarction on magnetic resonance imaging. In the patient with CJD, eyelid retraction did not subside. Among patients with infarctions, the retraction persisted after focal symptoms had subsided, showing an evolution that was apparently independent of the basic process. The analysis of these patients allows us to conclude that the pathogenesis of eyelid retraction includes supranuclear mechanisms in both the development and maintenance of the phenomenon. Unilateral or bilateral eyelid retraction does not alter the normal function of eyelid, which ever had normal close eye blink. In these reported cases, a hyperactivity of levator palpebrae superioris muscle was clinically ruled out.

Embryologic and Fetal Development of the Human Eyelid

PubMed Central

Abdulhafez, Mohamed H.; Fouad, Yousef A.; Dutton, Jonathan J.

2016-01-01

Purpose: To review the recent data about eyelid morphogenesis, and outline a timeline for eyelid development from the very early stages during embryonic life till final maturation of the eyelid late in fetal life. Methods: The authors extensively review major studies detailing human embryologic and fetal eyelid morphogenesis. These studies span almost a century and include some more recent cadaver studies. Numerous studies in the murine model have helped to better understand the molecular signals that govern eyelid embryogenesis. The authors summarize the current findings in molecular biology, and highlight the most significant studies in mice regarding the multiple and interacting signaling pathways involved in regulating normal eyelid morphogenesis. Results: Eyelid morphogenesis involves a succession of subtle yet strictly regulated morphogenetic episodes of tissue folding, proliferation, contraction, and even migration, which may occur simultaneously or in succession. Conclusions: Understanding the extraordinary process of building eyelid tissue in embryonic life, and deciphering its underlying signaling machinery has far reaching clinical implications beyond understanding the developmental abnormalities involving the eyelids, and may pave the way for achieving scar-reducing therapies in adult mammalian wounds, or control the spread of malignancies. PMID:27124372

Monopolar radiofrequency treatment of the eyelids: a safety evaluation.

PubMed

Biesman, Brian S; Pope, Karl

2007-07-01

Monopolar radiofrequency (RF) energy has been used to successfully accomplish noninvasive skin tightening of the face, abdomen, and extremities. Owing to concerns about injury to the eye itself, monopolar RF treatment of the eyelids has not been feasible. The objective was to evaluate the safety of a novel 0.25-cm(2)"shallow" treatment tip for noninvasive tightening of eyelid skin. This was a tripartite study that began with an animal model to evaluate soft tissue effects and temperature change at the ocular surface. Findings were then extrapolated to ex vivo evaluation of human eyelids and ultimately to an in vivo human eyelid safety study. The animal studies demonstrated that the 0.25-cm(2) treatment tip could be used safely on eyelids in conjunction with appropriate ocular protection. The ex vivo human eyelid studies confirmed that, at typical treatment settings, the shallow treatment tip did not produce frank eyelid injury. The in vivo human studies confirmed that, at the tested settings, the novel treatment tip did not injure the eyelids or eyes. If used properly, the 0.25-cm(2) treatment tip can be safely used on human eyelids.

Computation of breast ptosis from 3D surface scans of the female torso.

PubMed

Li, Danni; Cheong, Audrey; Reece, Gregory P; Crosby, Melissa A; Fingeret, Michelle C; Merchant, Fatima A

2016-11-01

Stereophotography is now finding a niche in clinical breast surgery, and several methods for quantitatively measuring breast morphology from 3D surface images have been developed. Breast ptosis (sagging of the breast), which refers to the extent by which the nipple is lower than the inframammary fold (the contour along which the inferior part of the breast attaches to the chest wall), is an important morphological parameter that is frequently used for assessing the outcome of breast surgery. This study presents a novel algorithm that utilizes three-dimensional (3D) features such as surface curvature and orientation for the assessment of breast ptosis from 3D scans of the female torso. The performance of the computational approach proposed was compared against the consensus of manual ptosis ratings by nine plastic surgeons, and that of current 2D photogrammetric methods. Compared to the 2D methods, the average accuracy for 3D features was ~13% higher, with an increase in precision, recall, and F-score of 37%, 29%, and 33%, respectively. The computational approach proposed provides an improved and unbiased objective method for rating ptosis when compared to qualitative visualization by observers, and distance based 2D photogrammetry approaches. Copyright © 2016 Elsevier Ltd. All rights reserved.

Orbital/Peri-Orbital Plexiform Neurofibromas in Children with Neurofibromatosis type 1: Multi-disciplinary Recommendations for Care

PubMed Central

Avery, Robert A.; Katowitz, James A.; Fisher, Michael J.; Heidary, Gena; Dombi, Eva; Packer, Roger J.; Widemann, Brigitte C.

2016-01-01

Children and adults with Neurofibromatosis type 1 (NF1), a common autosomal dominant condition, manifest a variety of ophthalmologic conditions. Plexiform neurofibromas involving the eyelid, orbit, periorbital and facial structures (termed OPPN) can result in significant visual loss in children. Equally important, OPPNs can cause significant alteration in physical appearance secondary to proptosis, ptosis, and facial disfigurement, leading to social embarrassment and decreased self-esteem. Despite NF1 being a relatively common disease in which routine ophthalmologic examinations are required, no formal recommendations for clinical care of children with OPPNs exist. While medical and surgical interventions have been reported, there are no agreed upon criteria for when OPPN require therapy and which treatment produces the best outcome. Since a multi-disciplinary team of specialists (oculofacial plastics, pediatric ophthalmology, neuro-ophthalmology, medical genetics and neuro-oncology) direct management decisions, the absence of a uniform outcome measure that represents visual and or aesthetic sequelae complicates the design of evidence based studies and feasible clinical trials. In September 2013, a multi-disciplinary task force, composed of pediatric practitioners from tertiary care centers experienced in caring for children with OPPN, was convened to address the lack of clinical care guidelines for children with OPPN. This consensus statement provides recommendations for ophthalmologic monitoring and outlines treatment indications, forthcoming biologic therapy, while also discussing challenges to performing clinical trials in this complicated condition. PMID:27817916

Atrophy, fibrosis, and increased PAX7-positive cells in pharyngeal muscles of oculopharyngeal muscular dystrophy patients.

PubMed

Gidaro, Teresa; Negroni, Elisa; Perié, Sophie; Mirabella, Massimiliano; Lainé, Jeanne; Lacau St Guily, Jean; Butler-Browne, Gillian; Mouly, Vincent; Trollet, Capucine

2013-03-01

Oculopharyngeal muscular dystrophy (OPMD) is a late-onset autosomal dominant inherited dystrophy caused by an abnormal trinucleotide repeat expansion in the poly(A)-binding-protein-nuclear 1 (PABPN1) gene. Primary muscular targets of OPMD are the eyelid elevator and pharyngeal muscles, including the cricopharyngeal muscle (CPM), the progressive involution of which leads to ptosis and dysphagia, respectively. To understand the consequences of PABPN1 polyalanine expansion in OPMD, we studied muscle biopsies from 14 OPMD patients, 3 inclusion body myositis patients, and 9 healthy controls. In OPMD patient CPM (n = 6), there were typical dystrophic features with extensive endomysial fibrosis and marked atrophy of myosin heavy-chain IIa fibers. There were more PAX7-positive cells in all CPM versus other muscles (n = 5, control; n = 3, inclusion body myositis), and they were more numerous in OPMD CPM versus control normal CPM without any sign of muscle regeneration. Intranuclear inclusions were present in all OPMD muscles but unaffected OPMD patient muscles (i.e. sternocleidomastoid, quadriceps, or deltoid; n = 14) did not show evidence of fibrosis, atrophy, or increased PAX7-positive cell numbers. These results suggest that the specific involvement of CPM in OPMD might be caused by failure of the regenerative response with dysfunction of PAX7-positive cells and exacerbated fibrosis that does not correlate with the presence of PABPN1 inclusions.

Foxl2 function in ovarian development.

PubMed

Uhlenhaut, Nina Henriette; Treier, Mathias

2006-07-01

Foxl2 is a forkhead transcription factor essential for proper reproductive function in females. Human patients carrying mutations in the FOXL2 gene display blepharophimosis/ptosis/epicanthus inversus syndrome (BPES), an autosomal dominant disease associated with eyelid defects and premature ovarian failure in females. Recently, animal models for BPES have been developed that in combination with a catalogue of human FOXL2 mutations provide further insight into its molecular function. Mice homozygous mutant for Foxl2 display craniofacial malformations and female infertility. The analysis of the murine phenotype has revealed that Foxl2 is required for granulosa cell function. These ovarian somatic cells surround and nourish the oocyte and play an important role in follicle formation and activation. Mutations upstream of FOXL2 in humans, not affecting the coding sequence itself, have also been shown to cause BPES, which points to the existence of a distant regulatory element necessary for proper gene expression. The same regulatory sequences may be deleted in the goat polled intersex syndrome (PIS), in which FoxL2 expression is severely reduced. Sequence comparison of FoxL2 from several vertebrate species has shown that it is a highly conserved gene involved in ovary development. Thus, the detailed understanding of Foxl2 function and regulation and the identification of its transcriptional targets may open new avenues for the treatment of female infertility in the future.

Comparison of HER2 gene amplification and KRAS alteration in eyelid sebaceous carcinomas with that in other eyelid tumors.

PubMed

Kwon, Mi Jung; Shin, Hyung Sik; Nam, Eun Sook; Cho, Seong Jin; Lee, Min Joung; Lee, Samuel; Park, Hye-Rim

2015-05-01

Eyelid sebaceous carcinoma (SC) represents a highly aggressive malignancy. Despite the poor prognosis, genetic alterations as potential molecular targets are not available. KRAS mutation and HER2 gene amplification may be candidates related to their genetic alterations. We examined the HER2 and KRAS alteration status in eyelid SCs and compared it with that in other eyelid tumors. The controversial topics of the human papillomavirus (HPV) and p16 expression were also investigated. HER2 amplification was determined by silver in situ hybridization, while immunohistochemistry was performed to study protein expressions in 14 SCs and controls, including 23 other eyelid malignancies and 14 benign tumors. Peptide nucleic acid-mediated PCR clamping and direct sequencing were used to detect KRAS mutations. HER2 protein overexpression was observed in 85.7% (12/14) of the SCs, of which two-thirds showed HER2 gene amplification. HER2 protein overexpression and HER2 amplification were found more frequently in eyelid SCs than in other eyelid tumors. All SCs harbored wild type KRAS genes. No HPV infections were identified in the SCs. Nevertheless, p16 overexpression was found in 71.4% (10/14) of SCs, irrespective of the status of HPV infection. Furthermore, p16 overexpression in eyelid SCs was also significantly higher than that in other eyelid tumors. HER2 protein overexpression, HER2 gene amplifications, and wild type KRAS genes are common in eyelid SCs. HER2 gene amplification may represent potential therapeutic targets for the treatment of eyelid SCs. Copyright © 2014 Elsevier GmbH. All rights reserved.

Morphological and acoustic characterization of Proceratophrys goyana (Lissamphibia: Anura: Odontophrynidae), with the description of a sympatric and related new species.

PubMed

Martins, Lucas Borges; Giaretta, Ariovaldo Antonio

2013-12-20

Proceratophrys goyana was until recently the only species of the genus described from central Brazil. In this paper we characterize the adult morphology and advertisement call of this species, based on data collected at its type-locality (Chapada dos Veadeiros, Goiás, Brazil). These new data allowed us to recognize a new species of Proceratophrys, sympatric to P. goyana, which is described herein. Proceratophrys goyana is mainly characterized by the male SVL = 38.8-46.5 mm; a well-developed and continuous pair of dorsal sagittal ridges; upper eyelids triangular; developed frontoparietal crests, delimiting a shallow depression between them; overall color pattern browned, with the symmetrical dorsal ridges bordered laterally by dark brown undulations. Proceratophrys rotundipalpebra sp. nov. is characterized by the male SVL = 30.4-39.3 mm; the pair of symmetrical dorsal ridges well-developed anteriorly and somewhat interrupted in the sacral region; upper eyelids short and rounded; frontoparietal crests not well-developed; overall color pattern stained by 3-4 tonalities of gray, without a clear background color. The advertisement calls of both species are emitted in a multi-note pattern, each note pulsed, the first and last notes differing from each other and from those amidst the call in temporal features. The description of this new species is another example of the underestimated diversity of Proceratophrys in the Cerrado of central Brazil. 

Buccal sulcus versus intranasal approach for postoperative periorbital oedema and ecchymosis in lateral nasal osteotomy.

PubMed

Ghazipour, Ali; Alani, Nadereh; Ghavami Lahiji, Shervin; Akbari Dilmaghani, Nader

2014-10-01

Lateral osteotomies are used in rhinoplasty to narrow the nasal bones, close the open roof deformity after hump removal, and achieve symmetry of an asymmetrical framework. But this procedure causes periorbital oedema & ecchymosis. Different techniques have been described for lateral osteotomy. To compare the postoperative ecchymosis and oedema after buccal sulcus lateral osteotomy versus intranasal lateral osteotomy. In a prospective experimental study, buccal sulcus approach was performed on the right side and an intranasal approach performed on the left side of patients randomly. Then blind analysis of postoperative photographs was performed to determine the incidence of oedema and ecchymosis on each side. Fifty patients were enrolled in the study after exclusion of unfit patients. On the right side (buccal approach osteotomies), a significantly lower incidence of upper and lower eyelid oedema and upper eyelid ecchymosis was seen on both the 2nd day and after 7th day (P < 0.05). The odds ratio of progression of ecchymosis was 2.66 (OR = 2.66, 95% CI: 1.09-5.52, p = 0.048) in intranasal group compare to buccal sulcus group. No significant complication observed. The buccal sulcus approach is a safe method for lateral osteotomy with a lower rate of postoperative oedema and ecchymosis and no significant complications. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Aseptic surgical preparation for upper eyelid blepharoplasty via full-face octenidine antiseptic without antibiotic medication shows effective prophylaxis against post-surgical wound infection.

PubMed

Matiasek, Johannes; Kienzl, Philip; Otti, Gerlinde R; Turk, Bela R; Djedovic, Gabriel; Rieger, Ulrich M

2018-02-01

Blepharoplasty is the third most common plastic surgical procedure in the USA. Due to the emergence of multiresistant bacteria, optimising the antiseptic procedure is crucial. Choice of antiseptics plays an important role as they may cause skin irritation and colouring of disinfected areas. In this study, the use of the aqueous antiseptic octenisept ® (octenidine) was evaluated in the outcome of blepharoplasties: incidence of wound dehiscence; haematoma; and infection in correlation with gender, medication, smoking habits and time of year. This retrospective surveillance study included 352 patients (median age 58·3 years). Skin disinfection was performed thrice prior to blepharoplasty. Sutures were removed on day 6. None of the patients suffered from wound infection. The total rate of wound dehiscence was 6·3%, with a higher ratio among male patients. Smokers and patients on anticoagulant medication showed a significantly higher incidence of wound dehiscence. Throughout the year, rates of wound dehiscence were highest in summer. Aseptic surgical preparation for blepharoplasty via full-face scrub with octenisept ® without oral antibiotic prophylaxis is well tolerated, with no report of wound infection, which may improve antibiotic stewardship as well as patient comfort. Elective upper eyelid blepharoplasty may ideally be performed in winter. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Basal cell carcinoma of the eyelid in Finland during 1953-97.

PubMed

Paavilainen, Ville; Tuominen, Juhani; Pukkala, Eero; Saari, K Matti

2005-04-01

To study the incidence of basal cell carcinoma (BCC) of the eyelid in Finland. We studied 6241 cases of BCC of the eyelid reported to the nationwide Finnish Cancer Registry during 1953-97. We determined the age- and sex- specific incidence rates and overall rates adjusted for age to the world standard population, and social class- and occupation-specific standardized incidence ratios, with the total Finnish population as reference. The incidence rates of BCC of the eyelid varied between 0.7 and 3.0 per 100 000 person-years in men and between 0.5 and 2.8 per 100 000 person-years in women during the study period. The age-adjusted incidence rates of BCC of the eyelid increased during 1953-87 (p < 0.0001). The incidence of BCC of the eyelid rose significantly with age. There were no significant differences in standardized incidence ratios (SIRs) for BCC of the eyelid between different social class and occupation categories. Age-adjusted incidence rates showed that BCC of the eyelid was more than twice as frequent during 1978-97 than before 1968. Ageing may partly explain the increased incidence of BCC of the eyelid, whereas there were no differences in the SIRs for BCC of the eyelid between different social class and occupation categories in Finland.

[About Cryptophthalmos (2nd Czech Study)].

PubMed

Krásný, J; Čakrtová, M; Kletenský, J; Novák, V; Šach, J

To get acquainted with the 2nd Czech study about cryptophthamos and with self-surgical methods. The boy with unilateral complete cryptophthalmos of left eye was treated from 2 to 20 years. The girls was treated from 4 month to 5 year yet for right abortive cryptophthalmos with microblepharon and left complete type still waiting for solutions.Surgical methods and results: Authors present a surgical procedures for correction of the upper and lower eyelids and ocular anomalies both patients studied. Successful reconstruction of palpebral fissure took place in several stages at the boy. The surgical procedure gradually contained: the insertion of gradually increased convex concave circular-shaped implant (silicone ruber) due a modeling of palpebral fissure, an enucleation of rudimentary eye, a reconstruction of bottom palpebral fissure by retro-auricular skin graf and a releasing of the lower transitory fold by the cul-de-sac method. An adequate depth of palpebral fissure to allow perfect position of an aesthetic protesis. Enucleated eye was atypically shaped, remiding partly sand-glass clock. The cornea was replaced by thick fibrous membrane, the iris and the lens were not revealed. Gliomatic retina was detached nearly totaly and the optic nerv was rudimental. The repairing the upper lid coloboma of girl by a lid rotation flap reconstruction using the inferior eyelid was performed at the age 17 month. Corneal dermoid simultaneously removed (histologically verified). Upper conjunctival fornix was formed using the spherical covering foil (silicone rubber) before and after the reconstruction of the lid. Plastic reconstructions required the need for patient access without trying immediate effect. An important role played silicone rubber implants (elastomer medical grade) which used temporarily. cryptophthalmos, microblepharon, relief surgery, silicon ruber implants.

Cervicothoracic epidural hematoma in a toddler with miosis, ptosis, nonspecific symptoms, and no history of major trauma: case report.

PubMed

Root, Brandon K; Schartz, Derrek A; Calnan, Dan R; Hickey, William F; Bauer, David F

2018-06-01

Spinal epidural hematomas are uncommon in children. The diagnosis can be elusive as most cases present without a history of trauma, while symptoms can be atypical. We encountered a 35-month-old male presenting with nonspecific symptoms and no history of trauma. He later developed unilateral miosis and ptosis; MRI discovered a subacute cervicothoracic epidural which was promptly evacuated. The patient made an excellent recovery. We emphasize the frequent absence of identifiable trauma and the importance of thorough imaging when this entity is suspected. Miosis and ptosis, likely representing a partial Horner syndrome, is an extremely rare presentation, this being one of the only reported cases.

Unexpected Effect of Propranolol and Prednisolone on Infantile Facial Rhabdomyosarcoma.

PubMed

Shilpakar, Rojina; Lemperle, Gottfried; Mentzel, Thomas; Shakya, Jaswan; Bhandari, Santosh Bikram

2017-11-01

A 14-month-old Nepalese infant had developed a rapidly growing facial tumor originating from a dark spot on her upper eyelid. A cavernous hemangioma was suspected and treated with high doses of propranolol and prednisolone. Remission was dramatic. Histology confirmed alveolar rhabdomyosarcoma. Chemotherapy was planned but not carried out due to complicated logistics. The girl died at the age of 3. We present this case for discussion as to whether propranolol and prednisolone might be effective in rapidly growing rhabdomyosarcomas.

Lower Eyelid Retraction Repair with Resorbable Polydioxanone Implants.

PubMed

Alsuhaibani, Adel H; Al-Faky, Yasser H

2016-01-01

To report a unique technique to repair lower eyelid retraction using resorbable polydioxanone implants. This was a retrospective, consecutive, nonrandomized interventional case series. Patients with lower eyelid retraction after trauma repaired facial fracture, thyroid eye disease, lower eyelid blepharoplasty, and long-standing facial palsy were treated with middle lamellar spacer using absorbable polydioxanone implant. All patients were recruited from the King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Only patients with minimum follow-up of 12 months were included in the study. Eight patients (4 males and 4 females) underwent lower eyelid retraction repair using absorbable polydioxanone implant. The mean age was 43 years (range, 23-63 years). All patients noted improved ocular surface symptoms. The improvement in eyelid retraction ranged from 1.5 to 4 mm with an average of 2.7 mm postoperatively. The implant was well tolerated with no major complications. Several options for spacer materials are available. Absorbable polydioxanone implants seem to be an effective middle lamellar spacer that is a good alternative for repairing middle lamella related lower eyelid retraction and lower eyelid support.

A modified surgical technique in the management of eyelid burns: a case series

PubMed Central

2011-01-01

Introduction Contractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness. Split-thickness or full-thickness skin grafts are commonly used for the treatment of acute eyelid burns. Plasma exudation and infection are common early complications of eyelid burns, which decrease the success rate of grafts. Case presentation We present the cases of eight patients, two Chinese women and six Chinese men. The first Chinese woman was 36 years old, with 70% body surface area second or third degree flame burn injuries involving her eyelids on both sides. The other Chinese woman was 28 years old, with sulfuric acid burns on her face and third degree burn on her eyelids. The six Chinese men were aged 21, 31, 38, 42, 44, and 55 years, respectively. The 38-year-old patient was transferred from the ER with 80% body surface area second or third degree flame burn injuries and third degree burn injuries to his eyelids. The other five men were all patients with flame burn injuries, with 7% to 10% body surface area third degree burns and eyelids involved. All patients were treated with a modified surgical procedure consisting of separation and loosening of the musculus orbicularis oculi between tarsal plate and septum orbital, followed by grafting a large full-thickness skin graft in three days after burn injury. The use of our modified surgical procedure resulted in 100% successful eyelid grafting on first attempt, and all our patients were in good condition at six-month follow-up. Conclusions This new surgical technique is highly successful in treating eyelid burn injuries, especially flame burn injuries of the eyelid. PMID:21843322

Acrofacial dysostosis syndrome type Rodriguez: prenatal diagnosis and autopsy findings.

PubMed

Sermer, David; Quercia, Nada; Chong, Karen; Chitayat, David

2007-12-15

A new lethal form of acrofacial dysostosis (AFD) syndrome was delineated by Rodriguez et al. [Rodriguez et al. (1990); Am J Med Genet 35:484-489]. We report on a male fetus with mandibulofacial dysostosis, including phocomelia-like upper limb deficiencies and lower limb anomalies which are characteristic of AFD Rodriguez type. The diagnosis was made on prenatal sonogram at 20 and at 24.1 weeks gestation. The severity of the upper limb defects, the involvement of lower limbs, and the absence of eyelid coloboma and polythelia excluded the possibility of other conditions associated with acrofacial dysostosis (AFD) including Nager acrofacial dysostosis syndrome (NADS) and postaxial acrofacial dysostosis syndrome (POADS). This case further delineates the AFD syndrome type Rodriguez. (c) 2007 Wiley-Liss, Inc.

De novo interstitial deletion of 3q22.3-q25.2 encompassing FOXL2, ATR, ZIC1, and ZIC4 in a patient with blepharophimosis/ptosis/epicanthus inversus syndrome, Dandy-Walker malformation, and global developmental delay.

PubMed

Lim, Byung Chan; Park, Woong Yang; Seo, Eul-Ju; Kim, Ki Joong; Hwang, Yong Seung; Chae, Jong Hee

2011-05-01

We report a case carrying a de novo interstitial deletion of chromosome 3q22-q25. The clinical phenotype of this case included blepharophimosis/ptosis/epicanthus inversus syndrome, Dandy-Walker malformation, and global developmental delay. Contiguous heterozygous deletion of FOXL2, ATR, ZIC1, and ZIC4 was postulated as the causative mechanism of the clinical phenotype. The association of blepharophimosis, ptosis, and epicanthus inversus syndrome with developmental delay or mental retardation may be an indication for the use of brain imaging and chromosomal analysis capable of detecting chromosomal rearrangements encompassing several candidate genes.

Eyelid skin as a potential site for drug delivery to conjunctiva and ocular tissues.

PubMed

See, Gerard Lee; Sagesaka, Ayano; Sugasawa, Satoko; Todo, Hiroaki; Sugibayashi, Kenji

2017-11-25

The feasibility of topical application onto the (lower) eyelid skin to deliver hydrophilic and lipophilic compounds into the conjunctiva and ocular tissues was evaluated by comparing with conventional eye drop application. Skin permeation and the concentration of several model compounds, and skin impedance were determined utilizing eyelid skin from hairless rats, as well as abdominal skin in the same animals for comparison. In vitro static diffusion cells were used to assess the skin permeation in order to provide key insights into the relationship between the skin sites and drugs. The obtained results revealed that drug permeation through the eyelid skin was much higher than that through abdominal skin regardless of the drug lipophilicity. Specifically, diclofenac sodium salt and tranilast exhibited approximately 6-fold and 11-fold higher permeability coefficients, respectively, through eyelid skin compared with abdominal skin. Histomorphological evaluation and in vivo distribution of model fluorescent dyes were also examined in the conjunctiva and skin after eyelid administration by conventional microscope and confocal laser scanning microscope analyses. The result revealed that eyelid skin has a thinner stratum corneum, thereby showing lower impedance, which could be the reason for the higher drug permeation through eyelid skin. Comparative evaluation of lipophilic and hydrophilic model compounds administered via the eyelid skin over 8h revealed stronger fluorescence intensity in the skin and surrounding tissues compared with eye drop administration. These results suggested that the (lower) eyelid skin is valuable as a prospective site for ophthalmic medicines. Copyright © 2017 Elsevier B.V. All rights reserved.

Micropunch blepharopeeling versus blepharoplasty; what is the best procedure for upper eyelid rejuvenation?

PubMed

Asilian, Ali; Bafandeh, Behzad; Shahmoradi, Zabihollah; Faghihi, Gita; Bostakian, Anis; Mozafarpoor, Samaneh; Hosseini, Sayed Mohsen

2018-05-17

Periocular rejuvenation is the most common aesthetic plastic surgery. The aim of this study was to determine effects of micropunch blepharopeeling (MBP) approach vs blepharoplasty (BP) in periocular rejuvenation. This is a clinical trial study on 22 patients who underwent periorbital rejuvenation referred to University Skin Clinics. Patients were randomly divided into two groups of blepharoplasty or micropunch blepharopeeling. After procedure, all patients were followed in 2 weeks and 2 months and were asked about complications. Patients' satisfaction was scored based on 5-grade scale. Physician satisfaction was assessed based on patients' photographs taken before and 2 months after surgery based on 4-grade scale. The mean age of group MBP was 48.45 ± 7.71 and group BP was 45.45 ± 7.20 (P-value = .36) and Fitzpatrick skin type was not significantly different. Scar was significantly different between groups that 4 (36.4%) patients of BP complained from scars, while none of MBP had significant scar (P-value = .04). Patients were statistically more satisfied with MBP in terms of symmetry, pain, and scar (P-value = .048, .040, and<.001, respectively). Also, MBP was significantly more satisfying for physicians in terms of symmetry and scar (P-value = .047 and <.001, respectively). Micropunch blepharopeeling can be considered as an acceptable procedure of upper eyelid rejuvenation mentioned by patients and physicians. Micropunch blepharopeeling causes fewer scars, better symmetry, and less pain. © 2018 Wiley Periodicals, Inc.

How to promote and preserve eyelid health.

PubMed

Benitez-Del-Castillo, Jose M

2012-01-01

Disorders of the lacrimal functional unit are common in ophthalmological practice, with meibomian gland dysfunction, blepharitis, and dry eye forming a significant part of the general ophthalmologist's practice. The eyelid and its associated structures form a complex organ designed to protect the fragile corneal surface and improve visual acuity. This organ is subject to a number of disorders, including meibomian gland dysfunction, dry eye syndrome, anterior blepharitis, allergic and dermatological conditions, and disorders associated with contact lens use. Although commonly described separately, disorders of the lacrimal function unit are better considered as a group of interacting pathologies that have inflammatory mediators as a central feature. Eyelid hygiene, in the sense of routine cleansing and massage of the eyelids, is well accepted in the management of many disorders of the eyelid. However, a broader concept of eyelid health may be appropriate, in which eyelid cleansing is but a part of a more complete program of care that includes screening and risk assessment, patient education, and coaching. The ophthalmologist has an important role to play in helping patients persist with routine eyelid care that may be long-term or lifelong. A number of preparations exist to make routine eyelid care both more effective and more pleasant, and might also improve compliance. Several such preparations have been devised, and are being assessed in clinical studies, and appear to be effective and preferred by patients over traditional soap and water or baby shampoo.

Total Reconstruction of Lower Eyelid in a Post-traumatic Patient Using Modified Fricke's Cheek Flap.

PubMed

Sengupta, Subhabrata; Baruah, Binayak; Pal, Suvra; Tuli, Isha Preet

2013-07-01

Eyelids are very complex structure, reconstruction of which is a challenge to surgeons. Reconstruction of eyelids may be required in a variety of conditions like congenital anomalies, trauma, or postsurgical excision in malignant lesions involving the eyelids. There are numerous ways to reconstruct the eyelids; the best procedure depends on both the skill of the surgeon and the condition of the patient. Fricke' lateral temporal based flap was first described in 1829 for reconstruction of the eyelids and lateral canthal region. This flap had inherent problems regarding cosmetic appearance of the eyebrows. The modified Fricke's flap based on the cheek has the advantage of avoiding such complications. It is very easy and rapid outpatient department (OPD) based procedure with acceptable cosmetic and functional result. It can be done by all ear, nose, and throat (ENT) and head and neck surgeons without any reconstructive training. In this article we are presenting a case of total reconstruction of lower eyelid using the modified Fricke's cheek flap.

SUNCT syndrome. Two cases in Argentina.

PubMed

Raimondi, E; Gardella, L

1998-05-01

Two patients suffering from SUNCT syndrome are presented. Some features are remarkable. The first patient was a 69-year-old man whose first crisis was located in the right supraorbital region. After a 4-month spontaneous remission, the pain returned to the upper part of the cheek, radiating to the supraciliary region on the same side, with lacrimation and conjunctival injection. Rhinorrhea was absent. The painful attacks were triggered by head movements. Clinical improvement occurred with carbamazepine treatment. The second patient was a 48-year-old woman whose painful attacks lasted from 30 to 45 seconds followed by a burning sensation lasting 2 hours. Autonomic signs such as conjunctival injection, lacrimation, and edema and ipsilateral ptosis of the upper lid were rather marked. There was never any rhinorrhea. Her attacks were triggered by head and eye movements. She responded to the administration of corticosteroids and carbamazepine. According to these features, the two patients had SUNCT syndrome, and the positive carbamazepine response suggests a relationship with trigeminal neuralgia.

Contribution of domestic animals to the identification of new genes involved in sex determination.

PubMed

Pailhoux, E; Vigier, B; Vaiman, D; Schibler, L; Vaiman, A; Cribiu, E; Nezer, C; Georges, M; Sundström, J; Pelliniemi, L J; Fellous, M; Cotinot, C

2001-12-01

Among farm animals, two species present an intersex condition at a relatively high frequency: pig and goat. Both are known to contain XX sex-reversed individuals which are genetically female but with a true hermaphrodite or male phenotype. It has been clearly demonstrated that the SRY gene is not involved in these phenotypes. Consequently, autosomal or X-linked mutations in the sex-determining pathway may explain these sex-reversed phenotypes. A mutation referred to as "polled" has been characterized in goats by the suppression of horn formation and abnormal sexual differentiation. The Polled Intersex Syndrome locus (PIS) was initially located in the distal region of goat chromosome 1. The homologous human region has been precisely identified as an HSA 3q23 DNA segment containing the Blepharophimosis Ptosis Epicanthus locus (BPES), a syndrome combining Premature Ovarian Failure (POF) and an excess of epidermis of the eyelids. In order to isolate genes involved in pig intersexuality, a similar genetic approach was attempted in pigs using genome scanning of resource families. Genetic analyses suggest that pig intersexuality is controlled multigenically. Parallel to this work, gonads of fetal intersex animals have been studied during development by light and electron microscopy. The development of testicular tissue and reduction of germ cell number by apoptosis, which simultaneously occurs as soon as 50 days post coïtum, also suggests that several separate genes could be involved in pig intersexuality. Copyright 2001 Wiley-Liss, Inc.

The Epidemiological, Clinical, and Histopathological Characteristics of Lacrimal Gland Biopsies in a Tertiary Care Center in Israel.

PubMed

Priel, Ayelet; Vishnevskia-Dai, Vicktoria; Hochma, Liran; Gildener-Leapman, Juliana; Ben Simon, Guy J; Rosner, Mordechai; Antman, Gal; Zloto, Ofira

2018-02-01

The distribution of pathology and clinical characteristics of lacrimal gland diseases are different in different areas of the world. To evaluate the incidence rate, patient characteristics, and indications for surgical intervention of lacrimal gland lesions in a tertiary care center in Israel. All biopsied or surgically removed lacrimal gland lesions at the Goldschleger Eye Institute from 2009 to 2015 were identified. The following data were collected: age, gender, indications for surgical intervention, diagnosis, treatment, and prognosis. We evaluated 28 lacrimal gland biopsies from 26 patients (11 men, 15 women). Mean age at biopsy was 47.5 years old. The most common presenting symptoms were: eyelid swollenness (57.14%), ptosis (32.14%), and proptosis (10.71%). All patients underwent computed tomography and magnetic resonance imaging. In 28 cases, infiltrations of the lacrimal gland were found. In nine cases infiltration of muscles or orbital extension were found. The most common pathologies were non-specified inflammation (44.82%), lymphoma (20.68%), and immunoglobulin G4-related disease (10.34%). The treatment was diverse according to the patient diagnosis. Prognosis of lacrimal gland disease was good; however, in five patients the systemic disease progressed. Lesions of the lacrimal gland comprise a wide variety of pathological findings that require different treatment strategies. Lacrimal gland biopsies enable physicians to precisely recognize the pathology; therefore, it is important to consider this surgical method in any patient with lesions in the lacrimal gland.

Volumization of the Brow at the Time of Blepharoplasty: Treating the Eyebrow Fat Pad as an Independent Unit.

PubMed

Vrcek, Ivan; Chou, Eva; Somogyi, Marie; Shore, John W

Loss of volume in the sub-brow fat pad with associated descent of the eyebrow is a common anatomical finding resulting in both functional and aesthetic consequences. A variety of techniques have been described to address brow position at the time of blepharoplasty. To our knowledge, none of these techniques treat the sub-brow fat pad as an isolated unit. Doing so enables the surgeon to stabilize and volumize the brow without resultant tension on the blepharoplasty wound. The authors describe a technique for addressing volume loss in the eyebrow with associated brow descent that treats the sub-brow fat pad as an isolated unit. A retrospective review of all patients undergoing brow ptosis repair by a single surgeon (J.W.S.) over an 11-month period was performed. Eighteen patients and 33 brows underwent the technique described. Patients were followed for an average of 11 weeks (range: 4 weeks to 20 weeks). All patients preoperatively displayed both visually significant dermatochalasis and brow descent below the orbital rim. Evaluation of pre- and postoperative photos demonstrates successful volumization of the brow with skin redraping without focal dimpling or undue tension on the eyelid wound. Performing a dissection that allows the sub-brow fat pad to be elevated in isolation from the overlying orbicularis and underlying periosteum allows for volumization and of the brow without compromising closure. This technique is a safe and effective means of volumizing the brow and treating secondary brow descent.

Dynamic eye socket reconstruction after extended total maxillectomy using temporalis transfer.

PubMed

Motomura, Hisashi; Hatano, Takaharu; Kobayashi, Rie; Sakahara, Daisuke; Fujii, Naho; Mineo, Mari

2014-03-01

The functional and cosmetic results of the reconstructive surgery after extended total maxillectomy greatly depend on the quality of the orbital reconstruction. In order to achieve good orbital reconstruction, we developed the dynamic eye socket reconstruction using temporalis transfer. In this report, I will present the details of the technique, including tips and innovations for dynamic eye socket reconstruction.Two patients (2 males, aged 70 and 72 years old) who underwent extensive resection of midfacial tumours were treated with dynamic eye socket reconstruction using temporalis transfer. The follow up period was 16 and 102 months. No acute complications were observed. The movements of the upper/lower eyelids including crow's feet were observed and a good shape in the reconstructed medial/lateral canthal area was maintained in all patients.This procedure provides both the eyelids with movement and also a good shape in the reconstructed medial/lateral canthal region. Furthermore, it contributes to achieving satisfactory functional and cosmetic results in the orbital reconstruction. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

A review of blepharochalasis and other causes of the lax, wrinkled eyelid.

PubMed

Held, J L; Schneiderman, P

1990-02-01

Cosmetically unappealing lax, wrinkled eyelid skin may result from various processes including connective tissue diseases, natural aging, and blepharochalasis. Since the end-stage eyelid changes due to several different processes are similar, the presence or absence of prior chronic or recurrent eyelid edema is an important differentiating point. We review blepharochalasis and provide a logical approach to its differential diagnosis.

Intratarsal fixation at the same level as the skin incision to reduce asymmetric double eyelids: evaluation of symmetry using photogrammetry.

PubMed

Han, Kihwan; Yeo, Hyeonjung; Choi, Tae Hyun; Son, Daegu; Kim, Jun Hyung

2010-03-01

One of the most common complications of double eyelid operations is asymmetry. To reduce asymmetry, we fixed the dermis to the tarsal plate at the same level as the skin incision, and objectively evaluated the symmetry of the height using photogrammetry.Of 30 patients who had double eyelid operations by the intratarsal fixation technique, 15 patients completed a minimum follow-up of 6 months. After the skin incision and removal of the orbicularis oculi muscle and the orbital fat, the pretarsal fat pad was excised to expose the superior portion of the tarsal plate. The 3 fixation points were marked on the tarsal plate at the same level with the skin incision using a spreading caliper. The dermis was fixed to the marked points of the tarsal plate and the skin was closed.The height of the double eyelid was measured by clinical photography at 4 points when the eyes were opened and at 3 points when the eyes were closed. The height proportional index at each point was obtained by dividing the height of the left double eyelid by that of the right double eyelid. We compared each height proportional index with "1" to evaluate the symmetry of both double eyelids using a paired t test.The follow-up period was an average of 9.0 months. The mean height proportional indices were 0.97 (a), 0.96 (b), 0.98 (c), 1.08 (d), 0.97 (e), 1.02 (f), and 1.13 (g). According to a paired t test, the height of the left double eyelid was not different from that of the right double eyelid.Intratarsal fixation, along with other previously known methods, decreases asymmetric double eyelids.

Hearing eyeball and/or eyelid movements on the side of a unilateral superior semicircular canal dehiscence.

PubMed

Bertholon, Pierre; Reynard, Pierre; Lelonge, Yann; Peyron, Roland; Vassal, François; Karkas, Alexandre

2018-02-01

Hearing of eyeball movements has been reported in superior semicircular canal dehiscence (SSCD), but not hearing of eyelid movements. Our main objective was to report the hearing of eyeball and/or eyelid movements in unilateral SSCD. Our secondary objective was to access its specificity to SSCD and discuss the underlying mechanism. Six patients with SSCD who could hear their eyeball and/or eyelid movements were retrospectively reviewed. With the aim of comparisons, eight patients with an enlarged vestibular aqueduct (EVA), who share the same mechanism of an abnormal third window, were questioned on their ability to hear their eyeball and/or eyelid movements. Three patients with SSCD could hear both their eyeball and eyelid movements as a soft low-pitch friction sound. Two patients with SSCD could hear only their eyelid movements, one of whom after the surgery of a traumatic chronic subdural hematoma. The latter remarked that every gently tapping on the skin covering the burr-hole was heard in his dehiscent ear as the sound produced when banging on a drum, in keeping with a direct transmission of the sound to the inner ear via the cerebrospinal fluid. One patient with SSCD, who could hear only his eyeball movements, had other disabling symptoms deserving operation through a middle fossa approach with an immediate relief of his symptoms. None of the eight patients with EVA could hear his/her eyeball or eyelid movements. Hearing of eyeball and/or eyelid movements is highly suggestive of a SSCD and do not seem to occur in EVA. In case of radiological SSCD, clinicians should search for hearing of eyeball and/or eyelid movements providing arguments for a symptomatic dehiscence. The underlying mechanism is discussed particularly the role of a cerebrospinal fluid transmission.

The structure and possible functions of the milkfish Chanos chanos adipose eyelid.

PubMed

Chang, C-H; Chiao, C-C; Yan, H Y

2009-07-01

Basic histological sections (with different staining methods) and scanning electron microscopy (SEM) examinations showed that there were three distinctive layers in the adipose eyelid of milkfish Chanos chanos, which is found in the cephalie region and covers the entire eye. The outer and inner layers were epithelial tissues and the middle layer was composed of connective tissue formed by type I collagen fibrils. No adipose tissue was found in any of the three layers of the so-called adipose eyelid. Examination by transmission spectrophotometer showed that the adipose tissue could filter out ambient light with a wavelength shorter than 305 nm. A photoretinoscope was used to investigate whether the adipose eyelid influenced the mechanism of eye focusing. Eye diopter values did not differ before or after eyelid removal, which indicated that the adipose eyelid did not play a role in eye focusing. In light of these findings, it is suggested that the adipose eyelid serves to block exposure of harmful ultraviolet light into eyes and may also to offer some protection against impact to the eye in the aquatic environment.

Nonsurgical Rejuvenation of the Eyelids with Hyaluronic Acid Gel Injections

PubMed Central

Lee, Seongmu; Yen, Michael T.

2017-01-01

There has been an increased recognition for the role volume deflation plays in the aging periorbital area, and as such, rejuvenation strategies to augment and restore volume have developed and evolved. Hyaluronic acid fillers provide an efficient option for volume augmentation with good efficacy, longevity, and safety. An understanding of the changes in the upper and lower periocular area due to aging, the meticulous identification of focal hollows, and the precise delivery of filler to these areas can smooth contours and restore a rejuvenated periorbital area. PMID:28255285

Our Experience with Brow Ptosis Correction: A Comparison of 4 Techniques

PubMed Central

Pascali, Michele; Avantaggiato, Anna; Cervelli, Valerio

2015-01-01

Background: Brow elevation is one of the goals of surgical rejuvenation procedures. In this article, the authors reviewed their experience with brow lift, and they compared 4 different techniques: direct brow lift, brow lift with endotine ribbon device, brow lift with temporoparietalis imbrication, and brow lift with Mersilene mesh to provide long-lasting results. Methods: This is a retrospective study of 80 patients (20 for each group), aged between 48 and 75 years undergoing brow lift surgery, between January 2011 and January 2013. In all cases, the brow lift was associated with an upper blepharoplasty. The amount of brow elevation reduced was assessed by comparison of the preoperative and postoperative vertical distances between the superior eyebrow hairline and the midpupil and lateral and medial canthal angle. The average follow-up period was 18 months. Results: No incidences of infection, alopecia, or excessive scarring were noticed. The main complication associated with direct brow lift was visibility of the scar in 2 patients. One patient treated with brow lift with suture had recurrent eyebrow ptosis. Transient frontal paresthesia was noticed in 1 case treated with endotine ribbon device and in 1 case treated with Mersilene mesh, but this sensation returned by 6–12 weeks. Conclusions: In our experience, there does not exist a technique better than the other, but the best procedure depends on eyebrow contour, sex and age of the patient, magnitude of desired correction, presence or absence of patient’s hair, and patient’s expectations. PMID:25878922

Occlusion therapy of unilateral amblyopia with botulinum toxin induced ptosis.

PubMed

Halkiadakis, Ioannis; Iliaki, Olga; Kalyvianaki, Maria I; Tsilimbaris, Miltiadis K

2007-01-01

In order to evaluate the role of botulinum toxin induced ptosis as an occlusion method to treat unilateral deep strabismic amblyopia in two uncooperative children, we injected 0.2 ml of diluted botulinum toxin in the levator palpaebrae; low sedation was necessary in one of the two children. In both cases a marked ptosis was achieved, which lasted about four weeks and then gradually resolved completely. The visual acuity of the ablyopic eye increased in both children, making patching easy thereafter. One child developed amblyopia in the injected eye, which was handled successfully using part-time occlusion. No other side effects were noted. Whether this new method could be a simple, safe and effective alternative method of occlusion for the treatment of deep amblyopia in uncooperative children needs to be proven with a larger series of children.

Magnetic resonance imaging study of eye congenital birth defects in mouse model

PubMed Central

Tucker, Zachary; Mongan, Maureen; Meng, Qinghang; Xia, Ying

2017-01-01

Purpose Embryonic eyelid closure is a well-documented morphogenetic episode in mammalian eye development. Detection of eyelid closure defect in humans is a major challenge because eyelid closure and reopen occur entirely in utero. As a consequence, congenital eye defects that are associated with failure of embryonic eyelid closure remain unknown. To fill the gap, we developed a mouse model of defective eyelid closure. This preliminary work demonstrates that the magnetic resonance imaging (MRI) approach can be used for the detection of extraocular muscle abnormalities in the mouse model. Methods Mice with either normal (Map3k1+/−) or defective (Map3k1−/−) embryonic eyelid closure were used in this study. Images of the extraocular muscles were obtained with a 9.4 T high resolution microimaging MRI system. The extraocular muscles were identified, segmented, and measured in each imaging slice using an in-house program. Results In agreement with histological findings, the imaging data show that mice with defective embryonic eyelid closure develop less extraocular muscle than normal mice. In addition, the size of the eyeballs was noticeably reduced in mice with defective embryonic eyelid closure. Conclusions We demonstrated that MRI can potentially be used for the study of extraocular muscle in the mouse model of the eye open-at-birth defect, despite the lack of specificity of muscle group provided by the current imaging resolution. PMID:28848319

Anatomy of lower eyelid and eyelid-cheek junction.

PubMed

Mojallal, A; Cotofana, S

2017-10-01

Understanding the anatomy of the lower eyelid and the lid-cheek junction is important for surgical and non-surgical approaches. It is important to understand the correlation between the clinical presentation and the individual anatomy to direct an adequate treatment. A review of the literature based on the authors experience combined with anatomical dissections was conducted to reveal the current concepts of the surgical and non-surgical anatomy. The various anatomical structures important for the understanding of the symptoms and the proposed treatment are described in this article. The anatomy of the lower eyelid and the lid-cheek junction has to be understood as a unit. Structures are continuous from the eyelid to the cheek influencing each other during aging. The concept of superficial, i.e. superficial to the orbicularis oculi muscle and deep facial fat compartments, i.e. deep to the orbicularis oculi muscle has to be applied in order to understand the relevant anatomy regarding the ligaments, fat compartments, muscular and tarsal structures and the vascularization. The understanding of the layered arrangement of the lower eyelid and eyelid-cheek junction anatomy enables practitioners to perform safe and effective surgical and non-surgical procedures. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Periorbital and eyelid edema: the initial manifestation of acute infectious mononucleosis.

PubMed

Decker, G R; Berberian, B J; Sulica, V I

1991-05-01

A case of periorbital and eyelid edema in an eighteen-year-old student is presented as the initial manifestation of acute infectious mononucleosis occurring one week before the typical prodrome. Although periorbital and eyelid edema have been reported in about 50 percent of patients with early infectious mononucleosis, its occurrence is much less frequent in clinical practice. Physicians, particularly those specializing in the treatment of cutaneous and ocular diseases, should now include acute infectious mononucleosis in the differential diagnosis of periorbital and eyelid edema.

Exogenous skeletal muscle satellite cells promote the repair of levator palpebrae superioris mechanical damage in rat.

PubMed

Ye, Lin; Yao, Yuanyuan; Guo, Hui; Peng, Yun

2018-05-17

Blepharoptosis is a drooping of the upper eyelid, usually due to dysfunction of the levator palpebrae superioris (LPS). Recently, skeletal muscle satellite cells (SSCs) have been reported to promote the repair of damaged skeletal muscle. This study aims to investigate the potential contribution of exogenous SSCs to the regeneration of mechanically damaged LPS. Thirty-two rats were randomly divided into four groups, including control group, SSCs-treated group, SSCs-treated injury group and non-treated injury group. After rats in injury groups were artificially lacerated on both the left and right LPS, HBBS (Hank's Balanced Salt Solution) containing SSCs was injected into upper eyelid tissue. After 7 days, the LPS muscle tissues were excised. In addition, skeletal muscle cells (SMCs) and SSCs were cocultured for use as an in vitro model, and the protective effects of SSCs on cultured SMCs were also investigated. Histological staining revealed that exogenous SSCs repaired the damaged muscle fibers and attenuated the fibrosis of LPS, possibly due to the increased level of IGF-1. In contrast, the level of IL-1β, IL-6, TGF-β1 and Smad2/3 (phospho-T8) were significantly reduced in the SSCs-treated group. The in vitro model using coculture of skeletal muscle cells (SMCs) and SSCs also revealed an increased level of IGF-1 and reduced level of inflammatory factors, resulting in a better cell survival rate. This study found that exogenous SSCs can promote the repair of LPS mechanical damage and provides new insight into the development of novel therapeutic approaches for blepharoptosis.

Wooden Foreign Body in the Skull Base: How Did We Miss It?

PubMed

Jusué-Torres, Ignacio; Burks, S Shelby; Levine, Corinna G; Bhatia, Rita G; Casiano, Roy; Bullock, Ross

2016-08-01

Timely detection of intraorbital and skull base wooden foreign bodies is crucial. Wooden foreign bodies are difficult to detect on imaging. The radiologist may fail to identify wooden foreign bodies on two thirds of initial scans and can miss them in almost one third of total cases. A 66-year-old woman sustained a penetrating injury through the left upper eyelid with a small tree branch. The branch was immediately removed in the field, and she was provided with prompt medical care at a local hospital. Initial computed tomography (CT) scan diagnosis was "posttraumatic sinusitis," and this was treated empirically with vancomycin and piperacillin/tazobactam. On the eighth day after injury, she developed progressive swelling and pain of her eyelid with left trigeminal/supraorbital numbness and complete left ophthalmoplegia. A new CT scan showed an open "track" from the region of the left upper orbit/superior rectus to the contralateral sphenoid sinus, which raised suspicion for a retained foreign body. Further imaging confirmed the suspicion. Endoscopic sinus surgery was performed with extraction of the wooden object and evacuation of the left orbital infection. This case indicates that intraorbital and skull base wooden foreign bodies are elusive, demanding a high index of suspicion from both clinicians and radiologists to identify retained material in the setting of ocular or sinus trauma. For better identification of wooden foreign bodies, bone windows on CT should have a width of -1000 Hounsfield units with a soft tissue window level of -500 Hounsfield units. Published by Elsevier Inc.

Canalicular laceration repair using a viscoelastic injection to locate and dilate the proximal torn edge.

PubMed

Örge, Faruk H; Dar, Suhail A

2015-06-01

Canalicular lacerations are common complications of eyelid trauma in the pediatric population. Irrigating air, water, and colored or viscous agents through the intact canaliculus have been suggested to identify the torn proximal edge. We report our experience in repairing canalicular lacerations using a novel viscoelastic injection technique with a Monoka monocanalicular stent. The medical records of patients <18 years of age who underwent repair of a canalicular laceration with a monocanalicular stent using superficial viscoelastic deployment to locate the torn canaliculus were retrospectively reviewed. Demographics, cause of eyelid injury, surgical management using our novel viscoelastic injection technique, and outcome were analyzed. A total of 38 children with lid lacerations were identified, of whom the 17 with canalicular involvement were included (mean age, 6.27 years). Canalicular injury in these 17 was due to dog bite (9 patients) and shearing trauma (8 patients). In 11 patients, the injury was located in the lower lid; in 4, the upper lid; and in 2, combined upper and lower lids. All patients had good anatomic repair and on follow-up had negative dye disappearance tests and were free of tearing. Deploying viscoelastic superficially near, and injecting into the injured canaliculus can improve visualization of the operative field by retracting the surrounding tissue and tamponading any bleeding, which aids in location and dilation of the torn canaliculus initially and in subsequent steps, eases intubation into the lubricated torn canaliculus and nasolacrimal duct, and avoids iatrogenic injury to an uninjured canaliculus. Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Molecular biology and genetics of embryonic eyelid development.

PubMed

Rubinstein, Tal J; Weber, Adam C; Traboulsi, Elias I

2016-09-01

The embryology of the eyelid is a complex process that includes interactions between the surface ectoderm and mesenchymal tissues. In the mouse and human, the eyelids form and fuse before birth; they open prenatally in the human and postnatally in the mouse. In the mouse, cell migration is stimulated by different growth factors such as FGF10, TGF-α, Activin B, and HB-EGF. These growth factors modulate downstream BMP4 signaling, the ERK cascade, and JNK/c-JUN. Several mechanisms, such as the Wnt/β-catenin signaling pathway, may inhibit and regulate eyelid fusion. Eyelid opening, on the other hand, is driven by the BMP/Smad signaling system. Several human genetic disorders result from dysregulation of the above molecular pathways.

Eyelid Edema: A Rare Cause of a Common Sign

PubMed Central

Almeida, Cristina; Freitas, Cristina; Sales-Sanz, Marco; Ribeiro, Sara

2017-01-01

We report a 48-year-old female patient who presented to the emergency room with right eyelid edema, with 3 days of evolution. She had suffered minor trauma to this eye one week before. She reported episodes of right eyelid swelling of spontaneous resolution since the occurrence of a traumatic brain injury 5 years ago. Ophthalmological examination showed a soft and painless eyelid edema of the right eye. Brain computed tomography showed an area of bone discontinuity of the orbital roof with brain herniation and a CSF leak into the eyelid (blepharocele). Magnetic resonance confirmed the result of TC and revealed an area of frontal encephalomalacia. Ibuprofen (800 mg/day) was prescribed, with complete resolution within 20 days. She was evaluated by Neurosurgery with no indication of surgery due to the resolution of the edema and absence of symptoms. Blepharocele is a rare entity that should be considered in the differential diagnosis of unilateral eyelid edema. It can be secondary to an orbital fracture or congenital lesion. PMID:28848682

A case of chronic inflammatory demyelinating polyneuropathy presented with unilateral ptosis.

PubMed

Izadi, Sadegh; Karamimagham, Sina; Poursadeghfard, Maryam

2014-01-01

Chronic Inflammatory Demyelinating Polyneuropathy is an autoimmune disease with progressive and relapsing courses. The main clinical presentations are diffuse deep tendon hyporeflexia or areflexia and symmetric proximal-distal muscles weakness. Myasthenia gravis is also an immune mediated disease with fluctuating ocular and bulbar symptoms and sometimes weakness. Although both myasthenia gravis and chronic inflammatory demyelinating polyneuropathy are immune mediated disorders, clinical presentations are obviously different in the two diseases. Herein, we will report a case of chronic inflammatory demyelinating polyneuropathy who presented with isolated unilateral ptosis. Initially, the patient was managed as ocular type of myasthenia gravis, but after progression to general limb weakness and areflexia, the diagnosis of chronic inflammatory demyelinating polyneuropathy was made. Although unilateral ptosis is a typical feature of myasthenia gravis, it may be seen as the first presentation of chronic inflammatory demyelinating polyneuropathy as well which mimics myasthenia gravis disease.

Posterior fossa reconstruction using titanium plate for the treatment of cerebellar ptosis after decompression for Chiari malformation.

PubMed

Udani, Vikram; Holly, Langston T; Chow, Daniel; Batzdorf, Ulrich

2014-01-01

We describe our use of a perforated titanium plate to perform a partial posterior fossa cranioplasty in the treatment of cerebellar ptosis and dural ectasia after posterior fossa decompression (PFD). Twelve patients who had undergone PFD underwent posterior fossa reconstruction using a titanium plate. Symptoms were related to either descent of the cerebellum into the decompression or to dural ectasia into the craniectomy defect. Twelve patients who had undergone large suboccipital craniectomies and who presented with persistent headaches and some with neurological symptoms related to syringomyelia, underwent reoperation with placement of a small titanium plate. Ten of 12 patients showed symptomatic improvement after reoperation. Placement of a titanium plate appears to be an effective method of treatment of cerebellar ptosis and dural ectasia after PFD for Chiari malformation. Copyright © 2014 Elsevier Inc. All rights reserved.

Eyelid sporotrichosis: Unique clinical findings in 72 patients.

PubMed

Zhang, Yaqin; Wang, Yuqian; Cong, Lele; Yang, Hongfeng; Cong, Xianling

2016-02-01

Sporotrichosis on the eyelids is uncommon and has been rarely reported. As the largest series of 72 adults and children with eyelid sporotrichosis from Jilin ̀P̀̀rovince in China, this study provides useful information for the improved diagnosis and treatment of sporotrichosis. © 2015 The Australasian College of Dermatologists.

21 CFR 886.5200 - Eyelid thermal pulsation system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Eyelid thermal pulsation system. 886.5200 Section 886.5200 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Therapeutic Devices § 886.5200 Eyelid thermal pulsation system...

Kindler syndrome causing severe cicatricial ectropion.

PubMed

Lelli, Gary J

2010-01-01

A 32-year-old female with Kindler syndrome presented with a 5-year history of lower eyelid malposition, corneal exposure, and recurrent erosions. Severe anterior lamellar cicatricial changes were noted bilaterally, with bilateral lower eyelid ectropion and retraction. Tarsal eversion was noted on the left lower eyelid. The patient had repeatedly failed conservative treatments for keratopathy and was treated surgically, with resolution of corneal disease and improved lower eyelid position. A review of Kindler syndrome is provided, geared toward the oculoplastic surgeon who may participate in the care of these patients.

Topical anesthetic abuse keratitis secondary to floppy eyelid syndrome.

PubMed

Goldich, Yakov; Zadok, David; Avni, Isaac; Hartstein, Morris

2011-01-01

To report the diagnosis and management of a patient with chronic ophthalmic topical anesthetic abuse and floppy eyelid syndrome. We describe the case of a 47-year-old man suffering from persistent bilateral ocular irritation and chronic corneal erosions. The patient was hospitalized in our ophthalmology department and underwent thorough ophthalmic, systemic, and psychiatric evaluation. Chronic topical anesthetic abuse was discovered. Removal of abused drops and copious lubricating treatment lead to partial improvement further permitting diagnosis of floppy eyelid syndrome. Definitive surgical treatment by horizontal eyelid tightening combined with continuous lubrication resulted in remission of symptoms. Uncommon conditions may coexist in 1 patient. In this case, floppy eyelid syndrome resulted in topical anesthetic abuse. Ophthalmologists should keep both these conditions in mind when treating patients with otherwise unexplained chronic persistent corneal erosions.

Investigating the Short-term Effect of Eyelid Massage on Corneal Topography.

PubMed

Riede-Pult, Britta H; Evans, Katharine; Pult, Heiko

2017-06-01

The aim of this study was to evaluate the short-term effect of eyelid massage, after the use of warm compresses, on corneal topography. Corneal topography was evaluated on 20 subjects (mean age, 47.0 [SD ±17.3] years) using the Oculus Keratograph (Oculus, Wetzlar, Germany). Corneal eccentricity (Epsilon) was compared between topography measurements before eyelid warming (using warm compresses) (T1), after eyelid warming (T2), directly after eyelid massage (T3), and 30 minutes after eyelid massage (T4). Differences in corneal eccentricity between the enrolment measurement (T1) and consecutive measurements (T1-4) were analyzed. The contralateral eye-treated by warm compresses, but not by eyelid massage-was the control. Visual acuity (decimal), bulbar conjunctival hyperemia, and corneal staining (Cornea and Contact Lens Research Unit grading scale) were evaluated at T1 and T4 to assess clinical safety. No significant differences were found between consecutive eccentricity measurements overall and with the central radii (repeated-measures analysis of variance, P > .238 (massaged eyelid: Epsilon T1: 0.48 [95% confidence interval, ±0.07], T2: 0.49 [±0.05], T3: 0.49 [±0.06], T4: 0.48 [±0.06]; horizontal radii T1: 7.76 [±0.13] mm, T2: 7.74 [±0.13] mm, T3: 7.75 [±0.13] mm, T4: 7.76 [±0.13] mm; vertical radii T1: 7.56 [±0.12] mm, T2: 7.55 [±0.10] mm, T3: 7.54 [±0.10] mm, T4: 7.58 [±0.11] mm). Decimal visual acuity significantly improved at the end of the study (massaged eyelid: T1: 1.1 [±0.1]; T4: 1.3 [±0.1]; P < .032). No significant differences were detected between the consecutive evaluation of corneal staining (Wilcoxon test; P > .285). Redness was not significantly different between time points (repeated-measures analysis of variance; P = .187) in the colateral eyes. Hyperemia was significantly reduced in the massaged eyes (T1: 2.0 grade units [±0.3]; T4: 1.9 [±0.3]; P = .021). Eyelid warming followed by eyelid massage appears to be a safe procedure, without any clinically relevant short-term effects on the cornea.

The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion

PubMed Central

Golan, Shani; Rabina, Gilad; Kurtz, Shimon; Leibovitch, Igal

2016-01-01

Purpose and design The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed. Participants All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial. Methods The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period. Main outcome measure In this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure. Results A total of 227 patients (57% men, mean age: 79.2 years) who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications. Conclusion An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients. PMID:27785003

Validation of the facial assessment by computer evaluation (FACE) program for software-aided eyelid measurements.

PubMed

Choi, Catherine J; Lefebvre, Daniel R; Yoon, Michael K

2016-06-01

The aim of this article is to validate the accuracy of Facial Assessment by Computer Evaluation (FACE) program in eyelid measurements. Sixteen subjects between the ages of 27 and 65 were included with IRB approval. Clinical measurements of upper eyelid margin reflex distance (MRD1) and inter-palpebral fissure (IPF) were obtained. Photographs were then taken with a digital single lens reflex camera with built-in pop-up flash (dSLR-pop) and a dSLR with lens-mounted ring flash (dSLR-ring) with the cameras upright, rotated 90, 180, and 270 degrees. The images were analyzed using both the FACE and ImageJ software to measure MRD1 and IPF.Thirty-two eyes of sixteen subjects were included. Comparison of clinical measurement of MRD1 and IPF with FACE measurements of photos in upright position showed no statistically significant differences for dSLR-pop (MRD1: p = 0.0912, IPF: p = 0.334) and for dSLR-ring (MRD1: p = 0.105, IPF: p = 0.538). One-to-one comparison of MRD1 and IPF measurements in four positions obtained with FACE versus ImageJ for dSLR-pop showed moderate to substantial agreement for MRD1 (intraclass correlation coefficient = 0.534 upright, 0.731 in 90 degree rotation, 0.627 in 180 degree rotation, 0.477 in 270 degree rotation) and substantial to excellent agreement in IPF (ICC = 0.740, 0.859, 0.849, 0.805). In photos taken with dSLR-ring, there was excellent agreement of all MRD1 (ICC = 0.916, 0.932, 0.845, 0.812) and IPF (ICC = 0.937, 0.938, 0.917, 0.888) values. The FACE program is a valid method for measuring margin reflex distance and inter-palpebral fissure.

Long-wave plasma radiofrequency ablation for treatment of xanthelasma palpebrarum.

PubMed

Baroni, Adone

2018-03-01

Xanthelasma palpebrarum is the most common type of xanthoma affecting the eyelids. It is characterized by asymptomatic soft yellowish macules, papules, or plaques over the upper and lower eyelids. Many treatments are available for management of xanthelasma palpebrarum, the most commonly used include surgical excision, ablative CO 2 or erbium lasers, nonablative Q-switched Nd:YAG laser, trichloroacetic acid peeling, and radiofrequency ablation. This study aims to evaluate the effectiveness of RF ablation in the treatment of xanthelasma palpebrarum, with D.A.S. Medical portable device (Technolux, Italia), a radiofrequency tool working with long-wave plasma energy and without anesthesia. Twenty patients, 15 female and 5 male, affected by xanthelasma palpebrarum, were enrolled for long-wave plasma radiofrequency ablation treatment. The treatment consisted of 3/4 sessions that were carried out at intervals of 30 days. Treatments were well tolerated by all patients with no adverse effects and optimal aesthetic results. The procedure is very fast and can be performed without anesthesia because of the low and tolerable pain stimulation. Long-wave plasma radiofrequency ablation is an effective option for treatment of xanthelasma palpebrarum and adds an additional tool to the increasing list of medical devices for aesthetic treatments. © 2018 Wiley Periodicals, Inc.

Lacrimal neuralgia: so far, a missing cranial neuralgia.

PubMed

Pareja, Juan A; Cuadrado, María-Luz

2013-10-01

The lacrimal nerve supplies the lacrimal gland, the lateral upper eyelid, and a small cutaneous area adjacent to the external CANTHUS . First division trigeminal neuralgia, supraorbital/supratrochlear neuralgia, and infraorbital neuralgia have been acknowledged as neuralgic causes of pain in the forehead and periorbit. However, the lacrimal nerve has never been identified as a source of facial pain. Here we report two cases of lacrimal neuralgia. A 66-year-old woman had continuous pain in the lateral aspect of her left superior eyelid and an adjacent area of the temple since age 64. A 33-year-old woman suffered from continuous pain in a small area next to the lateral CANTHUS of her left eye since age 25. In both patients the superoexternal edge of the orbit was tender. In addition, sensory dysfunction could be demonstrated within the painful area. Anaesthetic blockades of the lacrimal nerve with lidocaine 2% resulted in complete but short-lasting relief. Pregabalin provided a complete response in the first patient. The second patient was refractory to various oral and topical drugs and different radiofrequency procedures, but she eventually obtained partial relief with pregabalin. Lacrimal neuralgia should be considered among the neuralgic causes of orbital and periorbital pain.

The "sweet science" of reducing periorbital lacerations in mixed martial arts.

PubMed

Bastidas, Nicholas; Levine, Jamie P; Stile, Frank L

2012-01-01

The popularity of mixed martial arts competitions and televised events has grown exponentially since its inception, and with the growth of the sport, unique facial injury patterns have surfaced. In particular, upper eyelid and brow lacerations are common and are especially troublesome given the effect of hemorrhage from these areas on the fighter's vision and thus ability to continue. We propose that the convexity of the underlying supraorbital rim is responsible for the high frequency of lacerations in this region after blunt trauma and offer a method of reducing subsequent injury by reducing its prominence.

Periorbital dirofilariasis—Clinical and imaging findings: Live worm on ultrasound

PubMed Central

Gopinath, Thandre N; Lakshmi, K P; Shaji, P C; Rajalakshmi, P C

2013-01-01

Ocular dirofilariasis is a zoonotic filariasis caused by nematode worm,Dirofilaria. We present a case of dirofilariasis affecting the upper eyelid in a 2-year-old child presenting as an acutely inflammed cyst, from southern Indian state of Kerala. Live adult worm was surgically removed and confirmed to be Dirofilaria repens. Live worm showing continuous movement was seen on the pre-operative high-resolution ultrasound. Ultrasound can be helpful in pre-operative identification of live worm. Imaging findings reported in literature are very few. We describe the clinical, ultrasound, and magnetic resonance imaging (MRI) findings. PMID:23803483

Oral azithromycin for treatment of posterior blepharitis.

PubMed

Igami, Thais Zamudio; Holzchuh, Ricardo; Osaki, Tammy Hentona; Santo, Ruth Miyuki; Kara-Jose, Newton; Hida, Richard Y

2011-10-01

To evaluate the effects of oral azithromycin in patients with posterior blepharitis. Twenty-six eyes of 13 patients with posterior blepharitis diagnosed by a qualified ophthalmologist were enrolled in this study. Patients were instructed to use oral azithromycin 500 mg per day for 3 days in 3 cycles with 7-day intervals. Subjective clinical outcomes were graded and scored 1 day before and 30 days after the end of the treatment (53 days after initiating the treatment) based on severity scores of: (1) eyelid debris; (2) eyelid telangiectasia; (3) swelling of the eyelid margin; (4) redness of the eyelid margin; and (5) ocular mucus secretion. For the assessment of global efficacy, patients were asked by the investigator to rate the subjective symptoms (eyelid itching, ocular itching, eyelid hyperemia, ocular hyperemia, ocular mucus secretion, photophobia, foreign body sensation, and dry eye sensation) on a scale of 0 (no symptoms) to 5 (severe symptoms). Break-up time, Schirmer I test, corneal fluorescein staining score, and rose bengal staining score were also performed in all patients. All clinical outcomes scoring showed statistically significant improvement after oral azithromycin, except for eyelid swelling. Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. Average tear film break-up time values showed statistically significant improvement after the treatment with oral azithromycin. No statistically significant improvement was observed on average values of Schirmer I test, corneal fluorescein staining score, and rose bengal staining score. The combination of multiple clinical parameters shown in this study supports the clinical efficacy of pulsed oral azithromycin therapy for the management of posterior blepharitis.

Management of perineural invasion in sebaceous carcinoma of the eyelid.

PubMed

Connor, Michael; Droll, Lilly; Ivan, Doina; Cutlan, Jonathan; Weber, Randal S; Frank, Steven J; Esmaeli, Bita

2011-01-01

To report the occurrence and management of perineural invasion in patients with sebaceous carcinoma of the eyelid. An ophthalmology database was searched for all patients treated for sebaceous carcinoma of the eyelid by the principal investigator between May 1999 and May 2010. The clinical records and pathology specimens of the patients with microscopic perineural invasion as an incidental finding in their eyelid surgical specimen were reviewed. Forty-two patients with sebaceous carcinoma of the eyelid were treated by the principal investigator during the study period. Three of them had evidence of microscopic perineural invasion in the surgical specimen. Each patient was treated with surgery with or without radiotherapy. The first patient underwent orbital exenteration and negative sentinel lymph node biopsy, subsequently developed distant metastasis, and died 20 months after exenteration. The second patient underwent resection of the tumor and positive sentinel lymph node biopsy, postoperative irradiation of the eyelid, completion neck dissection and parotidectomy for the positive sentinel lymph node, and irradiation of nodal basins; she was free of disease at last follow up (12 months after tumor resection). The third patient underwent resection of the tumor, developed regional lymph node metastasis 3 months later, underwent lymph node dissection and postoperative nodal irradiation, and was free of disease at last follow up (9 months after tumor resection). Perineural invasion was encountered in 7% of patients with eyelid sebaceous carcinoma. The authors' preference is to treat patients with an incidental finding of microscopic perineural invasion with postoperative adjuvant radiotherapy, ideally within 4 to 6 weeks after surgical resection of the primary eyelid tumor.

CT-Guided, Ethanol Sympatholysis for Primary Axillary–Palmar Hyperhidrosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tsitskari, Maria, E-mail: mariadote@hotmail.com; Friehs, Gerhard, E-mail: gerhardf@amc.com.cy; Zerris, Vassilis, E-mail: vassilisz@amc.com.cy

PurposePrimary hyperhidrosis is an excessive sweating due to an overactive sympathetic system. Our objective was to test the feasibility and provide early data on the safety/efficacy of CT-guided sympatholysis, for primary hyperhidrosis.Materials and MethodsNine consecutive patients with axillary–palmar hyperhidrosis were treated between 2013 and 2015. CT-guided sympathetic block was performed in the outpatients at T-2, T-3, and T-4, bilaterally using alcohol under local anesthesia. Immediate postprocedure CT was obtained to assess the complications as per Common Terminology Criteria for Adverse Events, version 4. Technical success and clinical success were recorded. Primary and secondary efficacy were assessed by phone and clinicalmore » visits; mean follow-up was 12 months (6–26 months). Descriptive statistics was used to report the outcomes.ResultsOne procedure was aborted due to eyelid ptosis after lidocaine injection. All other eight patients (5:3, F:M) (median age 32) had immediate cessation of sweating. Two major complications (pneumothorax, one requiring a chest tube) occurred. Two patients recurred with unilateral and one with bilateral symptoms. One of the unilateral recurrence and the bilateral recurrence patients was retreated successfully. Median follow-up was 1 year. No cases of Horner’s or compensatory hyperhidrosis were observed.ConclusionsCT-guided EtOH sympatholysis for axillary/palmar primary hyperhidrosis is feasible. Technical failure rate was 11 %. Primary and secondary efficacy are 75 and 94 %, respectively, to a median follow-up of 1 year. Risk profile appears favorable. Despite a small sample size, results confirm feasibility and encourage a larger study.« less

Screening program for Waardenburg syndrome in Colombia: clinical definition and phenotypic variability.

PubMed

Tamayo, Marta L; Gelvez, Nancy; Rodriguez, Marcela; Florez, Silvia; Varon, Clara; Medina, David; Bernal, Jaime E

2008-04-15

A screening program to detect Waardenburg syndrome (WS) conducted between 2002 and 2005, among 1,763 deaf individuals throughout Columbia identified 95 affected individuals belonging to 95 families, giving a frequency of 5.38% of WS among the institutionalized deaf population. We confirmed the clinical diagnosis of WS in the 95 propositi and, through the family evaluation, we also identified 45 non-institutionalized affected relatives. Audiologic, ophthalmologic, and genetic studies were performed to confirm the diagnosis. Following the classification of the WS consortium, based on the Waardenburg Index (WI), to define the type of WS. We classified 62.1% of the propositi as WS2 and 37.9% as WS1. We present here the results of the study of clinical manifestations, analyzing the presence, severity, and symmetry of clinical findings among this affected population. Overall, among the 95 propositi, in addition to sensorineural deafness in all, the most frequent features were broad nasal root (58.9%), a first degree relative affected (37.9%), heterochromia irides (36.8%), skin hypopigmentation (31.6%), white forelock (28.0%), intense blue iris (27.4%), synophrys (12.6%), premature graying (10.5%), ptosis of the eyelids (9.5%), and hypoplasia alae nasi (1.1%). The majority of individuals had normal psychomotor development (87%), while the remaining 13% had developmental delay. Among the latter, 9.4% corresponded to WS2 and 3.6% to WS1. Our data confirm an interesting inter- and intrafamilial variability in the phenotypic manifestations as well as extremely variable expression. Copyright 2008 Wiley-Liss, Inc.

CT-Guided, Ethanol Sympatholysis for Primary Axillary-Palmar Hyperhidrosis.

PubMed

Tsitskari, Maria; Friehs, Gerhard; Zerris, Vassilis; Georgiades, Christos

2016-12-01

Primary hyperhidrosis is an excessive sweating due to an overactive sympathetic system. Our objective was to test the feasibility and provide early data on the safety/efficacy of CT-guided sympatholysis, for primary hyperhidrosis. Nine consecutive patients with axillary-palmar hyperhidrosis were treated between 2013 and 2015. CT-guided sympathetic block was performed in the outpatients at T-2, T-3, and T-4, bilaterally using alcohol under local anesthesia. Immediate postprocedure CT was obtained to assess the complications as per Common Terminology Criteria for Adverse Events, version 4. Technical success and clinical success were recorded. Primary and secondary efficacy were assessed by phone and clinical visits; mean follow-up was 12 months (6-26 months). Descriptive statistics was used to report the outcomes. One procedure was aborted due to eyelid ptosis after lidocaine injection. All other eight patients (5:3, F:M) (median age 32) had immediate cessation of sweating. Two major complications (pneumothorax, one requiring a chest tube) occurred. Two patients recurred with unilateral and one with bilateral symptoms. One of the unilateral recurrence and the bilateral recurrence patients was retreated successfully. Median follow-up was 1 year. No cases of Horner's or compensatory hyperhidrosis were observed. CT-guided EtOH sympatholysis for axillary/palmar primary hyperhidrosis is feasible. Technical failure rate was 11 %. Primary and secondary efficacy are 75 and 94 %, respectively, to a median follow-up of 1 year. Risk profile appears favorable. Despite a small sample size, results confirm feasibility and encourage a larger study.

Ptosis congénital: expérience d'un centre de soins tertiaires Marocain et mise au point

PubMed Central

Handor, Hanan; Hafidi, Zouheir; Bencherif, Moulayzahid; Amrani, Youssef; Belmokhtar, Adil; Laghmari, Mina; Daoudi, Rajae

2014-01-01

Le ptosis congénital constitue la malposition palpébrale la plus fréquente de l'enfant. Le but de ce travail est de rapporter l'expérience de notre service dans la prise en charge de cette affection. Cette étude analyse les données épidémiologiques, cliniques et thérapeutiques des patients opérés pour ptosis congénital dans notre service entre Janvier 2005 et Décembre 2012. 44 patients (48 yeux) ont été opérés. La médiane d'âge était de 10 ans et une prédominance masculine a été retrouvée. Le ptosis était unilatéral et isolé dans 40 cas (90,90 %), bilatéral et associé à un syndrome de blépharophimosis dans 3 cas et à un syndrome de fibrose congénitale des muscles oculomoteurs dans un cas. Une amblyopie a été notée dans 11 cas (25%). La résection du muscle releveur de la paupière supérieure était la technique chirurgicale la plus utilisée (81,81%). Les résultats postopératoires étaient bons dans 33 cas (75%). PMID:25767669

Interactions between Prefrontal Cortex and Cerebellum Revealed by Trace Eyelid Conditioning

ERIC Educational Resources Information Center

Kalmbach, Brian E.; Ohyama, Tatsuya; Kreider, Joy C.; Riusech, Frank; Mauk, Michael D.

2009-01-01

Eyelid conditioning has proven useful for analysis of learning and computation in the cerebellum. Two variants, delay and trace conditioning, differ only by the relative timing of the training stimuli. Despite the subtlety of this difference, trace eyelid conditioning is prevented by lesions of the cerebellum, hippocampus, or medial prefrontal…

Surgical Treatment as a First Option of the Lower Eyelid Xanthelasma.

PubMed

Obradovic, Bojan

2017-10-01

Xanthelasma palpebrarum represents yellowish plaques, which mostly appear near the inner cantus of the eyelid. In most patients, cosmetic reasons are the main purpose for their removal.The author presents a patient with a lower eyelid xanthelasma where surgical excision was used as a first treatment option. Cosmetic reasons, fast recovery, and possibility of a 1-stage procedure were the main requests of the patient for the removal of xanthelasma. Treatment and postrecovery period were routine.In the treatment of xanthelasma palpebrarum of the lower eyelids, it is necessary to consider surgical excision as a first treatment option.

Rehabilitation of the paralysed or lax lower eyelid using a graft of conchal cartilage.

PubMed

Krastinova, D; Franchi, G; Kelly, M B H; Chabolle, F

2002-01-01

Excessive laxity of the tarso-ligamentous sling of the lower eyelid may be caused by inadequate muscular support (resulting from injury to the muscle, facial palsy or senile degeneration) or prolonged mechanical distension (exophthalmia). Numerous techniques have been devised for functional reconstruction of the distended lower eyelid, based upon the principle that restoring the lower eyelid to its anatomical position will improve lacrimal transit andre-establish its natural protective function. We now use an autologous conchal cartilage graft to treat the distended or atonic lower eyelid. We review our results in a retrospective study of 20 patients, and aim to identify the indications for this procedure and to evaluate its advantages and disadvantages relative to other existing methods. All of our patients reported functional improvement after the operation in terms of decreased dry-eye symptoms, less epiphora and a decline in keratitis and conjunctivitis. All patients also reported a visible cosmetic improvement postoperatively. The major drawback of this operation is the partial loss of the visual field when looking down, due to the limited lowering of the lower eyelid. The stability of our results compares favourably with that achieved using other currently available techniques. We conclude that autologous conchal cartilage grafting is an effective procedure for improving both the function and the appearance of the atonic lower eyelid. Copyright 2002 The British Association of Plastic Surgeons.

[Ankyloblepharon filiforme adnatum].

PubMed

Haustein, M; Reschke, F; Terai, N; Lesczcynska, A; Wozniak, K; Pillunat, L E; Sommer, F

2014-02-01

The ankyloblepharon filiforme adnatum is a congenital eyelid anomaly in which the development of the eyelids is completed but the eyelids are not completely separated at birth. The abnormality can occur as an isolated anomaly, together with other eye diseases or in the context of systemic syndromes. In this case report the current classification and essential diagnostics of AFA will be reviewed.

Black Tar Heroin Skin Popping as a Cause of Wound Botulism.

PubMed

Qureshi, Ihtesham A; Qureshi, Mohtashim A; Rauf Afzal, Mohammad; Maud, Alberto; Rodriguez, Gustavo J; Cruz-Flores, Salvador; Kassar, Darine

2017-12-01

Botulism is a rare potentially fatal and treatable disorder caused by a bacteria-produced toxin that affects the presynaptic synaptic membrane resulting in a characteristic neuromuscular dysfunction. It is caused by either the ingestion of the toxin or the bacteria, inhalation, or wound infection. We present our observations with a descriptive case series of wound botulism secondary to black tar heroin (BTH) injection. We report a retrospective single-center case series of 15 consecutive cases of wound botulism presenting to University Medical Center of El Paso. Medical records where reviewed to obtain demographic information, clinical presentation, treatment, and outcome. We identified fifteen patients with mean age of 47 years: twelve men, and three women. All had administered BTH through skin popping and had abscesses in the administration areas. By history, the most common symptoms were dysphagia (66%), proximal muscle weakness of upper and lower extremity (60%), neck flexor muscle weakness (33%), ophthalmoplegia (53%), bilateral ptosis (46%), dysarthria (53%), double vision (40%), blurred vision (33%), and dry mouth (20%). During the examination, the most common features noted were: proximal muscle weakness of upper and lower extremities (73%), ophthalmoplegia (53%), ptosis (46%). In patients with documented wound botulism, the pupils were reactive in 46%. All patients required mechanical ventilation and were treated with the trivalent antitoxin. Eleven patients (73.3%) were discharged home, two were transferred to a skill nursing facility, and two were transferred to long-term acute care facility. In our patients, BTH injection, involving the action of injecting under the skin acetylated morphine derivatives (mostly 6-monoacetylmorphine and 3-monoacetylmorphine), was associated with the development of botulism. The availability of BTH at the US-Mexican border is not surprising since it is frequently produced in Latin America. Its association with the development of botulism should be recognized early to allow a prompt diagnosis and treatment with the antitoxin. A clinical feature worth noting is the presence of normal pupillary light reflex in nearly half of patients. Therefore, the presence of a normal pupillary response does not exclude the presence of wound botulism.

Facebook: can it be a diagnostic tool for neurologists?

PubMed Central

Mittal, Manoj K; Sloan, Jeff A; Rabinstein, Alejandro A

2012-01-01

A 56-year-old woman presented with acute ischaemic stroke with NIHSS 13. She had right eye ptosis and miosis. She and her husband were not sure if her facial features were different than usual. With her consent, we compared her face with her pictures on Facebook. In the absence of any ptosis or miosis in her pictures, she was diagnosed with acute Horner syndrome. Facebook may be a useful tool for the neurologists to define the timing of facial neurological signs. PMID:22914235

A kinetic study of blinking responses in cats

PubMed Central

Trigo, José Alberto; Roa, Laura; Gruart, Agnès; Delgado-García, José María

2003-01-01

Reflexively evoked and eye-related eyelid responses were recorded using the search coil in a magnetic field technique in alert cats. The downward phase of a blink was a large (up to 21 deg), fast (up to 2000 deg s−1) eyelid displacement in the closing direction, with an almost fixed rise time duration (15-20 ms); its maximum velocity was achieved in ≈10 ms. Upward eyelid motion was separated into two phases. The first phase consisted of a fast eyelid displacement, with a short duration (≈30 ms) and a maximum velocity up to 900 deg s−1. The second phase had an exponential-like form, lasting for 200–400 ms, and a maximum velocity ranging between 30 and 250 deg s−1. Maximum blink velocity in the downward direction was linearly related to maximum velocity of the first upward phase. The first phase in the upward direction was never observed if the eyelid stayed closed for a long period (> 50 ms) or moved slowly in the closing direction before it started to open. In these two cases, the upswing motion of the blink reflex contained only the exponential-like movement characteristic of the second upward phase, and maximum velocity in the downward direction was not related to that of the eyelid upward displacement. Mean duration of eyelid downward saccades was ≈130 ms, and their peak velocities ranged between 50 and 440 ms. A physiological model is presented explaining the active and passive forces involved in both reflex and saccadic eyelid responses. A second-order system seems to be appropriate to describe the postulated biomechanical model. PMID:12665614

Expression of Anti-apoptotic Protein BAG3 in Human Sebaceous Gland Carcinoma of the Eyelid.

PubMed

Yunoki, Tatsuya; Tabuchi, Yoshiaki; Hayashi, Atsushi

2017-04-01

Bcl-2-associated athanogene 3 (BAG3), a co-chaperone of heat shock protein 70 (HSP70), has been shown to play a role in anti-apoptosis of various malignant tumors. In this study, the expression of BAG3 was examined in human sebaceous gland carcinoma of the eyelid. The expression of BAG3 was evaluated by immunohistochemistry of surgical samples from 5 patients with sebaceous gland carcinoma in the eyelid. BAG3 was positive diffusely in the cytoplasm in all patients. The average positive rate of BAG3 was 73.0±26.0% in tumor cells of all patients. BAG3 was highly expressed in sebaceous gland carcinoma of the eyelid. BAG3 may play an important role in the pathogenesis and progression of sebaceous gland carcinoma of the eyelid. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

The onset of visual experience gates auditory cortex critical periods

PubMed Central

Mowery, Todd M.; Kotak, Vibhakar C.; Sanes, Dan H.

2016-01-01

Sensory systems influence one another during development and deprivation can lead to cross-modal plasticity. As auditory function begins before vision, we investigate the effect of manipulating visual experience during auditory cortex critical periods (CPs) by assessing the influence of early, normal and delayed eyelid opening on hearing loss-induced changes to membrane and inhibitory synaptic properties. Early eyelid opening closes the auditory cortex CPs precociously and dark rearing prevents this effect. In contrast, delayed eyelid opening extends the auditory cortex CPs by several additional days. The CP for recovery from hearing loss is also closed prematurely by early eyelid opening and extended by delayed eyelid opening. Furthermore, when coupled with transient hearing loss that animals normally fully recover from, very early visual experience leads to inhibitory deficits that persist into adulthood. Finally, we demonstrate a functional projection from the visual to auditory cortex that could mediate these effects. PMID:26786281

The lid wiper and muco-cutaneous junction anatomy of the human eyelid margins: an in vivo confocal and histological study

PubMed Central

Knop, Erich; Knop, Nadja; Zhivov, Andrey; Kraak, Robert; Korb, Donald R; Blackie, Caroline; Greiner, Jack V; Guthoff, Rudolf

2011-01-01

The inner border of the eyelid margin is critically important for ocular surface integrity because it guarantees the thin spread of the tear film. Its exact morphology in the human is still insufficiently known. The histology in serial sections of upper and lower lid margins in whole-mount specimens from 10 human body donors was compared to in vivo confocal microscopy of eight eyes with a Heidelberg retina-tomograph (HRT II) and attached Rostock cornea module. Behind the posterior margin of the Meibomian orifices, the cornified epidermis stopped abruptly and was replaced by a continuous layer of para-keratinized (pk) cells followed by discontinuous pk cells. The pk cells covered the muco-cutaneous junction (MCJ), the surface of which corresponded to the line of Marx (0.2–0.3 mm wide). Then a stratified epithelium with a conjunctival structure of cuboidal cells, some pk cells, and goblet cells formed an epithelial elevation of typically about 100 μm initial thickness (lid wiper). This continued for 0.3–1.5 mm and formed a slope. The MCJ and lid wiper extended all along the lid margin from nasal to temporal positions in the upper and lower lids. Details of the epithelium and connective tissue were also detectable using the Rostock cornea module. The human inner lid border has distinct zones. Due to its location and morphology, the epithelial lip of the lid wiper appears a suitable structure to spread the tear film and is distinct from the MCJ/line of Marx. Better knowledge of the lid margin appears important for understanding dry eye disease and its morphology can be analysed clinically by in vivo confocal microscopy. PMID:21413985

[Chronic eyelid oedema and rosacea (Morbus Morbihan): diagnostic and therapeutic challenges].

PubMed

Renieri, G; Brochhausen, C; Pfeiffer, N; Pitz, S

2011-01-01

Morbus Morbihan is a rare complication of rosacea, consisting of a persistent lymphoedema of the upper part of the face. It has typically a chronic course, unspecific histopathological findings and an extreme refractoriness to therapy. Between February 2008 and January 2010, 5 patients with Morbus Morbihan were observed at the Department of Ophthalmology of the University Medical Centre Mainz. In the present cohort study, we describe the clinical, laboratory and histological findings that led to the diagnosis. The course of the affection and the results of different therapeutic options are also reported. Each patient underwent a complete ophthalmological examination, as well as general and dermatological consultations. All patients showed facial skin alterations typical for rosacea. 4 out of 5 subjects underwent a lid biopsy to confirm the diagnosis of Morbus Morbihan, one patient refused it. Initial treatment consisted of various systemic and local medical therapies, however, with poor success. One patient had intravenous therapy with corticosteroids elsewhere with no effect. We treated 3 cases with intralesional triamcinolone injections with good results. 2 patients underwent upper lid blepharoplasty. Results of surgery remained stable also due to manual lymph drainage and intralesional injections of triamcinolon. No complications or side effects were seen in patients treated with triamcinolone. Morbus Morbihan can be diagnosed only after excluding other conditions leading to chronic lid swelling. In our series, good results were achieved with intralesional injection of triamcinolone. Surgery also led to relevant improvements for a long period (13 months), with some adjuvant therapy. The treatment of chronic eyelid oedema associated with rosacea remains a challenge for the ophthalmologist and the oculoplastic surgeon. © Georg Thieme Verlag KG Stuttgart · New York.

Species limits within the widespread Amazonian treefrog Dendropsophus parviceps with descriptions of two new species (Anura, Hylidae).

PubMed

Rivadeneira, C Daniel; Venegas, Pablo J; Ron, Santiago R

2018-01-01

The genus Dendropsophus is one of the most speciose among Neotropical anurans and its number of described species is increasing. Herein, molecular, morphological, and bioacoustic evidence are combined to assess species limits within D. parviceps , a widely distributed species in the Amazon Basin. Phylogenetic relationships were assessed using 3040 bp sequences of mitochondrial DNA, genes 12S, ND1, and CO1. The phylogeny shows three well-supported clades. Bioacoustic and morphological divergence is congruent with those clades demonstrating that Dendropsophus parviceps is a species complex. Dendropsophus parviceps sensu stricto occurs in the Amazon basin of Ecuador, northern Peru, southern Colombia and northwestern Brazil. It is sister to two previously undescribed species, D. kubricki sp. n. from central Peru and D. kamagarini sp. n. from southern Peru, northeastern Bolivia, and northwestern Brazil. Genetic distances (uncorrected p , gene 12S) between D. parviceps and the new species is 3 to 4%. Dendropsophus kamagarini sp. n. can be distinguished from D. parviceps by having a prominent conical tubercle on the distal edge of the upper eyelid (tubercle absent in D. parviceps ). Dendropsophus kubricki sp. n. differs from D. parviceps by having scattered low tubercles on the upper eyelids (smooth in D. parviceps ). Dendropsophus parviceps and both new species differ from all their congeners by their small size (adult maximum SVL = 28.39 mm in females, 22.73 mm in males) and by having a bright orange blotch on the hidden areas of the shanks and under arms. The advertisement call of the two new species has lower dominant frequency relative to D. parviceps . Probable speciation modes are discussed. Available evidence indicates that ecological speciation along an elevation gradient is unlikely in this species complex.

Species limits within the widespread Amazonian treefrog Dendropsophus parviceps with descriptions of two new species (Anura, Hylidae)

PubMed Central

Rivadeneira, C. Daniel; Venegas, Pablo J.; Ron, Santiago R.

2018-01-01

Abstract The genus Dendropsophus is one of the most speciose among Neotropical anurans and its number of described species is increasing. Herein, molecular, morphological, and bioacoustic evidence are combined to assess species limits within D. parviceps, a widely distributed species in the Amazon Basin. Phylogenetic relationships were assessed using 3040 bp sequences of mitochondrial DNA, genes 12S, ND1, and CO1. The phylogeny shows three well-supported clades. Bioacoustic and morphological divergence is congruent with those clades demonstrating that Dendropsophus parviceps is a species complex. Dendropsophus parviceps sensu stricto occurs in the Amazon basin of Ecuador, northern Peru, southern Colombia and northwestern Brazil. It is sister to two previously undescribed species, D. kubricki sp. n. from central Peru and D. kamagarini sp. n. from southern Peru, northeastern Bolivia, and northwestern Brazil. Genetic distances (uncorrected p, gene 12S) between D. parviceps and the new species is 3 to 4%. Dendropsophus kamagarini sp. n. can be distinguished from D. parviceps by having a prominent conical tubercle on the distal edge of the upper eyelid (tubercle absent in D. parviceps). Dendropsophus kubricki sp. n. differs from D. parviceps by having scattered low tubercles on the upper eyelids (smooth in D. parviceps). Dendropsophus parviceps and both new species differ from all their congeners by their small size (adult maximum SVL = 28.39 mm in females, 22.73 mm in males) and by having a bright orange blotch on the hidden areas of the shanks and under arms. The advertisement call of the two new species has lower dominant frequency relative to D. parviceps. Probable speciation modes are discussed. Available evidence indicates that ecological speciation along an elevation gradient is unlikely in this species complex. PMID:29430205

Arch fingerprints, hypotonia, and areflexia associated with X linked mental retardation.

PubMed Central

Stevenson, R E; Häne, B; Arena, J F; May, M; Lawrence, L; Lubs, H A; Schwartz, C E

1997-01-01

A syndrome with distinctive facies, poor muscle tone, absent deep tendon reflexes, tapered fingers, excessive fingerprint arches, genu valgum and mild-moderate mental retardation has occurred in four males in two generations of a white family of European ancestry. The facies are characterised by square configuration, tented upper lip, and thickening of the helices, upper eyelids, and alae nasi. At birth and at maturity, growth (head circumference, height, weight) of affected males is comparable to or greater than unaffected male sibs. Moderate impairment of cognitive function was documented (IQ scores between 40-51). Carriers show no heterozygote manifestations. This X linked condition appears to be different from other syndromes with mental retardation, although there are certain similarities with the alpha thalassaemia-mental retardation syndrome (ATR-X). Linkage analysis found tight linkage to DXS1166 and DXS995 in Xq13 and Xq21 respectively. Images PMID:9192265

Arch fingerprints, hypotonia, and areflexia associated with X linked mental retardation.

PubMed

Stevenson, R E; Häne, B; Arena, J F; May, M; Lawrence, L; Lubs, H A; Schwartz, C E

1997-06-01

A syndrome with distinctive facies, poor muscle tone, absent deep tendon reflexes, tapered fingers, excessive fingerprint arches, genu valgum and mild-moderate mental retardation has occurred in four males in two generations of a white family of European ancestry. The facies are characterised by square configuration, tented upper lip, and thickening of the helices, upper eyelids, and alae nasi. At birth and at maturity, growth (head circumference, height, weight) of affected males is comparable to or greater than unaffected male sibs. Moderate impairment of cognitive function was documented (IQ scores between 40-51). Carriers show no heterozygote manifestations. This X linked condition appears to be different from other syndromes with mental retardation, although there are certain similarities with the alpha thalassaemia-mental retardation syndrome (ATR-X). Linkage analysis found tight linkage to DXS1166 and DXS995 in Xq13 and Xq21 respectively.

Impression cytology diagnosis of ulcerative eyelid malignancy.

PubMed

Sen, S; Lyngdoh, A D; Pushker, N; Meel, R; Bajaj, M S; Chawla, B

2015-02-01

The utility of impression cytology in ocular diseases has predominantly been restricted to the diagnosis of dry eye, limbal stem cell deficiency and conjunctival neoplasias. Its role in malignant eyelid lesions remains largely unexplored. Although scrape cytology is more popular for cutaneous lesions, impression cytology, being non-traumatic, has an advantage in small and delicate areas such as the eyelid. The present study has been designed to evaluate its role in the diagnosis and management of malignant eyelid lesions. Thirty-two histopathologically proven malignant eyelid lesions diagnosed over a 2-year period, including 13 basal cell carcinomas, 11 sebaceous carcinomas, four squamous cell carcinomas, two malignant melanomas and two poorly differentiated carcinomas, formed the study group. The results of impression cytology were compared with those of histopathology in the study group and with an age- and sex-matched group of benign cases as controls. The sensitivity of impression cytology was 84% (27/32) for the diagnosis of malignancy and 28% (9/32) for categorization of the type of malignancy. Impression cytology is a simple, useful, non-invasive technique for the detection of malignant ulcerative eyelid lesions. It is especially useful as a follow-up technique for the detection of recurrences. © 2014 John Wiley & Sons Ltd.

Effects of a New Eyelid Shampoo on Lid Hygiene and Eyelash Length in Patients with Meibomian Gland Dysfunction: A Comparative Open Study.

PubMed

Kobayashi, Asuka; Ide, Takeshi; Fukumoto, Teruki; Miki, Emiko; Tsubota, Kazuo; Toda, Ikuko

2016-01-01

Purpose . Meibomian gland dysfunction (MGD) can lead to abnormalities in the composition and function of tear film, resulting in dry eye. Eyelid hygiene is a key to management of MGD. We tested a novel eyelid shampoo (Eye Shampoo Long, ESL) for its ability to maintain lid hygiene. This shampoo is nonirritating and can potentially lengthen eyelashes. This study was aimed to evaluate the efficacy of ESL in the treatment of MGD and its effects on eyelash length. Methods . Ten patients with MGD and 10 healthy subjects without MGD applied ESL twice daily for 8 weeks. Patients were examined for lid margin and dry eye before and after the trial. Subjective symptoms were evaluated. Eyelash length was measured at baseline and at the end of the trial. Results . In the MGD group, significant improvements were observed in subjective symptoms obstruction of the meibomian orifice, secretion of meibum, eyelashes contamination, eyelid margin foam, and SPK. Eyelash length became significantly longer. Conclusions . Maintaining eyelid hygiene using ESL improved the eyelid margins and symptoms of dry eye in MGD patients and increased eyelash length. These findings are promising and warrant confirmation in a larger randomized controlled study.

Clinical features of 10 cases of eyelid sporotrichosis in Jilin Province (Northeast China).

PubMed

Fan, Bin; Wang, Jin-Feng; Zheng, Bin; Qi, Xin-Zhu; Song, Jing-Yao; Li, Guang-Yu

2016-08-01

Sporotrichosis is a common subcutaneous mycosis caused by an infection with dimorphic fungus Sporothrix schenckii. We present a series of patients with eyelid sporotrichosis and study the clinical and histopathological presentation, microbiology, treatment options, and outcome. A retrospective case-series study of patients with a clinical diagnosis of eyelid sporotrichosis. Records were examined to obtain information regarding patient demographics, presenting symptoms and signs, histopathological examination, microbiology, management, and outcomes. Ten patients (4 men, 6 women; mean age 46.5 years, range 3-81 years) were included. Based on their clinical manifestations, eyelid sporotrichosis was classified into 3 major forms: (i) fixed cutaneous (6/10 cases), (ii) lymphocutaneous (3/10 cases), and (iii) eyelid abscess (1/10 cases). All the cases were treated with a terbinafine 12-week regimen. Nodules, papules, and abscesses regressed after treatment. No recurrence was discovered after a 12-week follow-up. Eyelid sporotrichosis has typical features of clinical manifestations. Histopathological examination and tissue culture are helpful for diagnosis. Confirmed cases normally require long-term systematic treatment with antifungal agents, but surgical removal is normally unnecessary. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Concentric Malar Lift in the Management of Lower Eyelid Rejuvenation or Retraction: A Clinical Retrospective Study on 342 Cases, 13 Years After the First Publication.

PubMed

Le Louarn, Claude

2018-06-01

Lower eyelid rejuvenation can, unfortunately, induce scleral show even if the lower eyelid procedure is limited. This study was designed to assess the effectiveness and reliability of the concentric malar lift technique in two scenarios: the first, in rejuvenation of the mid-face and, the second, in reconstructive surgery for correction of congenital or acquired eyelids malposition. The concentric malar lift technique was first published by Le Louarn (Aesthet Plast Surg 28(6):359-372, 2004). This retrospective study was carried out by analyzing data on patients operated on between January 2010 and January 2016. Patients operated on before 2010 were excluded because barbed thread sutures were not used in the first version of the technique. Patients after January 2016 were excluded to ensure adequate follow-up, and so 342 patients are included in the study. A total of 256 cases (75%) were for aesthetic mid-face lifting, and 86 cases (25%) were reconstructive surgeries for lower eyelid retraction. A spacer graft was used in 30 of these reconstructive cases (35%). The mean follow-up time was 13.6 months. All the concentric malar lifting procedures included strengthening the lateral canthus, which is a key element of the procedure. None of the patients developed secondary eyelid malposition, and all the cases of lower eyelid retraction displayed marked improvement both functionally and aesthetically. Two patients experienced loss of sensitivity of part in the infra-orbital nerve distribution for 4 months after the procedure. The concentric malar lift procedure enables the recruitment of a significant amount of skin into the lower eyelid: between 10 and 30 mm. It ensures better rejuvenation of the mid-face with minimal risk of lower eyelid malposition. In reconstruction of the lower eyelid lid, the concentric malar lift is able to reduce the need for skin grafting and a skin flap reducing the risks of visible scarring. 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 .

The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota.

PubMed Central

Bartley, G B

1994-01-01

Among incident cases of GO in Olmsted County, Minnesota: GO affected females six times more frequently than males (86% versus 14% of cases, respectively). The age-adjusted incidence rate was 16 cases per 100,000 population per year for females and 2.9 cases per 100,000 population for males. The peak incidence rates were bimodal, occurring in the age groups 40 to 44 years and 60 to 64 years in females and 45 to 49 years and 65 to 69 years in males. Among patients with GO, approximately 90% had Graves' hyperthyroidism, 1% had primary hypothyroidism, 3% had Hashimoto's thyroiditis, and 5% were euthyroid. Eyelid retraction was the most common ophthalmic feature of autoimmune thyroid disease, being present either unilaterally or bilaterally in more than 90% of patients at some point in their clinical course. Exophthalmos of one or both eyes affected approximately 60% of patients, restrictive extraocular myopathy was apparent in about 40% of patients, and optic nerve dysfunction occurred in either one or both eyes in 6% of patients with autoimmune thyroid disease. Only 5% of patients had the complete constellation of classic findings: eyelid retraction, exophthalmos, optic nerve dysfunction, extraocular muscle involvement, and hyperthyroidism. Upper eyelid retraction, either unilateral or bilateral, was documented in approximately 75% of patients at the time of diagnosis of GO. Lid lag also was a frequent early sign, being present either unilaterally or bilaterally in 50% of patients at the initial examination. At the time of diagnosis of GO, the most frequent ocular symptom was pain or discomfort, which affected 30% of patients. Some degree of diplopia was noted by approximately 17% of patients, lacrimation or photophobia was present in about 15% to 20% of patients, and 7.5% of patients complained of blurred vision. Decreased vision attributable to optic neuropathy was present in less than 2% of eyes at the time of diagnosis of GO. Thyroid dermopathy and acropachy accompanied GO in approximately 4% and 1% of patients, respectively. Myasthenia gravis occurred in less than 1% of patients. Superior limbic keratoconjunctivitis was documented in less than 4% of patients. The median age at the time of diagnosis of GO was 43 years (range, 8 to 88). Among patients with hyperthyroidism, 61% developed ophthalmopathy within 1 year of the onset of thyrotoxicosis. Symptoms and signs for which statistically significant changes occurred between the initial and final examinations included lacrimation, pain or ocular discomfort, photophobia, eyelid retraction, lid lag, eyelid fullness, conjunctival injection, chemosis, and exophthalmos.(ABSTRACT TRUNCATED AT 400 WORDS) Images FIGURE 1 FIGURE 2 FIGURE 3 PMID:7886878

The Use of Poly-4-Hydroxybutyrate (P4HB) Scaffold in the Ptotic Breast: A Multicenter Clinical Study.

PubMed

Adams, William P; Baxter, Richard; Glicksman, Caroline; Mast, Bruce A; Tantillo, Michael; Van Natta, Bruce W

2018-04-06

Mastopexy and reduction mammaplasty are often limited by the patient's poor native soft tissue quality, resulting in ptosis recurrence and loss of rejuvenated surgical results. Surgical scaffolds and acellular dermal matrices are used in these procedures to provide physical and mechanical stabilization of weakened or compromised tissue. GalaFLEX scaffold, made from poly-4-hydroxybutyrate (P4HB), is a next-generation product for soft tissue reinforcement that resorbs gradually while aiding tissue regeneration to achieve excellent outcomes. To assess the clinical performance of GalaFLEX scaffold in soft tissue reinforcement during elective mastopexy and reduction mammaplasty. This multicenter, single-arm, observational study assessed product performance and outcomes of GalaFLEX scaffold when used in breast surgery. Outcomes included ptosis correction and maintenance, associated adverse events, patient and surgeon satisfaction, and mammographic and ultrasound imaging evaluation. At 6 centers in the US, 62 of 69 enrolled patients were treated. Of this population, 89.7% had successful ptosis correction and maintenance at 1 year, with high patient and surgeon satisfaction for breast shape, droop/sag of the breast, and maintenance of results at 1 year. There were 5 adverse events deemed related to the device (8.0%), including nerve pain, breast swelling, ptosis, and 2 instances of asymmetry. GalaFLEX scaffold safely and successfully supports and elevates breast tissue in mastopexy and reduction mammaplasty, with maintained support at 1 year. Surgeon and patient satisfaction were high. No mammogram or ultrasound interference was detected.

Brachioplasty by Power-Assisted Liposuction and Fat Transfer: A Novel Approach That Obviates Skin Excision.

PubMed

Abboud, Marwan H; Abboud, Nicolas M; Dibo, Saad A

2016-09-01

Current brachioplasty techniques include excisional surgery alone or in combination with liposuction. These techniques are associated with poor outcomes, such as residual contour deformities and unfavorable scarring. The authors proposed a new classification system and treatment algorithm for brachial ptosis and described their experience with power-assisted liposuction and lipofilling to treat brachial ptosis without excisional surgery. Ninety-five patients with grades 1, 2, or 3 brachial ptosis who underwent brachioplasty were evaluated in a prospective study. Power-assisted liposuction was applied to the posterior arm and para-axillary region, and power-assisted lipofilling was applied to the so-called "bicipital triangle" of the medial arm. The patients' mean age was 39 years, mean body mass index was 28 kg/m(2), mean lipoaspirate volume was 240 mL per arm, and mean fat-injection volume was 110 mL per side. The mean operating time was 50 minutes, and the average follow-up period was 24 months. Hematoma developed in 2 patients who underwent brachioplasty in combination with another body contouring procedure (1 abdominal hematoma and 1 thigh hematoma; 2.1% complication rate). No other complications were recorded. Brachioplasty by means of power-assisted liposuction and lipofilling is a safe and reliable option that obviates excisional surgery in patients with mild to moderate brachial ptosis. 4 Therapeutic. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Malignant peripheral nerve sheath tumor of the third eyelid in a 3-year-old Rhodesian Ridgeback

PubMed Central

vom Hagen, Franziska; Romkes, Gwendolyna; Kershaw, Olivia; Eule, J Corinna

2015-01-01

Key Clinical Message A 3-year-old Rhodesian Ridgeback was presented with conjunctivitis, enlargement of the third eyelid and a dorsotemporal deviation of the right eye. A mass within the third eyelid was detected and excised. The histopathologic examination showed a malignant peripheral nerve sheath tumor, which most likely is a neurofibrosarcoma based on immunohistochemistry. PMID:25678975

Local injections of corticotropin releasing factor reduce doxorubicin-induced acute inflammation in the eyelid.

PubMed

McLoon, L K; Wirtschafter, J

1997-04-01

Doxorubicin chemomyectomy is an effective alternative treatment option for patients with blepharospasm and hemifacial spasm. One side effect of the use of doxorubicin in localized injections is the development of acute inflammation and skin injury at the injection site. Corticotropin releasing factor (CRF) was reported to reduce inflammation after acute inflammatory injuries due to other causes and at other sites. This study was performed to assess the potential of CRF to prevent the development of skin injury and eyelid soreness after local doxorubicin injection. Rabbits received lower eyelid injections of either 75 or 150 micrograms CRF followed by injection of either 0.5, 1, or 2 mg doxorubicin or doxorubicin alone. Eyelids were assessed for changes in acute inflammation by immunohistochemical localization of macrophages and monocytes using anti-CD11, an antibody specific for these cell types. Short-term alterations in vascular permeability were assessed using an Evans blue assay. Additional eyelids were followed daily for changes in the skin over the injection site to determine day of onset of skin injury and the total duration of skin injury. After 1 month, the eyelids were processed histologically for morphometric analysis of muscle fiber loss. Monkey eyelids also were examined for the effect of CRF and doxorubicin injections. Doxorubicin alone produced an acute inflammatory reaction in the treated eyelids, with a large influx of macrophages and monocytes throughout the connective tissue at 1 and 2 days. Corticotropin releasing factor pretreatment significantly reduced this influx of inflammatory cells into the connective tissue. Doxorubicin produced a large increase in vascular permeability in the treated eyelids, with resultant edema. Corticotropin releasing factor did not alter this change in vascular permeability, indicating that CRF appears to have a specific effect on migration of inflammatory cells rather than just a generalized effect on vascular permeability. Corticotropin releasing factor and doxorubicin cotreatments delayed the onset of skin injury and decreased the total duration of injury to the skin compared to doxorubicin alone. The effectiveness of doxorubicin chemomyectomy was maintained; muscle loss was significant at all doses of CRF combined with doxorubicin. Corticotropin releasing factor dramatically decreased the acute inflammatory reaction that results in the eyelid from local doxorubicin injections. Not only did CRF reduce the acute influx of monocytes and macrophages, but it protected the skin overlying the injection site, substantially reducing the extent of skin injury. The efficacy of doxorubicin-induced muscle toxicity was maintained. A treatment protocol that combines myotoxicity with antiinflammatory activity in the treated eyelids may lead to a more effective patient treatment by increasing patient acceptance. The potential should be explored that CRF may be of clinical use in limiting tissue injury when administered immediately after extravasation during cancer chemotherapy.

A new species of Theloderma (Amphibia: Anura: Rhacophoridae) from Vietnam.

PubMed

Nguyen, Truong Quang; Pham, Cuong The; Nguyen, Tao Thien; Ngo, Hai Ngoc; Ziegler, Thomas

2016-09-14

We describe a new species of Theloderma from northwestern Vietnam based on morphological differences and molecular divergence. Theloderma annae sp. nov. is distinguishable from its congeners on the basis of a combination of the following characters:  Size small, SVL 27.1-28.5 mm in males, 30.3-32.6 mm in females; head longer than wide;  vomerine teeth absent; snout long (SL/SVL 0.16-0.19); spines on upper eyelid absent;  tibiotarsal projection absent; dorsal skin smooth; dermal fringes on forearm and tarsus absent; dorsal surface grayish green; and throat and ventral surface of arms and thighs brown with white spots.

A case of unilateral phthiriasis palpebrarum infestation involving the left eye.

PubMed

Ashraf, Mohammad; Waris, Abdul; Kumar, Ashwini; Akhtar, Nahid

2014-06-06

Phthiriasis palpebrarum is a rare cause of eyelid infestation. We report a case of unilateral phthiriasis palpebrarum. A 28-year-old man presented with moderate itching associated with lacrimation and irritation in the left eye. The initial evaluation of the patient revealed multiple white dots on the left upper eyelashes. Slit-lamp examination revealed multiple nits attached to the base and shaft of the cilia. There was no hyperaemia or discharge present in the conjunctiva and the cornea was clear and shiny. The right eye was perfectly normal. The patient was treated with moxifloxacin eye ointment and was completely cured in 1 week. 2014 BMJ Publishing Group Ltd.

Effects of a New Eyelid Shampoo on Lid Hygiene and Eyelash Length in Patients with Meibomian Gland Dysfunction: A Comparative Open Study

PubMed Central

Miki, Emiko

2016-01-01

Purpose. Meibomian gland dysfunction (MGD) can lead to abnormalities in the composition and function of tear film, resulting in dry eye. Eyelid hygiene is a key to management of MGD. We tested a novel eyelid shampoo (Eye Shampoo Long, ESL) for its ability to maintain lid hygiene. This shampoo is nonirritating and can potentially lengthen eyelashes. This study was aimed to evaluate the efficacy of ESL in the treatment of MGD and its effects on eyelash length. Methods. Ten patients with MGD and 10 healthy subjects without MGD applied ESL twice daily for 8 weeks. Patients were examined for lid margin and dry eye before and after the trial. Subjective symptoms were evaluated. Eyelash length was measured at baseline and at the end of the trial. Results. In the MGD group, significant improvements were observed in subjective symptoms obstruction of the meibomian orifice, secretion of meibum, eyelashes contamination, eyelid margin foam, and SPK. Eyelash length became significantly longer. Conclusions. Maintaining eyelid hygiene using ESL improved the eyelid margins and symptoms of dry eye in MGD patients and increased eyelash length. These findings are promising and warrant confirmation in a larger randomized controlled study. PMID:28078136

[Management of eyelid tumors: general considerations].

PubMed

Lasudry, J

2011-12-01

Despite the fact that the majority of eyelid tumors are benign, proper management in daily practice requires detection of the malignant ones. Several clinical criteria are usually proposed to support or reject a hypothesis of malignancy; however, most are of limited reliability. In any case of doubt, outpatient biopsy is recommended, so as to establish the correct diagnosis and formulate the most appropriate treatment plan. In all facial malignancies, the first (and absolutely mandatory) consideration is control of the cancer. Then, restoration of eyelid function can be addressed, in the following order: protection of the globe by complete dynamic eyelid closure and opening, visual function (and prevention of possible deprivation amblyopia) by insuring a clear visual axis, correction of the tear film, efficient lachrymal drainage, and only then the role of the eyelids in facial expression and esthetics. For most malignant eyelid tumors, the best assurance of complete excision is obtained by extemporaneous examination of the resection margins by frozen section (by Mohs' micrographic surgery techniques, or a variation thereof). Currently, advancement and transposition flaps, possibly in combination with tarso-conjunctival or skin grafts, are the most utilised techniques. Despite the lack of histological verification, new treatment modalities, including topical chemotherapy, photodynamic therapy and cryotherapy, may provide interesting treatment options, particularly in collaboration with the dermatologist. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

[Magnetic resonance imaging findings on the eyelids of Japanese cadavers for anatomical studies and a comparative examination of their histological pictures].

PubMed

Ide, Atsushi; Wakimasu, Koichi; Shiba, Tomoko; Kodama, Junichi; Shirasawa, Nobuyuki

2009-12-01

To clarify ambiguous areas in interpreting MR images of Japanese eyelids, a histological examination was conducted on cadavers after the MRI for a comparative evaluation. Orbital sections including the unilateral upper and lower palpebrae of two Japanese cadavers (an 87-year-old woman and a 49-year-old man) were examined. Following MRI, the specimens of the same cadavers were examined histologically for a comparative evaluation. In both cadavers, a high signal intensity area with a hazy appearance unlike the orbital fat--fibroadipose tissue rich with connective tissue--was recognized between the orbicularis muscle and orbital septum. The same high signal intensity area that appeared to encase the posterior section of the descending orbital fat was also composed of fibroadipose tissue. Because of the presence of this intervening fibroadipose tissue, the posterior surface of the orbicularis muscle and the orbital septum could not come into contact with each other. Although limited to only two subjects, the current observation proved that fibroadipose tissue exists not only in the superficial layer of the orbital fat but that it further descends to surround the lowest portion of the orbital fat. As already reported, it was mainly the fibroadipose tissue, but not the orbital fat, that descends into the palpebral space.

Induced videokeratography alterations in patients with excessive meibomian secretions.

PubMed

Markomanolakis, Marinos M; Kymionis, George D; Aslanides, Ioannis M; Astyrakakis, Nikolaos; Pallikaris, Ioannis G

2005-01-01

To describe lipid-induced specific videokeratographic (VKG) corneal changes and subsequent resolution after eyelid washing. VKG was performed with C-Scan corneal topography. In all patients an excessive meibomian gland lipid secretion was found with or without coexistent chronic posterior blepharitis. After the initial VKG, a meticulous cleaning of the lids with a mild alkali shampoo (10% Johnson's baby shampoo in sterile water) was done, first by gently scrubbing the closed eyelid fissure with the solution to mobilize and emulsify any Meibomian gland secretions followed by cleaning of the upper and lower margins individually, using Q-tip applicators soaked in the detergent. Three patients with tear film lipid layer excess (TFLE), which correlated with the presence of a superior or central corneal steepening in VKG, were studied. In two of the subjects, careful lid washing reversed either completely or partially this VKG effect, whereas in the last patient the VKG changes after artificially increasing the tear film lipid content is described. Meibomian gland lipid secretions may induce mainly superior and occasionally central VKG corneal steepening that is not correlated with any slit-lamp pathologic findings. Computerized corneal topography can help detect such corneal abnormalities, and their reversibility may distinguish them from other pathologic conditions (such as contact lens-induced warpage, eccentric ablations, irregular astigmatism, superior keratoconus).

Large Kelvin-Helmholtz Billow Trains Observed in the Kuroshio above a Seamount

NASA Astrophysics Data System (ADS)

Chang, M. H.; Jheng, S. Y.; Lien, R. C.

2016-02-01

Trains of large Kelvin-Helmholtz (KH) billows were observed within the Kuroshio core, off southeastern Taiwan, at 230-m depth above a seamount in shipboard echo sounder, ADCP, and LADCP/CTD profiling, and moored ADCP measurements. The large KH billow trains were present in a strong shear band along 0.55 ms-1 isotach within the Kuroshio core as a result of the Kuroshio current interacting with the rapid changing topography. Each individual billow, resembling a cats' eye, had a horizontal length scale of 200 m and a vertical amplitude scale of 100 m, and a propagation timescale of 7 minutes, near local buoyancy period. Overturns were frequently observed in both the billow core and the upper eyelid. The shear instability criterion (Ri < 0.25) was reached in the billow core. The dissipation rate of turbulent kinetic energy in the core and in the eyelid is comparable at an average value of O(10-4) WKg-1 and a maximum value of O(10-3) WKg-1. The KH billows derive energy from the Kuroshio kinetic energy. The corresponding turbulence mixing allows the water mass exchange between the Kuroshio and the surrounding water. These small-scale processes play an important role in the energy and water mass budgets within the Kuroshio.

Eyelid drooping

MedlinePlus

... around or behind the eye Diabetes Horner syndrome Myasthenia gravis Stroke Swelling in the eyelid, such as with ... performed include: Slit-lamp examination Tension test for myasthenia gravis Visual field testing

MRI Evidence of Cerebellar and Extraocular Muscle Atrophy Differently Contributing to Eye Movement Abnormalities in SCA2 and SCA28 Diseases.

PubMed

Politi, Letterio Salvatore; Bianchi Marzoli, Stefania; Godi, Claudia; Panzeri, Marta; Ciasca, Paola; Brugnara, Gianluca; Castaldo, Anna; Di Bella, Daniela; Taroni, Franco; Nanetti, Lorenzo; Mariotti, Caterina

2016-05-01

Spinocerebellar ataxias type 2 and 28 (SCA2, SCA28) are autosomal dominant disorders characterized by progressive cerebellar and oculomotor abnormalities. We aimed to investigate cerebellar, brainstem, and extraocular muscle involvement in the mitochondrial SCA28 disease compared with SCA2. We obtained orbital and brain 1.5 T-magnetic resonance images (MRI) in eight SCA28 subjects, nine SCA2, and nine age-matched healthy subjects. Automated segmentation of cerebellum and frontal lobe was performed using Freesurfer software. Manual segmentations for midbrain, pons, and extraocular muscles were performed using OsiriX. Eye movement abnormalities in SCA2 subjects were characterized by slow horizontal saccades. Subjects with SCA28 variably presented hypometric saccades, saccadic horizontal pursuit, impaired horizontal gaze holding, and superior eyelid ptosis. Quantitative brain MRI demonstrated that cerebellar and pons volumes were significantly reduced in both SCA2 and SCA28 subjects compared with controls (P < 0.03), and in SCA2 subjects compared with SCA28 (P < 0.01). Midbrain and frontal lobe volumes were also significantly reduced in SCA2 compared to controls (P < 0.03), whereas these volumes did not differ between SCA2 and SCA28 and between SCA28 and control subjects. The extraocular muscle areas were 37% to 48% smaller in SCA28 subjects compared with controls (P < 0.002), and 14% to 36% smaller compared with SCA2 subjects (P < 0.03). Extraocular muscle areas did not differ between SCA2 and controls. Our MRI findings support the hypothesis of different cerebellar and extraocular myopathic contributions in the eye movement abnormalities in SCA2 and SCA28 diseases. In SCA28, a myopathic defect selectively involving the extraocular muscles supports a specific impairment of mitochondrial energy metabolism.

Anxiolytic- and Antidepressant-like Effects of the Methadone Metabolite 2-ethyl-5-methyl-3,3-diphenyl-1-pyrroline (EMDP)

PubMed Central

Lee, Bridgin G.; Olson, Thao T.; Xie, Teresa; Xiao, Yingxian; Blendy, Julie A.; Kellar, Kenneth J.

2015-01-01

The enhancement of GABAergic and monoaminergic neurotransmission has been the mainstay of pharmacotherapy and the focus of drug-discovery for anxiety and depressive disorders for several decades. However, the significant limitations of drugs used for these disorders underscores the need for novel therapeutic targets. Neuronal nicotinic acetylcholine receptors (nAChRs) may represent one such target. For example, mecamylamine, a non-competitive antagonist of nAChRs, displays positive effects in preclinical tests for anxiolytic and antidepressant activity in rodents. In addition, nicotine elicits similar effects in rodent models, possibly by receptor desensitization. Previous studies (Xiao et al., 2001) have identified two metabolites of methadone, EMDP (2-ethyl-5-methyl-3,3-diphenyl-1-pyrroline) and EDDP (2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine), which are considered to be inactive at opiate receptors, as relatively potent noncompetitive channel blockers of rat α3β4 nAChRs. Here, we show that these compounds are likewise highly effective blockers of human α3β4 and α4β2 nAChRs. Moreover, we show that they display relatively low affinity for opiate binding sites labeled by [3H]-naloxone. We then evaluated these compounds in rats and mice in preclinical behavioral models predictive of potential anxiolytic and antidepressant efficacy. We found that EMDP, but not EDDP, displayed robust effects predictive of anxiolytic and antidepressant efficacy without significant effects on locomotor activity. Moreover, EMDP at behaviorally active doses, unlike mecamylamine, did not produce eyelid ptosis, suggesting it may produce fewer autonomic side effects than mecamylamine. Thus, the methadone metabolite EMDP may represent a novel therapeutic avenue for the treatment of some affective disorders. PMID:26365569

An unusual cutaneous manifestation of Crohn's disease.

PubMed

Weiser, Jessica A; Markowitz, David M; Husain, Sameera; Grossman, Marc E

2011-01-01

A 61-year-old man with a 12-year history of quiescent Crohn's disease on mesalamine presented to his gastroenterologist in April 2009, complaining of abdominal cramping, diarrhea, and a 25-lb weight loss over 6 weeks. He did not respond to prednisone 50 mg and 6-mercaptopurine 100 mg daily. Abdominal computed tomography findings revealed diffuse submucosal edema consistent with extensive colitis. Colonoscopy demonstrated diffuse inflammation with erythema, friability, and shallow ulcerations in the rectum and colon. Biopsies were consistent with Crohn's colitis. He was admitted for infliximab infusion for his unremitting diarrhea. Five days before admission, the patient noted mild swelling and redness of the left lower eyelid, which progressed to involve the right lower eyelid with frank pus draining from both eyes. He had no visual impairment or eye pain. Two days before admission, an ophthalmologist prescribed a steroid eyedrop with no relief. He also complained of seropurulent painful skin lesions on his face and scalp, which spread to involve his upper trunk and proximal arms. On admission to the hospital, dermatology, ophthalmology, and infectious disease consultations were obtained to rule out disseminated infection before initiation of infliximab therapy. The patient was afebrile and hemodynamically stable. His oral mucosa was normal. He had prominent bilateral lower eyelid edema, erythema, and superficial erosions with hemorrhagic crusting and frank green purulent drainage from both eyes, with crusting along the lower lash line and bilateral sclera injection (Figure 1). On his scalp, face, trunk, and proximal extremities, he had 25 to 30 erythematous, 4- to 8-mm papulopustules with narrow red halos, some with central necrosis and crusting (Figure 2). Cultures from the purulent ocular drainage and pustules on the trunk and arms were all negative for bacteria, virus, and fungi. Gram stain from the eye drainage showed polymorphonuclear leukocytes without organisms. Tissue cultures were negative for bacterial, fungal, and mycobacterial infection. Skin biopsy taken from the central upper back demonstrated subcorneal pustules with areas of eroded epidermis and collections of neutrophils in the superficial dermis (Figure 3). Special stains were negative for organisms. He received infliximab infusion 5 mg/kg for a total dose of 420 mg over 2 hours. Within 48 hours of infusion, there was notable decrease in size of lesions, in addition to reduction of purulent drainage from both eyes. The patient was discharged home following infliximab infusion. His skin lesions resolved during a period of 2 weeks, leaving small pink atrophic scars. He received his second infusion of infliximab 2 weeks after discharge with continued improvement in his gastrointestinal symptoms.

Preliminary evidence that light through the eyelids can suppress melatonin and phase shift dim light melatonin onset

PubMed Central

2012-01-01

Background A previous study reported a method for measuring the spectral transmittance of individual human eyelids. A prototype light mask using narrow-band “green” light (λmax = 527 nm) was used to deliver light through closed eyelids in two within-subjects studies. The first study investigated whether an individual-specific light dose could suppress melatonin by 40% through the closed eyelid without disrupting sleep. The light doses were delivered at three times during the night: 1) beginning (while subjects were awake), 2) middle (during rapid eye movement (REM) sleep), and 3) end (during non-REM sleep). The second study investigated whether two individual-specific light doses expected to suppress melatonin by 30% and 60% and delivered through subjects’ closed eyelids before the time of their predicted minimum core body temperature would phase delay the timing of their dim light melatonin onset (DLMO). Findings Compared to a dark control night, light delivered through eyelids suppressed melatonin by 36% (p = 0.01) after 60-minute light exposure at the beginning, 45% (p = 0.01) at the middle, and 56% (p < 0.0001) at the end of the night. In the second study, compared to a dark control night, melatonin was suppressed by 25% (p = 0.03) and by 45% (p = 0.009) and circadian phase, as measured by DLMO, was delayed by 17 minutes (p = 0.03) and 71 minutes (ns) after 60-minute exposures to light levels 1 and 2, respectively. Conclusions These studies demonstrate that individual-specific doses of light delivered through closed eyelids can suppress melatonin and phase shift DLMO and may be used to treat circadian sleep disorders. PMID:22564396

Preliminary evidence that light through the eyelids can suppress melatonin and phase shift dim light melatonin onset.

PubMed

Figueiro, Mariana G; Rea, Mark S

2012-05-07

A previous study reported a method for measuring the spectral transmittance of individual human eyelids. A prototype light mask using narrow-band "green" light (λmax = 527 nm) was used to deliver light through closed eyelids in two within-subjects studies. The first study investigated whether an individual-specific light dose could suppress melatonin by 40% through the closed eyelid without disrupting sleep. The light doses were delivered at three times during the night: 1) beginning (while subjects were awake), 2) middle (during rapid eye movement (REM) sleep), and 3) end (during non-REM sleep). The second study investigated whether two individual-specific light doses expected to suppress melatonin by 30% and 60% and delivered through subjects' closed eyelids before the time of their predicted minimum core body temperature would phase delay the timing of their dim light melatonin onset (DLMO). Compared to a dark control night, light delivered through eyelids suppressed melatonin by 36% (p = 0.01) after 60-minute light exposure at the beginning, 45% (p = 0.01) at the middle, and 56% (p < 0.0001) at the end of the night. In the second study, compared to a dark control night, melatonin was suppressed by 25% (p = 0.03) and by 45% (p = 0.009) and circadian phase, as measured by DLMO, was delayed by 17 minutes (p = 0.03) and 71 minutes (ns) after 60-minute exposures to light levels 1 and 2, respectively. These studies demonstrate that individual-specific doses of light delivered through closed eyelids can suppress melatonin and phase shift DLMO and may be used to treat circadian sleep disorders.

Eyelid Dermatitis Caused by Allergic Contact to Acrylates in Artificial Nails.

PubMed

Moreira, Jorge; Gonçalves, Rita; Coelho, Pedro; Maio, Tiago

2017-03-13

Over the past few years, there has been an increase in cases of allergic contact dermatitis caused by acrylates, because of the growing popularity of artificial nails. Pathological reactions to artificial nails typically occur on or around the nail area. Eyelid contact dermatitis due to artificial nails is rarely seen, especially in a nonoccupational setting. The authors report the case of a 45-year-old female accountant who developed eyelid dermatitis due to artificial nails.

Pattern of eyelid motion predictive of decision errors during drowsiness: oculomotor indices of altered states.

PubMed

Lobb, M L; Stern, J A

1986-08-01

Sequential patterns of eye and eyelid motion were identified in seven subjects performing a modified serial probe recognition task under drowsy conditions. Using simultaneous EOG and video recordings, eyelid motion was divided into components above, within, and below the pupil and the durations in sequence were recorded. A serial probe recognition task was modified to allow for distinguishing decision errors from attention errors. Decision errors were found to be more frequent following a downward shift in the gaze angle which the eyelid closing sequence was reduced from a five element to a three element sequence. The velocity of the eyelid moving over the pupil during decision errors was slow in the closing and fast in the reopening phase, while on decision correct trials it was fast in closing and slower in reopening. Due to the high variability of eyelid motion under drowsy conditions these findings were only marginally significant. When a five element blink occurred, the velocity of the lid over pupil motion component of these endogenous eye blinks was significantly faster on decision correct than on decision error trials. Furthermore, the highly variable, long duration closings associated with the decision response produced slow eye movements in the horizontal plane (SEM) which were more frequent and significantly longer in duration on decision error versus decision correct responses.

[Descriptive study on basal cell eyelid carcinoma].

PubMed

Pfeiffer, M J; Pfeiffer, N; Valor, C

2015-09-01

To describe a series of cases of basal cell carcinomas of the eyelid. A descriptive and retrospective study was conducted by reviewing the medical outcome, histopathological history, and photographic images of 200 patients with basal cell eyelid carcinomas. All were treated in the Herzog Carl Theodor Eye Hospital in Munich, Germany, between 2000 and 2013. In the present study, it was found that females are more affected than males. The mean age of presentation of the tumor occurred at the age of 70 years. In 50% of the cases the tumor was found on the lower lid, especially medially from the center of the lid. The lid margin was involved in 47% of all tumors. The mean diameter was 9.2mm. The recurrence rate after surgery with histologically clear resection margins was 5%. There was a significant relationship between tumor diameter and age. As tumors where located farther away from medial and closer to the lid margin, they became larger. There is a predominance of women affected by this tumor. This may be related to the fact that the sample was taken from those attending an oculoplastic surgery clinic, where there are generally more women than men attending. The formation of basal cell carcinomas increases with age. The infrequent involvement of the upper lid could be explained by the protection of the the eyebrow. The frequent involvement of the lower lid may be due to the light reflection (total reflection) by the cornea on the lower lid margin. Also chemical and physical effects of the tears may be more harmful on the lower lid. Patients tend to ask for medical help when they are females, younger, when the tumor is closer to the medial canthus or when the tumor is away from the lid margin. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Eyelid Problems

MedlinePlus

... wine stain, because of its resemblance to a dark red wine. If this birthmark involves the eye, ... examined by an ophthalmologist shortly after birth. Small dark moles, called nevi, on the eyelids or on ...

Slit-lamp exam

MedlinePlus

... eyes, especially the eyelids, cornea, conjunctiva, sclera, and iris. Often a yellow dye (fluorescein) is used to ... lens on the front of the eye) Eyelids Iris (colored part of the eye between the cornea ...

Eyelid Dermatitis Caused by Allergic Contact to Acrylates in Artificial Nails

PubMed Central

Moreira, Jorge; Gonçalves, Rita; Coelho, Pedro; Maio, Tiago

2017-01-01

Over the past few years, there has been an increase in cases of allergic contact dermatitis caused by acrylates, because of the growing popularity of artificial nails. Pathological reactions to artificial nails typically occur on or around the nail area. Eyelid contact dermatitis due to artificial nails is rarely seen, especially in a nonoccupational setting. The authors report the case of a 45-year-old female accountant who developed eyelid dermatitis due to artificial nails. PMID:28603598

Eyelid lift

MedlinePlus

... while sleeping (rarely permanent) Double or blurred vision Dry eyes Temporary swelling of the eyelids Tiny whiteheads after ... conditions that make blepharoplasty more risky are: Diabetes Dry eye or not enough tear production Heart disease or ...

Cyanoacrylates

MedlinePlus

Wash exposed areas with warm water right away. If the glue gets on the eyelids, try to keep the eyelids separated. If the eye becomes glued shut, get emergency medical care right away. If the eye is partially ...

A new species of Pristimantis from southern Ecuador (Anura, Craugastoridae).

PubMed

Székely, Paul; Cogălniceanu, Dan; Székely, Diana; Páez, Nadia; Ron, Santiago R

2016-01-01

A new species of Pristimantis is described from Reserva Buenaventura, southern Ecuador, at elevations between 878 and 1082 m. A molecular phylogeny based on nuclear and mitochondrial genes shows that the new species is closely related to Pristimantis phoxocephalus, Pristimantis riveti, and Pristimantis versicolor. The new species differs from them and other morphologically similar congeners in having a low W-shaped dermal ridge in the scapular region, a large conical tubercle on the upper eyelid and on the heel, a thin mid dorsal fold, and a longitudinal lateral fold starting behind the tympanic fold and extending along the anterior two thirds of the flank. The new species inhabits cloud forests in the Pacific slopes of the Andes.

Influence of atipamezole on effects of midsacral subarachnoidally administered detomidine in mares.

PubMed

Skarda, R T; Muir, W W

1998-04-01

To examine effects of atipamezole on detomidine midsacral subarachnoidally-induced analgesia, cardiovascular and respiratory activity, head ptosis, and position of pelvic limbs in healthy mares. 10 healthy mares. Using a randomized, blinded, crossover study design, mares received detomidine (0.03 mg/kg of body weight, diluted in 3 ml of CSF) midsacral subarachnoidally, followed by atipamezole (0.1 mg/kg [test]) or sterile saline (0.9% NaCl) solution (control), i.v. 61 minutes later and saline solution (3 ml, midsacral subarachnoidally) on a separate occasion, at least 2 weeks later. Analgesia was determined by lack of sensory perception to electrical stimulation at the perineal dermatome and no response to needle-prick stimulation extending from the coccygeal to T15 dermatomes. Arterial acid-base (pH, standard bicarbonate, and base excess values), gas tensions (PO2, PCO2), PCV, total solids concentration, heart and respiratory rates, rectal temperature, and arterial blood pressure were determined, and mares were observed for sweating and urination. Mean scores of perineal analgesia, head ptosis, position of pelvic limbs, and cardiovascular and respiratory data were compared for the 3-hour test period. Subarachnoidally administered detomidine induced perineal analgesia (mean +/- SD onset, 9.0 +/- 4.6 minutes; duration, 130 +/- 26 minutes), marked head ptosis, moderate changes in pelvic limb position, cardiovascular and respiratory depression, sweating in analgesic zones, and diuresis. Intravenously administered atipamezole significantly reduced mean scores of detomidine-induced perineal analgesia, head ptosis, pelvic limb position, sweating and diuresis; partially antagonized detomidine-induced bradycardia; and did not effect detomidine-induced bradypnea. Most effects of midsacral subarachnoidally administered detomidine, except bradycardia and bradypnea, were reversed by atipamezole (0.1 mg/kg, i.v.), indicating that most of the actions of detomidine were mediated via activation of alpha2-adrenergic receptors.

DIEP Flap Breast Reconstruction in Patients with Breast Ptosis: 2-Stage Reconstruction Using 3-Dimensional Surface Imaging and a Printed Mold

PubMed Central

Yano, Kenji; Taminato, Mifue; Nomori, Michiko; Hosokawa, Ko

2017-01-01

Background: Autologous breast reconstruction can be performed for breasts with ptosis to a certain extent, but if patients desire to correct ptosis, mastopexy of the contralateral breast is indicated. However, accurate prediction of post-mastopexy breast shape is difficult to make, and symmetrical breast reconstruction requires certain experience. We have previously reported the use of three-dimensional (3D) imaging and printing technologies in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. In the present study, these technologies were applied to the reconstruction of breasts with ptosis. Methods: Eight breast cancer patients with ptotic breasts underwent two-stage unilateral DIEP flap breast reconstruction. In the initial surgery, tissue expander (TE) placement and contralateral mastopexy are performed simultaneously. Four to six months later, 3D bilateral breast imaging is performed after confirming that the shape of the contralateral breast (post-mastopexy) is somewhat stabilized, and a 3D-printed breast mold is created based on the mirror image of the shape of the contralateral breast acquired using analytical software. Then, DIEP flap surgery is performed, where the breast mold is used to determine the required flap volume and to shape the breast mound. Results: All flaps were engrafted without any major perioperative complications during both the initial and DIEP flap surgeries. Objective assessment of cosmetic outcome revealed that good breast symmetry was achieved in all cases. Conclusions: The method described here may allow even inexperienced surgeons to achieve reconstruction of symmetrical, non-ptotic breasts with ease and in a short time. While the requirement of two surgeries is a potential disadvantage, our method will be particularly useful in cases involving TEs, i.e., delayed reconstruction or immediate reconstruction involving significant skin resection. PMID:29184728

21 CFR 886.5200 - Eyelid thermal pulsation system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... use in the application of localized heat and pressure therapy to the eyelids. The device is used in...-ionizing radiation; (2) Design, description, and performance data should validate safeguards related to the...

21 CFR 886.5200 - Eyelid thermal pulsation system.

Code of Federal Regulations, 2013 CFR

2013-04-01

... use in the application of localized heat and pressure therapy to the eyelids. The device is used in...-ionizing radiation; (2) Design, description, and performance data should validate safeguards related to the...

Bilateral eyelid ecchymosis and subconjunctival haemorrhage manifesting as presenting feature in a case of dengue haemorrhagic fever.

PubMed

Jain, Sparshi; Goswami, Anup; Singh, Nidhi; Kaur, Savleen

2015-10-01

We report a case of bilateral eyelid ecchymosis and subconjunctival haemorrhage, a rare presenting feature of dengue haemorrhagic fever. A 17-year-old boy presented to the emergency department with complaints of redness in both eyes and vomiting. He had bilateral eyelid ecchymosis with subconjunctival haemorrhage. Complete blood count revealed a significantly reduced platelet count of 11000/µL suggestive of dengue haemorrhagic fever (DHF). Ocular manifestations were followed by other systemic haemorrhagic manifestations of dengue later on which violates the usual sequence of events of dengue fever. Bilateral eyelid ecchymosis is a rare clinical manifestation and a rare presenting feature of dengue fever and one has to keep high index of suspicion for presence of dengue whenever a case of fever presents with lid ecchymosis/haemorrhage. © The Author(s) 2014.

Traditional Lower Blepharoplasty: Is Additional Support Necessary? A 30-Year Review.

PubMed

Maffi, Terry R; Chang, Shiliang; Friedland, Jack A

2011-07-01

Several refinements have been made in lower eyelid rejuvenation, and there is now strong belief that the traditional approach places too little emphasis on lower eyelid support. The purpose of this study was to retrospectively review the 30-year experience of the senior author (J.A.F.) performing primary lower blepharoplasty by the traditional approach and to determine the complication rate when lower lid-tightening procedures were not performed concomitantly. A retrospective chart review of all traditional blepharoplasties performed by the senior author over the past 30 years was performed. The traditional approach was performed through an external, subciliary incision. Concomitant lower lid-tightening procedures were not performed. The authors determined the complication rate of the procedure, such as symptomatic lower eyelid malposition and chemosis. A total of 3014 patients underwent traditional lower blepharoplasties and, after applying the exclusion criteria, 2007 patients were studied. A postoperative complication was defined as the development of either chemosis or symptomatic lower eyelid malposition. Chemosis developed in only 1.2 percent of the patients (24 of 2007). Eight of the 2007 patients (0.4 percent) developed symptomatic lower eyelid malposition. This study proves that when performed meticulously and precisely, traditional lower blepharoplasty is safe and effective. Correction of preoperatively diagnosed lower lid laxity is essential; however, when lower eyelid tone is adequate, the authors believe that the routine addition of a tightening procedure for support or the routine use of combined internal and external approaches is unnecessary. Therapeutic, IV.

Histological and Ultrastructural Studies on the Conjunctiva of the Barred Owl (Strix varia)

PubMed Central

Jochems, Brian; Phillips, Thomas E.

2015-01-01

This report is the first characterization of the histology and ultrastructure of the barred owl conjunctiva. The inferior eyelid was dominated by a large disk-shaped plate covered by a non-keratinized stratified squamous or cuboidal epithelium of variable thickness. The apical surface of the plate epithelium varied from flat to long microvilli or even short cytoplasmic extensions similar to those seen in the third eyelid. All specimens had a few goblet cells filled with mucous secretory granules in the plate region. The underlying connective tissue was a dense fibroelastic stroma. Eosinophils were surprisingly common in the epithelial layer and underlying connective tissue in the plate and more distal orbital mucosal region. The orbital mucosa contained goblet cells with heterogeneous glycosylation patterns. The leading edge and marginal plait of the third eyelid are designed to collect fluid and particulate matter as they sweep across the surface of the eye. The palpebral conjunctival surface of the third eyelid was covered by an approximately five-cell-deep stratified squamous epithelium without goblet cells. The bulbar surface of the third eyelid was a bilayer of epithelial cells whose superficial cells have elaborate cytoplasmic tapering extensions reaching out 25 μm. Narrow cytofilia radiated outwards up to an additional 15–20 μm from the cytoplasmic extensions. Lectin labeling demonstrated heterogeneous glycosylation of the apical membrane specializations but only small amounts of glycoprotein-filled secretory granules in the third eyelid. PMID:26562834

Interactions between prefrontal cortex and cerebellum revealed by trace eyelid conditioning.

PubMed

Kalmbach, Brian E; Ohyama, Tatsuya; Kreider, Joy C; Riusech, Frank; Mauk, Michael D

2009-01-01

Eyelid conditioning has proven useful for analysis of learning and computation in the cerebellum. Two variants, delay and trace conditioning, differ only by the relative timing of the training stimuli. Despite the subtlety of this difference, trace eyelid conditioning is prevented by lesions of the cerebellum, hippocampus, or medial prefrontal cortex (mPFC), whereas delay eyelid conditioning is prevented by cerebellar lesions and is largely unaffected by forebrain lesions. Here we test whether these lesion results can be explained by two assertions: (1) Cerebellar learning requires temporal overlap between the mossy fiber inputs activated by the tone conditioned stimulus (CS) and the climbing fiber inputs activated by the reinforcing unconditioned stimulus (US), and therefore (2) trace conditioning requires activity that outlasts the presentation of the CS in a subset of mossy fibers separate from those activated directly by the CS. By use of electrical stimulation of mossy fibers as a CS, we show that cerebellar learning during trace eyelid conditioning requires an input that persists during the stimulus-free trace interval. By use of reversible inactivation experiments, we provide evidence that this input arises from the mPFC and arrives at the cerebellum via a previously unidentified site in the pontine nuclei. In light of previous PFC recordings in various species, we suggest that trace eyelid conditioning involves an interaction between the persistent activity of delay cells in mPFC-a putative mechanism of working memory-and motor learning in the cerebellum.

First case of surgical treatment of Farber's disease.

PubMed

Haraoka, G; Muraoka, M; Yoshioka, N; Wakami, S; Hayashi, I

1997-10-01

Farber's disease (Farber's lipogranulomatosis), which is inherited as an autosomal recessive trait, was first reported by Farber in 1952. We report a case of Farber's disease in a 12-year-old female. Her younger brother was affected with Farber's disease and died of it at 2 years of age. When she first presented, our patient's main clinical features were a shrill voice; subcutaneous nodules; contracture of the joints throughout the body; and granulomas of the oral cavity, the pharynx, and the upper and lower eyelids. Serial radiographs disclosed deformation of the joints throughout the body. Due to the granulomas in her oral cavity, she could take little food orally and therefore was malnourished. We performed a granulectomy under general anesthesia, and her difficulty with feeding and upper airway obstruction improved. There is no specific treatment for Farber's disease, and most patients reported have died by 2 years of age. This is the first reported patient with Farber's disease who has been surgically treated.

Eyelid Dermatitis: Contact Allergy to 3-(Dimethylamino)propylamine

PubMed Central

Knopp, Eleanor; Watsky, Kalman

2014-01-01

We present the case of a 42-year-old woman with intractable eyelid dermatitis. Patch testing revealed sensitization to 3-(dimethylamino)propylamine (DMAPA). DMAPA is an important etiology of allergic contact dermatitis of the eyelids and face but is easily missed even with expanded-series patch testing. We also review the most common causative allergens in eyelid dermatitis cited in the literature over the past decade. DMAPA is a reagent used in the formation of cocamidopropyl betaine (CAPB), a common additive to liquid soaps, shampoos, and other cleansing products because of its utility as a surfactant. Beginning in the 1980s, reports of allergy to CAPB surfaced in the literature. Ultimately, a majority of patch testing studies have shown that clinical allergy to CAPB-containing products actually reflects allergy to contaminant DMAPA in most cases. Amidoamine, another intermediate in the formation of CAPB, may also be implicated through a proposed mechanism of conversion to DMAPA in the skin. When patch-testing for eyelid and facial dermatitis, it is crucial to test with DMAPA directly, not just with CAPB; unlike commercial-grade CAPB, the CAPB in patch test kits is ultrapure and does not contain contaminant DMAPA. PMID:19134437

Unilateral orbital lacrimal gland abscess in a horse.

PubMed

Greenberg, Shari M; Plummer, Caryn E; Brooks, Dennis E; Porter, Michael; Farina, Lisa L; Winter, Matthew D

2011-01-01

A 20-year-old Thoroughbred gelding presented for evaluation of a periorbital dorsal swelling of the left eye that had been intermittently present for 3 months. Upon ocular examination, a firm, non-painful swelling was identified under the upper eyelid in the region of the orbital lacrimal gland, and was noted to extend anteriorly from underneath the dorsal orbital rim. Ultrasonographic examination revealed a mixed echogenic mass along the dorsal orbital rim that followed the contour of the globe. CT scan showed a moderately contrast enhancing mass that was contiguous with the eyelid. Differential diagnoses included neoplasia, inflammatory lesions such as a granuloma, foreign body or abscess. Surgical exploration and excision of the mass revealed a lobular structure with a purulent center. Histopathology identified the mass as the orbital lacrimal gland with concurrent severe dacryoadenitis. Culture of the purulent center of the mass revealed beta-hemolytic Staphylococcus aureus. The patient was maintained on supportive care and antibiotic treatment based on sensitivity postoperatively. No recurrence was reported 40 months later. This paper aims to identify bacterial dacryoadenitis as a cause for unilateral periorbital swelling in the horse. Differential diagnoses for this presentation, as well as successful surgical management are discussed. To the author's knowledge, this is the first case of bacterial dacryoadenitis and subsequent abscessation of the orbital lacrimal gland in the horse. © 2011 American College of Veterinary Ophthalmologists.

Objective measurements of excess skin in post bariatric patients--inter-rater reliability.

PubMed

Biörserud, Christina; Fagevik Olsén, Monika; Elander, Anna; Wiklund, Malin

2016-01-01

An ability to reliably assess excess skin after massive weight loss using well-described and transferrable methods is important. The aim of this trial was to evaluate inter-rater reliability of ptosis and circumference measurements in patients with excess skin after bariatric surgery. Twenty-five postbariatric patients were included in the study, and their excess skin was measured 18 months after surgery. A protocol was designed to measure excess skin in a standardised way. To evaluate the inter-rater reliability in the measuring protocol, all patients were measured twice, by a specialist nurse and a specialist physiotherapist. All circumference measurements on different body parts had an ICC > 0.9, indicating high reliability. Furthermore, all breast and abdominal ptosis measurements had high reliability. In contrast, visual evaluation of abdominal ptosis had poor reliability. Measurements of ptoses on different body parts had an ICC > 0.6. There were no systematic differences between the results of the two testers, except for measurements of the buttocks and maximal knee circumference. The measuring protocol presented in this study has high reliability and, therefore, represents a useful instrument to provide a consistent and objective assessment of excess skin in the postbariatric patient.

A lateral tarsorrhaphy with forehead hitch to pre-empt and treat burns ectropion with a contextual review of burns ectropion management

PubMed Central

Lymperopoulos, Nikolaos S; Jordan, Daniel J; Jeevan, Ranjeet; Shokrollahi, Kayvan

2016-01-01

Introduction: Facial burns around the eyes and eyelid ectropion can lead to corneal exposure, irritation, dryness, epiphora, infection or visual loss. We undertook a review of the published articles describing management of eyelid burns as well as methods to treat or prevent ectropion. We describe early experience of a surgical technique that we have found to mitigate ectropion in facial burns with peri-ocular involvement. Materials and methods: Two illustrative cases with our surgical technique is described from our experience of three cases. We reviewed the literature using the PubMed and EMBASE databases using the search terms ‘burn’ and ‘ectropion’. Results: The literature review produced a total of 17 relevant papers. Treatment options for eyelid burns were varied and were invariably level 4 or 5 evidence. Various techniques were used to treat eyelid burns including the use of a full thickness skin graft with or without concurrent scar contracture release but also use of a local flap reconstruction with or without a tissue expander or release of the underlying muscle. Other techniques included canthoplasty, Z-plasty, forehead flaps, fat transfer, and tarsorrhaphy with full thickness skin grafting. In general, the focus of articles was therapeutic and reconstructive rather than pre-emptive/preventative management. Procedure: We describe our early experience of a novel technique for temporary lateral tarsorrhaphy with forehead hitch which protexts the globe and counters the scar- and gravity-related ectropic effects on the lower eyelids. Discussion: Facial burns pose a difficult problem to the burn surgeon, especially when the eyelids are affected, both directly or indirectly. The optimal surgical management of eyelid burns remains unclear and the literature base lies mainly in the domain of case series. We review the literature on this subject and tabulate our findings and also describe our contribution to this area with a method of lateral and lower lid elevator that we have found valuable. PMID:29799558

A lateral tarsorrhaphy with forehead hitch to pre-empt and treat burns ectropion with a contextual review of burns ectropion management.

PubMed

Lymperopoulos, Nikolaos S; Jordan, Daniel J; Jeevan, Ranjeet; Shokrollahi, Kayvan

2016-01-01

Facial burns around the eyes and eyelid ectropion can lead to corneal exposure, irritation, dryness, epiphora, infection or visual loss. We undertook a review of the published articles describing management of eyelid burns as well as methods to treat or prevent ectropion. We describe early experience of a surgical technique that we have found to mitigate ectropion in facial burns with peri-ocular involvement. Two illustrative cases with our surgical technique is described from our experience of three cases. We reviewed the literature using the PubMed and EMBASE databases using the search terms 'burn' and 'ectropion'. The literature review produced a total of 17 relevant papers. Treatment options for eyelid burns were varied and were invariably level 4 or 5 evidence. Various techniques were used to treat eyelid burns including the use of a full thickness skin graft with or without concurrent scar contracture release but also use of a local flap reconstruction with or without a tissue expander or release of the underlying muscle. Other techniques included canthoplasty, Z-plasty, forehead flaps, fat transfer, and tarsorrhaphy with full thickness skin grafting. In general, the focus of articles was therapeutic and reconstructive rather than pre-emptive/preventative management. We describe our early experience of a novel technique for temporary lateral tarsorrhaphy with forehead hitch which protexts the globe and counters the scar- and gravity-related ectropic effects on the lower eyelids. Facial burns pose a difficult problem to the burn surgeon, especially when the eyelids are affected, both directly or indirectly. The optimal surgical management of eyelid burns remains unclear and the literature base lies mainly in the domain of case series. We review the literature on this subject and tabulate our findings and also describe our contribution to this area with a method of lateral and lower lid elevator that we have found valuable.

A randomised controlled trial of the effects of cryotherapy on pain, eyelid oedema and facial ecchymosis after craniotomy.

PubMed

Shin, Yong Soon; Lim, Nan Young; Yun, Sung-Cheol; Park, Kwang Ok

2009-11-01

To identify the effects of cryotherapy on patient discomfort following craniotomy. Following craniotomy, many patients suffer from unexpected discomfort, including pain, eyelid oedema and ecchymosis. Cryotherapy is regarded as a safe method for managing these postcraniotomy problems. Randomised controlled trial. A total of 97 Korean patients who underwent elective supratentorial craniotomy were randomly assigned to a cryotherapy or a control group. In the cryotherapy group, ice bags were applied to surgical wounds, and cold gel packs were applied to periorbital areas, for 20 minutes per hour, beginning three hours postoperatively and for three days thereafter. The level of patient pain was measured using the visual analogue scale while the eyelid oedema was measured using the Kara & Gokalan's scale. Ecchymosis was also classified according to its extent. The level of pain three hours after craniotomy was similar in the cryotherapy and control groups (57.9 vs. 58.7). Three days after surgery, pain had significantly decreased in the cryotherapy group (p = 0.021). After adjusting diagnosis by analysis of covariance (ANCOVA), pain score did not differ significantly between the two groups. The mean eyelid oedema scores were lower in the cryotherapy group than in the control group (0.59 vs. 2.29, p < 0.001), with ANCOVA showing that cryotherapy had a significant effect on eyelid oedema (p < 0.001). Pain (p = 0.047) and eyelid oedema (p < 0.001) in the cryotherapy group were significantly decreased over time. Ecchymosis were significantly less frequent in the cryotherapy (11/48, 22.9%) than in the control (26/49, 53.1%) group (p = 0.003). Logistic regression analysis showed that cryotherapy affected ecchymosis (p = 0.001). These results indicate that cryotherapy can control pain, eyelid oedema and facial ecchymosis after craniotomy. Cryotherapy, which is both convenient and cost-effective, can be used to prevent postoperative discomforts in a clinical setting.

The influence of lens care systems on eyelid tissue changes during silicone hydrogel contact lens wear.

PubMed

Guillon, Michel; Maissa, Cécile; Wong, Stéphanie; Patel, Trisha; Garofalo, Renée

2018-04-14

To compare the effects of a hydrogen peroxide (H 2 O 2 )-based lens care solution and a polyhexamethylene biguanide (PHMB) multi-purpose solution on the eyelids when used with silicone hydrogel (SiHy) contact lenses. A total of 74 symptomatic wearers of ACUVUE ® OASYS ® (senofilcon A; n = 39) or PureVision ® (balafilcon A; n = 35) contact lenses were randomised 1:1 to either CLEAR CARE ® Cleaning & Disinfecting Solution or renu ® fresh™ multi-purpose solution (n = 37 each). Assessments of hyperaemia, papillae and lid margin staining of eyelid tissue were evaluated subjectively by a masked investigator at enrolment (with the subjects' habitual SiHy contact lenses and PHMB-preserved care systems), at dispensing visit (when no lenses were worn) and at 3-months' follow-up. There were no differences in eyelid assessments between the two lens care groups at dispensing visit (p = 0.086 to 0.947). After 3 months, the papillae response was significantly less marked with H2O2-based solution than with PHMB-based solution (p = 0.017). Lid hyperaemia (p < 0.001) and papillae (p = 0.002) were also significantly reduced. Although lid hyperaemia was also reduced with PHMB-based solution (p < 0.001), there was no concurrent decrease in papillae response (p = 0.051). No improvements were found in eyelid margin staining either over time or between the two lens care groups. In symptomatic contact lens wearers, a H 2 O 2 -based lens care solution used with senofilcon A and balafilcon A lenses was better tolerated by eyelid tissues than was a PHMB-based solution and led to a decrease in clinical markers of eyelid inflammation. Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Eyelid bump

MedlinePlus

... 423. Review Date 8/20/2016 Updated by: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Eyelid Disorders Read more ...

An Individualized 3-Dimensional Designed and Printed Conformer After Dermis Fat Grafting for Complex Sockets.

PubMed

Mourits, Daphne L; Remmers, Jelmer S; Tan, Stevie H; Moll, Annette C; Hartong, Dyonne T

2018-04-03

To introduce a novel technique to design individually customized conformers for postenucleation sockets with dermis fat implants. We use a 3-dimensional scan of the frontal face/orbit and eyelid contour to design an individualized conformer. This polymethylmetacrylate printed conformer is adapted to patients' socket, palpebral fissures, horizontal eyelid aperture, curvature of the eyelids, and mean diameter of patients' contralateral eye. Sutures through holes in the inferior part of the conformer and in the extension can be placed to fixate the conformer and anchor fornix deepening sutures. A correct fitting conformer can be printed and attached to the socket and eyelids. The shape of this conformer can be used subsequently postsurgically to design the ocular prosthesis. Presurgical planning is important to anticipate for a functional socket to adequately fit an artificial eye. The presented technique using 3-dimensional imaging, designing, and printing promises to prevent conformer extrusion and forniceal shortening.

Fibrosarcoma of the eyelid in two sibling Czech wolfdogs

PubMed Central

Nordio, Laura; Fattori, Sabina; Giudice, Chiara

2017-01-01

Most canine tumors of the eyelid are tumors generally encountered in the skin. They are most commonly of epithelial origin and benign. In this report, we describe the cases of two sibling Czech wolfdogs presented, one year apart, with a subcutaneous mass involving the left eyelid. Both lesions were histologically consistent with a diagnosis of subcutaneous fibrosarcoma. Immunohistochemical analyses of the tumors revealed a mild positivity for vimentin and negativity for GFAP, desmin, αSMA, myoglobin, S100, PNL2 and calponin, excluding all differential diagnosis (i.e. peripheral nerve sheath tumor, melanoma, perivascular sarcoma, myofibroblastic sarcoma, rhabdomyosarcoma). To the best of authors’ knowledge, this is the first report of canine eyelid fibrosarcoma. Since this rare tumor has been observed in two full siblings, we could speculate the existence of some genetic predisposition to sarcoma, however the present data did not allow any definite conclusion on the etiopathogenesis or genetic basis of these tumors. PMID:28616389

Bilateral nevus comedonicus of the eyelids.

PubMed

Mendoza, Pia R; Jakobiec, Frederick A; Townsend, Daniel J

2013-01-01

Nevus comedonicus is a rare developmental abnormality of the infundibulum of the hair follicle. It is usually unilateral and commonly presents at birth or during childhood. A rare case of late-onset, bilateral nevus comedonicus of the eyelids is reported. A 79-year-old man presented with asymptomatic but disfiguring eyelid lesions noted several months earlier. On physical examination, multiple papules resembling comedones were present bilaterally in the eyelids, canthi, temple regions, and bridge of the nose. Microscopically, there were deep invaginations of the follicular canals forming focal tunnels or pseudosinus tracts with poral openings to the surface. These variably cystic structures were lined by keratinizing and nonkeratinizing squamous epithelium, contained concentric lamellae of keratin in their lumens, and some were acutely or chronically inflamed. The diagnosis of a nevus comedonicus was made. The clinical and histopathologic characteristics, pathogenesis, differential diagnosis, and management of nevus comedonicus are briefly discussed.

Stereoscopic three-dimensional images of an anatomical dissection of the eyeball and orbit for educational purposes.

PubMed

Matsuo, Toshihiko; Takeda, Yoshimasa; Ohtsuka, Aiji

2013-01-01

The purpose of this study was to develop a series of stereoscopic anatomical images of the eye and orbit for use in the curricula of medical schools and residency programs in ophthalmology and other specialties. Layer-by-layer dissection of the eyelid, eyeball, and orbit of a cadaver was performed by an ophthalmologist. A stereoscopic camera system was used to capture a series of anatomical views that were scanned in a panoramic three-dimensional manner around the center of the lid fissure. The images could be rotated 360 degrees in the frontal plane and the angle of views could be tilted up to 90 degrees along the anteroposterior axis perpendicular to the frontal plane around the 360 degrees. The skin, orbicularis oculi muscle, and upper and lower tarsus were sequentially observed. The upper and lower eyelids were removed to expose the bulbar conjunctiva and to insert three 25-gauge trocars for vitrectomy at the location of the pars plana. The cornea was cut at the limbus, and the lens with mature cataract was dislocated. The sclera was cut to observe the trocars from inside the eyeball. The sclera was further cut to visualize the superior oblique muscle with the trochlea and the inferior oblique muscle. The eyeball was dissected completely to observe the optic nerve and the ophthalmic artery. The thin bones of the medial and inferior orbital wall were cracked with a forceps to expose the ethmoid and maxillary sinus, respectively. In conclusion, the serial dissection images visualized aspects of the local anatomy specific to various procedures, including the levator muscle and tarsus for blepharoptosis surgery, 25-gauge trocars as viewed from inside the eye globe for vitrectomy, the oblique muscles for strabismus surgery, and the thin medial and inferior orbital bony walls for orbital bone fractures.

Is a specific eyelid patch test series useful? Results of a French prospective study.

PubMed

Assier, Haudrey; Tetart, Florence; Avenel-Audran, Martine; Barbaud, Annick; Ferrier-le Bouëdec, Marie-Christine; Giordano-Labadie, Françoise; Milpied, Brigitte; Amsler, Emmanuelle; Collet, Evelyne; Girardin, Pascal; Soria, Angèle; Waton, Julie; Truchetet, François; Bourrain, Jean-Luc; Gener, Gwendeline; Bernier, Claire; Raison-Peyron, Nadia

2018-06-08

Eyelids are frequent sites of contact dermatitis. No prospective study focused on eyelid allergic contact dermatitis (EACD) has yet been published, and this topic has never been studied in French patients. To prospectively evaluate the usefulness of an eyelid series in French patients patch tested because of EACD, and to describe these patients. We prospectively analysed standardized data for all patients referred to our departments between September 2014 and August 2016 for patch testing for suspected EACD as the main reason. All patients were patch tested with an eyelid series, the European baseline series (EBS), the French additional series, and their personal products. Patch testing with additional series and repeated open application tests (ROATs) or open tests were performed if necessary. A standardized assessment of the relevance was used, and the analysis of the results was focused on patients having positive test results with a current certain relevance. Two-hundred and sixty-four patients (238 women and 26 men) were included. Three-hundred and twenty-two tests gave positive results in 167 patients, 84 of whom had currently relevant reactions: 56 had currently relevant positive test reactions to the EBS, 16 had currently relevant positive test reactions to their personal products, 8 had currently relevant positive test reactions to the French additional series, and 4 had currently relevant positive test reactions to the eyelid series. Sixty-seven per cent of all relevant cases were related to cosmetic products. The most frequent allergens with current relevance were methylisothiazolinone (10.2%), fragrance mix I (3%), nickel (2.7%), hydroxyperoxides of linalool (2.7%) and limonene (2.3%), and Myroxylon pereirae (2.3%). Current atopic dermatitis was found in 9.5% of patients. The duration of dermatitis was shorter (23.2 vs 34.2 months; P = .035) in patients with currently relevant test reactions. The percentage of currently relevant tests remained the same when atopic patients or dermatitis localized only on the eyelids were taken into account. In French patients, testing for EACD with the extended baseline series and personal products, also including ROATs and use tests, appears to be adequate, considering the currently relevant positive test reactions. The regular addition of an eyelid series does not seem to be necessary. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Periorbital Scar Correction.

PubMed

Chambers, Christopher B; Moe, Kristen S

2017-02-01

Periorbital scarring with eyelid retraction can have serious visual effects and can lead to loss of vision or even loss of the eye. Understanding of eyelid anatomy and the delicate balance of its structural supports is critical for the identification of the eyelid disorder responsible for the cicatrix and helps to guide treatment. The 2-finger test and lateral distraction of the lid can also be of significant help in proper diagnosis of the underlying disorder. Proper reconstruction with respect to the anterior and posterior lamellae helps to ensure a favorable outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

Intratarsal keratinous eyelid cysts in Gorlin syndrome: A review and reappraisal.

PubMed

Wolkow, Natalie; Jakobiec, Frederick A; Yoon, Michael K

2017-12-27

A 38-year-old woman presented with multiple bilateral recurrent eyelid cysts. Her medical history was notable for Gorlin (nevoid basal cell carcinoma) syndrome. Histopathologic and immunohistochemical examinations revealed that the lesions were intratarsal keratinous cysts. They were similar in appearance to sporadic intratarsal keratinous cysts and closely resembled odontogenic keratocysts of the jaw. Eyelid cysts occur in up to 40% of patients with Gorlin syndrome; however, their description has been cursory and, for the most part, outside of the ophthalmic literature. Although ophthalmologists are familiar with the periocular basal cell carcinomas that occur in patients with Gorlin syndrome, up to 10% of patients never develop a basal cell carcinoma, but they may manifest other ophthalmic findings. Awareness of these other features may contribute to the earlier diagnosis of the syndrome. We discuss the clinical and histopathologic features of intratarsal keratinous cysts in Gorlin syndrome, comparing them to sporadic intratarsal keratinous cysts, other eyelid cysts, and jaw cysts that also characterize this syndrome. We briefly review the ocular and systemic manifestations of Gorlin syndrome and recent genetic and therapeutic developments so that the eyelid cysts may be appreciated within the appropriate context of Gorlin syndrome as a whole. Copyright © 2017 Elsevier Inc. All rights reserved.

Spontaneous eyelid closures link vigilance fluctuation with fMRI dynamic connectivity states

PubMed Central

Wang, Chenhao; Ong, Ju Lynn; Patanaik, Amiya; Chee, Michael W. L.

2016-01-01

Fluctuations in resting-state functional connectivity occur but their behavioral significance remains unclear, largely because correlating behavioral state with dynamic functional connectivity states (DCS) engages probes that disrupt the very behavioral state we seek to observe. Observing spontaneous eyelid closures following sleep deprivation permits nonintrusive arousal monitoring. During periods of low arousal dominated by eyelid closures, sliding-window correlation analysis uncovered a DCS associated with reduced within-network functional connectivity of default mode and dorsal/ventral attention networks, as well as reduced anticorrelation between these networks. Conversely, during periods when participants’ eyelids were wide open, a second DCS was associated with less decoupling between the visual network and higher-order cognitive networks that included dorsal/ventral attention and default mode networks. In subcortical structures, eyelid closures were associated with increased connectivity between the striatum and thalamus with the ventral attention network, and greater anticorrelation with the dorsal attention network. When applied to task-based fMRI data, these two DCS predicted interindividual differences in frequency of behavioral lapsing and intraindividual temporal fluctuations in response speed. These findings with participants who underwent a night of total sleep deprivation were replicated in an independent dataset involving partially sleep-deprived participants. Fluctuations in functional connectivity thus appear to be clearly associated with changes in arousal. PMID:27512040

Diagnostic features of feline restrictive orbital myofibroblastic sarcoma.

PubMed

Bell, C M; Schwarz, T; Dubielzig, R R

2011-05-01

A progressive debilitating disease of the orbit and adjacent connective tissues of cats has historically been called feline orbital pseudotumor. The authors reviewed clinical, histopathologic, and diagnostic imaging features of this disease in 12 cases from the Comparative Ocular Pathology Laboratory of Wisconsin. The cats' ages ranged from 7 to 16 years (mean, 10.8 years). All cats had a history of severely restricted mobility of the globe and eyelids with secondary corneal disease. Eleven cats (92%) had concurrent involvement of the contralateral eye and/or the oral cavity. Diffuse scleral or episcleral thickening was seen with computed tomography in all clinically affected eyes. Histologically, an insidious infiltration of neoplastic spindle cells in the orbit, eyelids, and periorbital skin and soft tissues, with collagen deposition and a few perivascular lymphocytes, led to entrapment and restricted mobility of the eyelids and orbital tissues. The tumor failed to form a discrete mass, and it spread along fascial planes to the contralateral orbit and eyelids and/or the lips and oral cavity. In all tested cases (n = 10), neoplastic cells were immunohistochemically positive for vimentin, S100 protein, and smooth muscle actin. The authors adopted the term feline restrictive orbital myofibroblastic sarcoma to reflect the restricted mobility of the eyelids and globe and the imaging and histologic features of an invasive yet low-grade myofibroblastic sarcoma.

A System for Studying Facial Nerve Function in Rats through Simultaneous Bilateral Monitoring of Eyelid and Whisker Movements

PubMed Central

Heaton, James T.; Kowaleski, Jeffrey M.; Bermejo, Roberto; Zeigler, H. Philip; Ahlgren, David J.; Hadlock, Tessa A.

2008-01-01

The occurrence of inappropriate co-contraction of facially innervated muscles in humans (synkinesis) is a common sequela of facial nerve injury and recovery. We have developed a system for studying facial nerve function and synkinesis in restrained rats using non-contact opto-electronic techniques that enable simultaneous bilateral monitoring of eyelid and whisker movements. Whisking is monitored in high spatio-temporal resolution using laser micrometers, and eyelid movements are detected using infrared diode and phototransistor pairs that respond to the increased reflection when the eyelids cover the cornea. To validate the system, eight rats were tested with multiple five-minute sessions that included corneal air puffs to elicit blink and scented air flows to elicit robust whisking. Four rats then received unilateral facial nerve section and were tested at weeks 3–6. Whisking and eye blink behavior occurred both spontaneously and under stimulus control, with no detectable difference from published whisking data. Proximal facial nerve section caused an immediate ipsilateral loss of whisking and eye blink response, but some ocular closures emerged due to retractor bulbi muscle function. The independence observed between whisker and eyelid control indicates that this system may provide a powerful tool for identifying abnormal co-activation of facial zones resulting from aberrant axonal regeneration. PMID:18442856

Periorbital edema secondary to imatinib mesylate.

PubMed

McClelland, Collin M; Harocopos, George J; Custer, Philip L

2010-05-14

Imatinib mesylate (Gleevec((R))) is a well-established pharmacologic treatment for all phases of chronic myeloid leukemia and for advanced gastrointestinal stromal tumors (GISTs). Edema-related side effects are relatively common in imatinib therapy with the periocular skin representing one of the most common sites for localized edema. While the adverse effect of periorbital edema with imatinib is well documented in the oncology literature, there is limited reference to this common reaction in the ophthalmology literature. We report two patients with upper eyelid edema associated with imatinib therapy who required surgical intervention to ameliorate significant visual field obstruction. We highlight the details of each case including the histopathologic findings of excised redundant skin followed by a thorough review of the literature on imatinib related periorbital edema.

Periorbital edema secondary to imatinib mesylate

PubMed Central

McClelland, Collin M; Harocopos, George J; Custer, Philip L

2010-01-01

Imatinib mesylate (Gleevec®) is a well-established pharmacologic treatment for all phases of chronic myeloid leukemia and for advanced gastrointestinal stromal tumors (GISTs). Edema-related side effects are relatively common in imatinib therapy with the periocular skin representing one of the most common sites for localized edema. While the adverse effect of periorbital edema with imatinib is well documented in the oncology literature, there is limited reference to this common reaction in the ophthalmology literature. We report two patients with upper eyelid edema associated with imatinib therapy who required surgical intervention to ameliorate significant visual field obstruction. We highlight the details of each case including the histopathologic findings of excised redundant skin followed by a thorough review of the literature on imatinib related periorbital edema. PMID:20505834

Surgical Approach, Findings, and Eight-Year Follow-Up in a Twenty-Nine Year Old Female With Freeman-Sheldon Syndrome Presenting With Blepharophimosis Causing Near-Complete Visual Obstruction.

PubMed

Portillo, Augusto L; Poling, Mikaela I; McCormick, Rodger J

2016-07-01

The authors describe the surgical approach, findings, and 8-year follow-up in a 29-year-old woman, with severe Freeman-Sheldon syndrome, presenting with congenital blepharophimosis of both upper eyelids resulting in near-complete functional visual obstruction. To avoid possible Freeman-Sheldon syndrome-associated complications of malignant hyperthermia, difficult vascular access, and challenging endotracheal intubation, the surgery was completed under local anesthesia without sedation, and anatomical and functional correction was immediate and remained stable at 8-year follow-up. Unlike many congenital craniofacial syndromes, which frequently involve life-long impairments, important implications exist for plastic surgeons to facilitate opportunities for patients to overcome functional limitations.

A new species of Pristimantis from southern Ecuador (Anura, Craugastoridae)

PubMed Central

Székely, Paul; Cogălniceanu, Dan; Székely, Diana; Páez, Nadia; Ron, Santiago R.

2016-01-01

Abstract A new species of Pristimantis is described from Reserva Buenaventura, southern Ecuador, at elevations between 878 and 1082 m. A molecular phylogeny based on nuclear and mitochondrial genes shows that the new species is closely related to Pristimantis phoxocephalus, Pristimantis riveti, and Pristimantis versicolor. The new species differs from them and other morphologically similar congeners in having a low W-shaped dermal ridge in the scapular region, a large conical tubercle on the upper eyelid and on the heel, a thin mid dorsal fold, and a longitudinal lateral fold starting behind the tympanic fold and extending along the anterior two thirds of the flank. The new species inhabits cloud forests in the Pacific slopes of the Andes. PMID:27551223

Periorbital varicella gangrenosa: A rare complication of chicken pox.

PubMed

Jain, Jagriti; Thatte, Shreya; Singhai, Prakhar

2015-01-01

A previously healthy six year old male child presented in pediatrics ICU in state of shock with history of fever and rashes and later was diagnosed as chicken pox. He developed right sided periorbital varicella gangrenosa which is a form of necrotizing fasciitis secondary to skin infection. Patient was treated with intravenous acyclovir, antibiotics, amphotericin B, extensive debridement and later reconstruction of upper eyelid with skin grafting. Aggressive treatment helped preventing the eyeball and orbital involvement which would have necessitated orbital exenteration. However delayed presentation resulted in necrosis of orbicularis oculi and underlying tissue which resulted in graft retraction and lid dysfunction. Clinicians should be aware of this rare but fulminating condition to minimise the sight and life threatening complications associated with it.

Orbital embryonal rhabdomyosarcoma with metastasis in a young dog.

PubMed

Kato, Y; Notake, H; Kimura, J; Murakami, M; Hirata, A; Sakai, H; Yanai, T

2012-01-01

A 2-year-old male Welsh corgi dog was brought to an animal hospital because of left upper eyelid enlargement with lachrymal gland protrusion. The lachrymal and orbital cavity mass was removed surgically. Microscopically, the orbital mass consisted of a mixture of large rhabdomyoblastic and small round tumour cells. Immunohistochemically, the rhabdomyoblastic cells expressed desmin and myoglobin and the small round cells expressed desmin, myogenin and MyoD1. A diagnosis of embryonal rhabdomyosarcoma (ERS) was made. One month later, multiple masses throughout the body were identified, in particular around the cervical region. One of these lesions was sampled and diagnosed as metastatic ERS. The dog died 84 days after the time of first admission. Copyright © 2012 Elsevier Ltd. All rights reserved.

Corneal Sensitivity and Presence of Pathogenic Organisms Among Participants Who Have Undergone Trichiasis Surgery Differ by Surgical Outcome.

PubMed

Schein, Yvette; Harding, Jennifer C; Merbs, Shannath L; Cassard, Sandra D; Mabula, Kasubi; Othman, Majid S; West, Sheila K; Gower, Emily W

2016-04-01

To explore the potential association between reduced corneal sensation and/or conjunctival bacterial colonization and postoperative trichiasis and eyelid contour abnormalities after corrective eyelid surgery among participants with a history of trachomatous trichiasis. As an ancillary study to the Partnership for Rapid Elimination of Trachoma (PRET) Surgery Trial in southern Tanzania, we collected data on 580 PRET participants who had undergone trichiasis surgery 1 year earlier and 200 age-group-matched individuals without trichiasis. Assessments included eyelid status evaluation (presence and severity of postoperative trichiasis and/or eyelid contour abnormality), corneal sensitivity by Cochet-Bonnet aesthesiometer, a questionnaire on symptoms of ocular irritation, and conjunctival microbiology. We divided PRET participants based on their eyelid status and compared results across PRET groups and versus normals. PRET participants had reduced corneal sensitivity compared with age-matched normals (mean sensitivity ranged from 2.8 to 3.8 cm in PRET participants vs. 5.9 cm in normals), and increasing severity of postoperative trichiasis was associated in a stepwise fashion with reduced corneal sensitivity (mean = 3.5 cm for mild and 2.6 cm for severe postoperative trichiasis). Conjunctival colonization with pathogenic bacteria was also associated with more severe postoperative trichiasis (Cochran-Armitage trend test P = 0.001) and with reduced corneal sensitivity (trend test P < 0.0001). Symptoms of ocular irritation were not associated with previous trichiasis surgery, postoperative trichiasis, or eyelid contour abnormality. These findings indicate that reduced corneal sensitivity accompanies trachomatous trichiasis and suggest that reduced corneal sensitivity may play an important role in the harboring of pathogenic bacteria on the ocular surface.

Defective eyelid leading edge cell migration in C57BL/6-corneal opacity mice with an "eye open at birth" phenotype.

PubMed

Wu, L C; Liu, C; Jiang, M R; Jiang, Y M; Wang, Q H; Lu, Z Y; Wang, S J; Yang, W L; Shao, Y X

2016-08-26

Development of the eyelid requires coordination of the cellular processes involved in proliferation, cell size alteration, migration, and cell death. C57BL/6J-corneal opacity (B6-Co) mice are mutant mice generated by the administration of N-ethyl-N-nitrosourea (100 mg/kg). They exhibit the eyelids open at birth phenotype, abnormal round cell shape from tightened F-actin bundles in leading edge keratinocytes at E16.5, and gradual corneal opacity with neovessels. The tip of the leading edge in B6-Co mice did not move forward, and demonstrated a sharp peak shape without obvious directionality. Analysis of the biological characteristics of B6-Co mice demonstrated that abnormal migration of keratinocytes could affect eyelid development, but proliferation and apoptosis in B6-Co mice had no effect. Mutant gene mapping and sequence analysis demonstrated that in B6-Co mice, adenosine was inserted into the untranslated regions, between 3030 and 3031, in the mRNA 3'-terminal of Fgf10. In addition, guanine 7112 was substituted by adenine in the Mtap1B mRNA, and an A2333T mutation was identified in Mtap1B. Quantitative real-time polymerase chain reaction analysis showed that expression of the Hbegf gene was significantly down-regulated in the eyelids of B6- Co mice at E16.5, compared to B6 mice. However, the expression of Rock1, Map3k1, and Jnk1 genes did not show any significant changes. Abnormal keratinocyte migration and down-regulated expression of the Hbegf gene might be associated with impaired eyelid development in B6-Co mice.

Reconstruction of eyelids with Washio flap in anophthalmia.

PubMed

Tvrdek, M; Kozák, J

2014-01-01

The authors present a case report of a patient with anophthalmia in whom retroauriculo-temporal flap (Washio flap) was used for reconstruction of eyelids. This flap, which is mostly used for reconstructions of nasal defects, was not used in this way according to available literature.

Third eyelid in the small Indian mongoose (Herpestes javanicus): a morphological and histological study.

PubMed

Kamali, Younes; Khaksar, Zabihollah; Gholami, Soghra

2015-01-01

The Indian mongoose (Herpestes javanicus) is native to parts of Asia, Iran. The purpose of this study was to describe the gross anatomy of the cartilage and histology of the superficial gland of the third eyelid of two adult mongooses. The animals, in terminal stages of disease and near death due to aging or unknown reasons, were referred from Park Zoo (Shiraz, Iran) to our center. By using a modified maceration technique, the morphological characteristics of the cartilage were examined. For histological examinations of the superficial gland of the third eyelid, the samples were stained with haematoxylin and eosin. Also, to detect the elastic fibers in the cartilage sections were stained with orcein and Weigert's resorcin-fuchsin. The cartilage consisted of an ovoid appendix and a mild reverse sigmoid crossbar. Elastic fibers were scattered throughout the cartilage but were more concentrated in the center. The superficial gland of the third eyelid was compound tubuloacinar with serous acini.

Clinical predictors for the prognosis of myasthenia gravis.

PubMed

Wang, Lili; Zhang, Yun; He, Maolin

2017-04-19

Clinical predictors for myasthenia gravis relapse and ocular myasthenia gravis secondary generalization during the first two years after disease onset remain incompletely identified. This study attempts to investigate the clinical predictors for the prognosis of Myasthenia Gravis. Eighty three patients with myasthenia gravis were concluded in this study. Baseline characteristics were analyzed as predictors. Relapse of myasthenia gravis developed in 26 patients (34%). Generalization developed in 34 ocular myasthenia gravis patients (85%). Other autoimmune diseases were observed more commonly in relapsed myasthenia gravis (P = 0.012). Second generalization group contained more late onset patients (P = 0.021). Ocular myasthenia gravis patients with thymus hyperplasia progressed more rapidly than those with other thymus pathology (P = 0.027). Single onset symptom of ocular myasthenia gravis such as ptosis or diplopia predicted early progression than concurrence of ptosis and diplopia (P = 0.027). Treatment effect including glucocorticoid, pyridostigmine, thymectomy, IVIG, immunosuppressive drugs did not show significant difference between the relapsed and non-relapsed groups. The treatment outcome also showed no difference between the single OMG and second generalized groups. Occurrence of associated autoimmune disease can serve as a potential predictor for myasthenia gravis relapse. Either ptosis or diplopia, as well as thymic hyperplasia can predict generalization in the first six months.

Myasthenia gravis imitating pituitary apoplexy in macroprolactinoma.

PubMed

Zoli, Matteo; Guaraldi, Federica; Faustini, Marco; Mazzatenta, Diego

2018-06-02

Myasthenia gravis (MG) is an autoimmune disease affecting neuromuscular transmission that manifests with muscle weakness and typically involves the eye muscles, often producing diplopia and ptosis. Recent studies suggest that hyperprolactinaemia may have a role in the development of MG, although its association with prolactinoma is extremely rare. We report the unusual case of a 71-year-old male affected with macroprolactinoma, who presented at our Center 2 weeks after starting cabergoline treatment because of acute onset of headache, diplopia, and ptosis. On admission, he presented with drowsiness, dropped head, swallowing impairment and bilateral ptosis, which rapidly worsened. Based on clinical manifestation and history, emergency surgery was performed on suspicion of pituitary apoplexy (PA), the typical complication occurring in patients with macroadenomas who present these symptoms. No pituitary haemorrhage was found. The symptoms initially resolved after surgery, but soon returned and worsened day by day, especially in the evening, despite the increase of cortisone replacement doses. MG was thus suspected and confirmed by the detection of antibodies to the acetylcholine receptor. Pyridostigmine was started with prompt improvement of neurological symptoms. In conclusion, although very rare, MG should be considered in the differential diagnosis of patients with macroprolactinomas and suggestive neurological symptoms in order to provide early and appropriate treatment. The role of hyperprolactinaemia in MG onset and evolution is also discussed.

Gynecomastia Management: An Evolution and Refinement in Technique at UT Southwestern Medical Center

PubMed Central

Bailey, Steven H.; Guenther, Dax; Constantine, Fadi

2016-01-01

Summary: Gynecomastia is a benign proliferation of male breast glandular tissue. Gynecomastia can affect men at any stage of life. Traditional treatment options involved excisional surgeries with periareolar or T-shaped scars, which can leave more visible scars on the chest. The technique presented represents a technique used by the senior author, which relies on ultrasonic liposuction and pull-through technique to remove breast tissue. A retrospective chart review was performed, including all patients who were treated, from 2000 to 2013 by the senior author, for gynecomastia. A deidentified database was created to record patient characteristics, including age, height, weight, ptosis, stage of gynecomastia, and gynecomastia classification. Surgical approaches, complications, and revisions were also recorded. Our experience includes 75 patients with all grades of gynecomastia from 2000 to 2013. These cases span the evolution of our technique to include direct pull-through excision with ultrasound-assisted liposuction. The distribution of the grades I, II, III, and IV ptosis was 30.6%, 36 %, 22.6%, and 10.6% respectively. There were no complications in this series. Only one patient with grade III ptosis required revision surgery. This technique provides a safe and aesthetically pleasing way to treat gynecomastia with a low need for revision. PMID:27482482

Lateral orbital propeller flap technique for reconstruction of the lower eyelid defect.

PubMed

Ding, J-P; Chen, B; Yao, J

2018-05-01

The lower eyelid, which has a unique anatomy and esthetic importance, is a common site of basal cell carcinoma. The reconstruction of the defect after the wide excision of the tumour is a special concern of many plastic surgeons. How to achieve the most satisfying effect through minimal invasive is important for patients. We successfully applied the lateral orbital propeller flap for one-stage reconstruction of a large lower eyelid defect after tumour resection. We consider that this flap can achieve better tissue mobilisation as it provides effective coverage of soft tissue defects and thus is especially useful for repairing facial defects.

Floppy eyelid syndrome associated with keratotorus.

PubMed Central

Parunović, A; Ilić, B

1988-01-01

A case of floppy eyelid syndrome associated with keratotorus is presented. The patient was thoroughly examined and followed up for several years. During that time he developed an acute corneal hydrops. The importance of this association for the better understanding of the syndrome is discussed. Images PMID:3415960

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Ying, E-mail: yingliu@doheny.org; Sun Yet-sen University, Zhongshan Ophthalmic Center, State Key Ophthalmic Laboratory, Guangzhou 510060; Kawai, Kirio

Research highlights: {yields} Inactivation of Smad4 caused disruption in the development of the anterior segment. {yields} Inactivation of Smad4 failed to disrupt early lens development. {yields} Smad4 controlled lens cell cycle and cell death processes. {yields} Smad4 may regulate actin stress fiber assembly and eyelid epithelial movement. -- Abstract: Purpose: Signaling by members of the TGF{beta} superfamily of molecules is essential for embryonic development and homeostasis. Smad4, a key intracellular mediator in TGF{beta} signaling, forms transcriptional activator complexes with Activin-, BMP-, and TGF{beta}-restricted Smad proteins. However, the functional role of Smad4 in controlling different visual system compartments has not beenmore » fully investigated. Methods: Using the Pax6 promoter-driven Cre transgenic, smad4 was conditionally inactivated in the lens, cornea and ectoderm of the eyelids. Standard histological and molecular analytical approaches were employed to reveal morphological and cellular changes. Results: Inactivation of Smad4 in the lens led to microphthalmia and cataract formation in addition to the persistent adhesion of the retina to the lens and the iris to the cornea. Inactivation of Smad4 from the ectoderm of the eyelid and cornea caused disruption to eyelid fusion and proper development of the corneal epithelium and corneal stroma. Conclusions: Smad4 is required for the development and maintenance of the lens in addition to the proper development of the cornea, eyelids, and retina.« less

Grhl3 and Lmo4 play coordinate roles in epidermal migration.

PubMed

Hislop, Nikki R; Caddy, Jacinta; Ting, Stephen B; Auden, Alana; Vasudevan, Sumitha; King, Sarah L; Lindeman, Geoffrey J; Visvader, Jane E; Cunningham, John M; Jane, Stephen M

2008-09-01

In addition to its role in formation of the epidermal barrier, the mammalian transcription factor Grainy head-like 3 (Grhl3) is also essential for neural tube closure and wound repair, processes that are dependent in part on epidermal migration. Here, we demonstrate that the LIM-only domain protein, LMO4 serves as a functional partner of GRHL3 in its established roles, and define a new cooperative role for these factors in another developmental epidermal migration event, eyelid fusion. GRHL3 and LMO4 interact biochemically and genetically, with mutant mice exhibiting fully penetrant exencephaly, thoraco-lumbo-sacral spina bifida, defective skin barrier formation, and a co-incident eyes-open-at-birth (EOB) phenotype, which is not observed in the original individual null lines. The two genes are co-expressed in the surface ectoderm of the migrating eyelid root, and electron microscopy of Grhl3/Lmo4-null eyes reveals a failure in epithelial extension and a lack of peridermal clump formation at the eyelid margins. Accumulation of actin fibers is also absent in the circumference of these eyelids, and ERK1/2 phosphorylation is lost in the epidermis and eyelids of Grhl3(-/-)/Lmo4(-/-) embryos. Keratinocytes from mutant mice fail to "heal" in in vitro scratch assays, consistent with a general epidermal migratory defect that is dependent on ERK activation and actin cable formation.

Treatment of Dysphagia with Pyridostigmine Bromide in a Patient with the Pharyngeal-Cervical-Brachial Variant of Guillain-Barré Syndrome

PubMed Central

Lee, Kwang Lae; Lim, Oh Kyung; Park, Ki Deok

2012-01-01

A 24-year-old male developed bulbar palsy, ophthalmoplegia, ptosis, and shoulder weakness bilaterally 2 weeks after he had experienced an upper respiratory infection. The electrodiagnostic study demonstrated axonal polyradiculoneuropathy. The repetitive nerve stimulation study (RNS) showed no significant decrement of the compound muscle action potentials (CMAPs). The videofluoroscopic swallowing study (VFSS) showed severe impairment of the pharyngeal phase of swallowing. He was diagnosed as having the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. The patient's dysphagia was not improved for 3 months. A follow up RNS showed a significant decrement of the CMAPs. Pyridostigmine bromide was tried to improve the dysphagia. The patient showed immediate improvement of his dysphagia on the VFSS after the trial with pyridostigmine bromide. Pyridostigmine bromide was given before each meal for 8 days and he showed continuous improvement of his dysphagia. The follow up VFSS after 3 months showed complete recovery of dysphagia. PMID:22506249

Treatment of Dysphagia with pyridostigmine bromide in a patient with the pharyngeal-cervical-brachial variant of guillain-barré syndrome.

PubMed

Lee, Kwang Lae; Lim, Oh Kyung; Lee, Ju Kang; Park, Ki Deok

2012-02-01

A 24-year-old male developed bulbar palsy, ophthalmoplegia, ptosis, and shoulder weakness bilaterally 2 weeks after he had experienced an upper respiratory infection. The electrodiagnostic study demonstrated axonal polyradiculoneuropathy. The repetitive nerve stimulation study (RNS) showed no significant decrement of the compound muscle action potentials (CMAPs). The videofluoroscopic swallowing study (VFSS) showed severe impairment of the pharyngeal phase of swallowing. He was diagnosed as having the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. The patient's dysphagia was not improved for 3 months. A follow up RNS showed a significant decrement of the CMAPs. Pyridostigmine bromide was tried to improve the dysphagia. The patient showed immediate improvement of his dysphagia on the VFSS after the trial with pyridostigmine bromide. Pyridostigmine bromide was given before each meal for 8 days and he showed continuous improvement of his dysphagia. The follow up VFSS after 3 months showed complete recovery of dysphagia.

Long lasting dysautonomia due to botulinum toxin B poisoning: clinical-laboratory follow up and difficulties in initial diagnosis.

PubMed

Potulska-Chromik, Anna; Zakrzewska-Pniewska, Beata; Szmidt-Sałkowska, Elżbieta; Lewandowski, Jacek; Siński, Maciej; Przyjałkowski, Witold; Kostera-Pruszczyk, Anna

2013-10-30

Botulism is an acute form of poisoning caused by one of four types (A, B, E, F) toxins produced by Clostridium botulinum, ananaerobic, spore forming bacillus. Usually diagnosis of botulism is considered in patients with predominant motor symptoms: muscle weakness with intact sensation and preserved mental function. We report a case of 56-year-old Caucasian female with a history of arterial hypertension, who presented with acute respiratory failure and bilateral ptosis misdiagnosed as brainstem ischemia. She had severe external and internal ophtalmoplegia, and autonomic dysfunction with neither motor nor sensory symptoms from upper and lower limbs. Diagnosis of botulinum toxin poisoning was made and confirmed by serum antibody testing in the mouse inoculation test. Ophtalmoplegia, autonomic dysfunction and respiratory failure can be caused by botulism. Early treatment and intensive care is essential for survival and recovery. The electrophysiological tests are crucial to correct and rapid diagnosis. Botulism (especially type B) should be considered in any case of acute or predominant isolated autonomic dysfunction.

Intraocular involvement of a nasal natural killer T-cell lymphoma: a case report.

PubMed

Yoo, Jae Ho; Kim, Soo Young; Jung, Kyu Bong; Lee, Jung Joo; Lee, Sang Joon

2012-02-01

Herein, we report a case of nasal natural killer T-cell lymphoma (NKTL) with intraocular involvement. A 57-year-old woman was referred due to a three-day history of photophobia and diplopia in the left eye. One-month previously, she was diagnosed with nasal NKTL of the right nasal cavity. Ophthalmic examination revealed conjunctival injection and ptosis. The left pupil was fully dilated and non-reactive to light. Ocular motion was restricted on left-upper gaze. Five days later, anterior uveitis developed and persisted despite topical steroid treatment. An orbital magnetic resonance imaging was without specific findings, however, ophthalmoplegia, vitreous opacity, and an iris mass were observed. A diagnostic anterior chamber aspiration was performed. Aqueous humor aspiration revealed 35% morphologically atypical lymphocytes. After an intravitreal triamcinolone injection, radiotherapy and chemotherapy were administered; this resolved the uveitis and iris mass. When refractory uveitis or orbital pseudotumor occurs in patients with nasal NKTL, ocular and orbital involvement of the NKTL should be considered.

Dry eye and meibomian gland dysfunction in pseudophakic bullous keratopathy.

PubMed

Palamar, Melis; Kiyat, Pelin; Yagci, Ayse

2018-02-01

To evaluate dry eye tests and meibography of patients with pseudophakic bullous keratopathy (PBK). Thirty-seven patients with PBK were included. The eyes with PBK were compared with the normal pseudophakic fellow eyes. All patients had undergone a detailed ophthalmic examination including corneal and conjunctival fluorescein staining and Oxford scoring, tear film breakup time, Schirmer 1 test, Ocular Surface Disease Index (OSDI) score assessment, lid margin abnormalities, upper and lower eyelid Meibomian gland evaluation using infrared captures of a biomicroscope. Partial or complete loss of the Meibomian glands (Meibomian dropout) was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area was > 2/3 of the total meibomian gland area). The mean age of the patients was 73.2 ± 8.9 (range, 50-93). Mean tear film breakup time value was statistically lower in PBK eyes (P ≤ 0.001). OSDI, Oxford, lid margin abnormalities, inferior meibography, total meibography score were significantly higher in PBK eyes (P ≤ 0.001). The comparison of Schirmer 1 and superior meibography scores of the groups was insignificant (P = 0.143, P = 0.793, respectively). The Meibomian gland morphology of the PBK eyes demonstrates significant differences when compared with normal fellow eyes and might be related to evaporative dry eye. For this reason, patients with PBK should be monitored for Meibomian gland dysfunction and when needed start prompt treatment in order to prevent further disturbance of the ocular surface.

Ocular manifestations of canine transmissible venereal tumour: a retrospective study of 25 cases in Greece.

PubMed

Komnenou, A Th; Thomas, A L N; Kyriazis, A P; Poutahidis, T; Papazoglou, L G

2015-05-16

Transmissible venereal tumour (TVT) is a sexually transmitted neoplasm that frequently affects dogs of either sex, in tropical and subtropical regions. TVT primarily involves the external genitalia, although extragenital sites have also been reported. This study describes the ocular manifestations of TVT in 25 naturally infected dogs and their response to treatment. Seventeen male and eight female dogs were included in the study. TVT ocular lesions were either unilateral (21 dogs) or bilateral (four dogs). Ocular lesions as the single manifestation of TVT were seen in 22 animals. One dog presented external genitalia involvement while two others were found to have tumours in the oral and nasal mucosa. Variably sized multilobular tumour masses with irregular surface were noticed on the bulbar conjunctiva of the nictitating membrane in 17 dogs, on the conjunctiva of the upper eyelid in five dogs and on the conjunctiva of the lower eyelid and adjacent skin in three dogs. Deep ulcerative keratitis was observed in eight animals. TVT diagnosis was based on cytology and histopathology. The large eye masses were surgically excised. All dogs were treated with a single chemotherapeutic agent (vincristine). After four weeks of treatment, complete remission of the tumours was evident in all but one animal. Extragenital primary ophthalmic TVT can be completely eliminated by vincristine chemotherapy, while any further ocular damage is prevented with the combination of the above treatment and surgical excision. British Veterinary Association.

Classical Conditioning of Eyelid and Mystacial Vibrissae Responses in Conscious Mice

ERIC Educational Resources Information Center

Delgado-Garcia, Jose Maria; Troncoso, Julieta; Munera, Alejandro

2004-01-01

The murine vibrissae sensorimotor system has been scrutinized as a target of motor learning through trace classical conditioning. Conditioned eyelid responses were acquired by using weak electrical whisker-pad stimulation as conditioned stimulus (CS) and strong electrical periorbital stimulation as unconditioned stimulus (US). In addition,…

Eye disorders associated with obstructive sleep apnoea.

PubMed

West, Sophie D; Turnbull, Chris

2016-11-01

Obstructive sleep apnoea (OSA) is increasing in prevalence due to rising obesity. Public awareness is also growing. Although OSA is a disorder primarily of the upper airway during sleep, its physiological impact on other parts of the body is now well recognized. There is increasing interest in the association of OSA with various eye disorders. Work in this field has been directed predominantly to OSA prevalence and association studies, but some authors have tried to elucidate the effect of OSA therapies on eye diseases, including continuous positive airway pressure, upper airway surgery or bariatric surgery. This review discusses the publications in this area from the past year. The key ocular disorders featured in the studies and meta-analayses include glaucoma, floppy eyelid syndrome, nonarteritic ischaemic optic neuropathy, keratoconus, age-related macular degeneration and diabetic retinopathy. Associations with OSA were found with all these conditions, but aspects of the studies still leave gaps in our knowledge. This review highlights the need for ophthalmologists to consider OSA in their patients and also makes recommendations for future research studies, especially whether therapies for OSA can be effective for ocular disorders also.

Eighteen-point abobotulinum toxin a upper face rejuvenation: an eye plastic perspective on 845 subjects.

PubMed

Kashkouli, Mohsen Bahmani; Amani, Afsaneh; Jamshidian-Tehrani, Mansooreh; Yousefi, Sahar; Jazayeri, Anis Alsadat

2014-01-01

To report the method and results of 18-point Abobotulinum toxin A (ABO-BTA, Dysport) upper face rejuvenation on 845 subjects. In a retrospective chart review, all subjects (the first cycle of injection) with ABO-BTA upper face rejuvenation from 2003 to 2009 were included. Excluded were subjects with facial spastic disorders, injection after upper face lifting, and aberrant regeneration of facial nerves. Upper face rejuvenation included 18 points of injection at forehead creases (4), frown lines (5), bunny line (1), crow's feet (4 on both sides), and lower eyelid crease (4 on both sides). They were revisited in 10 to 14 days for assessment of the effects and possible touch-up injection. Demographics, year of injection, topical anesthetic usage, touch-up injection, and adverse effects (AE) were recorded. There were 845 subjects (85.8% women) whose age was below 40 in 49.3%. All but 68 (8%) were happy with the touch-up visit, 10 to 14 days after injection. Touch-up injection was performed in 8% of subjects mainly for the eyebrow asymmetry. AE (22/845, 2.6%) were bruise (15/845, 1.8%), blepharoptosis (3/845, 0.3%), remained eyebrow asymmetry after touch-up injection (2/845, 0.2%), and headache (2/845, 0.2%). They were significantly more in subjects with touch-up injection, younger than 40 years, and in the first and second year of experience (especially for the bruise). Eighteen-point ABO-BTA upper face rejuvenation had a low rate of AE in this series in which majority was bruise at the lateral canthal area. They were significantly more in the first years of experience, subjects younger than 40, and who had touch-up injections.

Palatal botulinum toxin as a novel therapy for objective tinnitus in forced eyelid closure syndrome.

PubMed

Kaffenberger, Thomas M; Mandal, Rajarsi; Schaitkin, Barry M; Hirsch, Barry E

2017-05-01

Objective tinnitus associated with eyelid closure is a rare clinical entity with only a few reported cases. This association previously was identified as forced eyelid closure syndrome (FECS) and involves an aberrant neural reflex between cranial nerve VII (activating the orbicularis oculi muscle) and cranial nerve V (activating the tensor tympani muscle). We present a 52-year-old Caucasian female with a 2-month history of FECS who was successfully treated with intrapalatal botulinum toxin, with full resolution of her objective tinnitus symptoms. This is the first reported use of botulinum toxin in FECS. Laryngoscope, 127:1199-1201, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Chronic cutaneous lupus erythematosus presenting as periorbital edema and erythema.

PubMed

Cyran, S; Douglass, M C; Silverstein, J L

1992-02-01

We report two unusual cases of cutaneous lupus erythematosus presenting as dramatic eyelid edema and erythema. Neither patient had evidence of systemic or other significant cutaneous involvement. The eyelid edema and erythema were unilateral in one case and bilateral in the other. Both cases responded to therapy with antimalarial drugs.

Surgical correction of congenital entropion in related Boer goat kids using a combination Hotz-Celsus and lateral eyelid wedge resection procedure.

PubMed

Donnelly, Kevin S; Pearce, Jacqueline W; Giuliano, Elizabeth A; Fry, Pamela R; Middleton, John R

2014-11-01

Five related Boer goat kids (≤4 months of age) were presented to the University of Missouri, Veterinary Teaching Hospital (MU-VMTH) with epiphora and blepharospasm of several weeks duration and commencing prior to 1 month of age in all animals. Clinical examination confirmed euryblepharon and entropion bilaterally in two females and one male and unilaterally in two female kids. Deep stromal corneal ulceration was present in two eyes, and corneal granulation tissue and fibrosis were present in half (5/10) the affected eyes. A combination Hotz-Celsus and lateral eyelid wedge resection procedure was performed on all affected eyelids. Recheck examinations and long-term follow-up confirmed resolution of the entropion, preservation of normal eyelid conformation, and restoration of ocular comfort. Pedigree analysis ruled out sex-linked and autosomal dominant inheritance patterns; a specific mode of inheritance could not be determined. The Boer goat breed may be at increased risk for the development of entropion. This cases series represents the first report of entropion in the caprine species. © 2014 American College of Veterinary Ophthalmologists.

Vasoactive intestinal polypeptide (VIP) innervation of the human eyelid glands.

PubMed

Seifert, P; Spitznas, M

1999-06-01

This study was conducted to obtain morphological proof of innervating nerve fibres in the glands of the human eyelid (accessory lacrimal glands of Wolfring, meibomian glands, goblet cells, glands of Zeis, glands of Moll, sweat glands, glands of lanugo hair follicles) and identification of the secretomotorically active neuropeptide vasoactive intestinal polypeptide (VIP) as a common transmitter. Epoxy-embedded ultrathin sections of tissue samples from human eyelids were studied using electron microscopy. Paraffin sections fixed in Bouin-Hollande solution were immunostained with rabbit antiserum against VIP. With the electron microscope we were able to identify nerves in the glandular stroma of all the glands examined with the exception of goblet cells. Intraepithelial single axons were only seen in the parenchyma of Wolfring glands. The morphological findings corresponded with the immunological finding of VIP-positive, nerve-like structures in the same locations, with the exception of lanugo hair follicle glands, and goblet cells. Our findings indicate that the glands of the eyelids and main lacrimal gland represent a functional unit with VIP as a possible common stimulating factor. Copyright 1999 Academic Press.

Pain associated with local anesthetic injection in eyelid procedures: Comparison of microprocessor-controlled versus traditional syringe techniques.

PubMed

Lee, Edward W; Tucker, Nancy A

2007-01-01

To evaluate the pain associated with local infiltration of the eyelid, using a microprocessor-controlled delivery system (CompuMed, using the Wand), as compared with traditional manual syringe infiltration technique. A randomized clinical trial of 30 patients undergoing minor eyelid surgical procedures was performed. Fifteen patients were injected by use of the CompuMed system and 15 patients were injected by the traditional manual syringe technique. The severity of pain was recorded from each patient by using a visual analog scale (0 to 10). The duration of pain experienced by the patient was also recorded. The mean pain level reported was 1.5 in the Wand group and 3.2 in the syringe group (p < 0.01). The mean duration of pain experienced was 1.5 seconds in the Wand group and 34 seconds in the syringe group (p < 0.01). The Wand was effective at significantly reducing the pain associated with local anesthetic infiltration in minor eyelid surgical procedures. Patients appear to feel pain from the initial needle stick but not during the actual injection.

Comparative study of the efficacy of different treatment options in patients with chronic blepharitis.

PubMed

Arrúa, M; Samudio, M; Fariña, N; Cibils, D; Laspina, F; Sanabria, R; Carpinelli, L; Mino de Kaspar, H

2015-03-01

To compare the efficacy of 3 treatment options in patients with chronic blepharitis. An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P<.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29). Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Canine mesenchymal hamartoma of the eyelid.

PubMed

Kafarnik, Christiane; Calvarese, Sara; Dubielzig, Richard R

2010-03-01

Characterization of a benign disease syndrome involving the eyelids of dogs, describing the signalment, clinical appearance, anatomic location, and pathologic features. The records and submitted tissue of 10 dogs with mesenchymal hamartomatous lesions of the periocular connective tissues were retrieved from the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW) database. The submitted tissue in each case was stained with hematoxilyn & eosin and Masson's Trichrome stain and examined histopathologically. Clinical information was collected from the submission requests. The clinical history, treatment, and follow-up are described in more detail for one of the 10 dogs. Seven different breeds, including four Golden Retrievers, were represented. The ages of affected dogs ranged from 6 to 11 years. Eight of 10 lesions were located at the temporal canthus, ranging in diameter from 0.6 to 3 cm. Clinically, the masses were subcutaneous, firm, lobular soft-tissue growths, which were in some cases adherent to the underlying orbital rim, and in others, freely palpable between the skin and conjunctiva of the eyelid. Histologically, all had distinct margins but were not encapsulated and contained normal appearing collagen-rich connective tissue with some adipose tissue. Five also contained fully differentiated skeletal muscle tissue arranged in poorly formed aggregates or as individual muscle fibers. Mesenchymal hamartoma of the eyelid has not been previously described. The mass has a predisposition to occur at the temporal canthus and should be included in the list of differential diagnoses of benign eyelid masses in dogs.

Novel Homozygous Missense Mutation in RYR1 Leads to Severe Congenital Ptosis, Ophthalmoplegia, and Scoliosis in the Absence of Myopathy.

PubMed

Dilaver, Nafi; Mazaheri, Neda; Maroofian, Reza; Zeighami, Jawaher; Seifi, Tahere; Zamani, Mina; Sedaghat, Alireza; Shariati, Gholam Reza; Galehdari, Hamid

2017-12-01

Ryanodine receptor 1 ( RYR1 ) is an intracellular calcium receptor primarily expressed in skeletal muscle with a role in excitation contraction. Both dominant and recessive mutations in the RYR1 gene cause a range of RYR1 -related myopathies and/or susceptibility to malignant hyperthermia (MH). Recently, an atypical manifestation of ptosis, variably presenting with ophthalmoplegia, facial paralysis, and scoliosis but without significant muscle weakness, has been reported in 9 cases from 4 families with bialleic variants in RYR1 . Two affected children from a consanguineous family with severe congenital ptosis, ophthalmoplegia, scoliosis, and distinctive long faces but without skeletal myopathy were studied. To identify the cause of the hereditary condition, DNA from the proband was subjected to whole exome sequencing (WES). WES revealed a novel homozygous missense variant in RYR1 (c.14066T>A; p.IIe4689Asn), which segregated within the family. Although the phenotype of the affected siblings in this study was similar to previously described cases, the clinical features were more severely expressed. Our findings contribute to the expansion of phenotypes related to RYR1 dysfunction. Additionally, it supports a new RYR1 -related clinical presentation without musculoskeletal involvement. It is important that individuals with RYR1 mutations are considered susceptible to MH, as 70% of the MH cases are caused by mutations in the RYR1 gene.

Inferior Pedicle Autoaugmentation Mastopexy After Breast Implant Removal

PubMed Central

Frey, Hans Peter; Hasse, Frank Michael; Hasselberg, Jens

2010-01-01

Background A new method of autoaugmentation mammaplasty is presented to correct ptosis and to increase the projection and volume of the breast in patients who would like a reposition augmentation mammaplasty after breast implant removal but do not want a new implant. Methods Between 1999 and 2007, a total of 27 patients (age = 54 ± 7.3 years) underwent mammaplasty using an inferior-based flap of deepithelialized subcutaneous and breast tissue modularized to its pedicle which was inserted beneath a superior pedicle used for correction of ptosis and to increase the projection and apparent volume of the breast. Results The results confirmed that autoaugmentation mammaplasty of the breast following removal of the implant yields longstanding results. It corrects ptosis and increases the projection and apparent volume of the breast when mastopexy is planned without use of a new implant. Twelve months after surgery the degree of descent of the inframammary fold generally parallels that of the nipple. The mean level of the inframammary fold was below the mean level of the nipple. Postoperatively, the optimum distance had been largely achieved. Conclusion The advantages of the technique presented here are that it minimizes the skin scar in cases using vertical mammaplasty techniques and optimizes the breast shape after breast implant removal in patients who do not want a new implant. PMID:20174800

Multinational Comparison of Prophylactic Antibiotic Use for Eyelid Surgery.

PubMed

Fay, Aaron; Nallasamy, Nambi; Bernardini, Francesco; Wladis, Edward J; Durand, Marlene L; Devoto, Martin H; Meyer, Dale; Hartstein, Morris; Honavar, Santosh; Osaki, Midori H; Osaki, Tammy H; Santiago, Yvette M; Sales-Sanz, Marco; Vadala, Giuseppe; Verity, David

2015-07-01

Antibiotic stewardship is important in controlling resistance, adverse reactions, and cost. The literature regarding antibiotic use for eyelid surgery is lacking. To determine standard care and assess factors influencing antibiotic prescribing practices for eyelid surgery. A survey study was conducted from February 2, 2014, to March 24, 2014. The survey was distributed to 2397 oculoplastic surgeons in private and academic oculoplastic surgery practices in 43 countries. All surgeons were members of ophthalmic plastic and reconstructive surgery societies. Data were analyzed by geographic location. Linear regression was performed to quantify contributions to rates of prescribing postoperative antibiotics for routine eyelid surgical procedures. Rates of prescribing prophylactic intravenous, oral, and topical antibiotics as well as factors that influence surgeons' prescribing practices. A total of 782 responses were received from 2397 surgeons (average response rate, 36.7%; 2.5% margin of error) from 43 countries. Topical antibiotic use was common in all regions (85.2%). Perioperative intravenous antibiotic use was uncommon in all regions (13.5%). Geographic location was the greatest predictor of antibiotic prescribing practices (range, 2.9% in the United Kingdom to 86.7% in India; mean, 24%). Within Europe, Italy had the highest rate of antibiotic prescriptions for eyelid surgery (41.7%) and the United Kingdom had the lowest rate (2.9%.) In South America, Venezuela had the highest rate of antibiotic prescriptions for eyelid surgery (83.3%) and Chile had the lowest rate (0%). The practice locations that were associated with routinely prescribing postoperative oral antibiotics were India (odds ratio [OR], 15.83; 95% CI, 4.85-51.68; P < .001), Venezuela (OR, 13.47; 95% CI, 1.43-127.19; P = .02), and Southeast Asia (OR, 2.80; 95% CI, 1.15-6.84; P = .02). Conversely, practice location in the United Kingdom (OR, 0.048; 95% CI, 0.0063-0.37; P = .004), Australia and New Zealand (OR, 0.15; 95% CI, 0.033-0.67; P = .01), and the United States and Canada (OR, 0.41; 95% CI, 0.23-0.72; P = .002) were associated with decreased rates of postoperative oral antibiotic use. Surgeons' concern for allergic reactions was associated with decreased rates of prescribing antibiotics (OR, 0.34; 95% CI, 0.23-0.49; P < .001), while surgeons' concern for infection was associated with increased rates of prescribing antibiotics (OR 1.80; 95% CI, 1.45-2.23; P < .001). These results from members of ophthalmic plastic and reconstructive surgery societies confirm that antibiotic prescribing practices for routine eyelid surgical procedures vary widely throughout the world. No standard of care has been established that would require the routine use of postoperative prophylactic antibiotics following eyelid surgery.

Superselective intra-arterial chemotherapy in the primary management of advanced intra-ocular retinoblastoma: first 4-year experience from a single institution in Turkey.

PubMed

Tuncer, Samuray; Sencer, Serra; Kebudi, Rejin; Tanyıldız, Burak; Cebeci, Zafer; Aydın, Kubilay

2016-11-01

To report our 4-year experience in Turkey, with advanced intra-ocular retinoblastoma managed primarily with intra-arterial chemotherapy (IAC). From October 2011 to September 2015, 26 group D eyes of 24 treatment-naïve retinoblastoma patients managed primarily with IAC were evaluated in this prospective study. Of 76 procedures, ophthalmic artery cannulation failed in two patients with unilateral involvement. In the remaining 22 patients (24 eyes), the mean age at diagnosis was 18 months (range, 6-55 months). Each eye received a mean of 3 IAC sessions/eye (range, 2-5 sessions). After a median follow-up of 29 months (range, 6-55 months), complete regression of the main tumour was achieved in 23 of 24 eyes. One eye with partial regression required enucleation due to ciliary body involvement by the tumour. Overall, 16 eyes (66.6%) were salvaged with primary IAC with or without additional local treatments, and eight (33.3%) required enucleation. The main IAC-related periocular complications included transient eyelid oedema (n = 13), ptosis (n = 6) and forehead hyperpigmentation (n = 3), each resolving in 2 weeks to 4 months. Intra-ocular complications included chorioretinal atrophy (n = 9), newly noted retinal detachment (n = 5) and vitreous haemorrhage (n = 1). Kaplan-Meier eye estimates of enucleation-free survival rates were 83.3% (95% CI, 68.4-98.1%), 69.1% (95% CI, 49.8-88.3%) and 62.9 (95% CI, 41.9-83.8%) at 6 months, 1 and 2 years, respectively, and stable thereafter. Our first 4-year experience in Turkey showed that enucleation or external-beam radiotherapy could be avoided in two-thirds of eyes with advanced intra-ocular retinoblastoma managed primarily with IAC. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Eye Injuries--The A-B-C's and a Few X-Y-Z's for the Athletic Trainer.

ERIC Educational Resources Information Center

Minton, Lee

Suggestions are given for diagnosing and treating sport-related injuries to the eye: (1) hyphema; (2) abrasion of the cornea; (3) subconjunctival hemorrhage; (4) traumatic iritis; (5) lacerations of the eyelids and brows; (6) eyelid margin lacerations; (7) traumatic retinal detachment; (8) superficial foreign body; (9) traumatic cataracts and…

Periocular necrotizing fasciitis in an infant.

PubMed

Proia, Alan D

Periocular necrotizing fasciitis developed in a 12-month-old boy with swelling of both eyes and redness and a discharge from the left eye approximately 36 hours after blunt trauma. Computed tomography revealed preseptal and soft-tissue edema on the left side, but no signs of orbital involvement, orbital fractures, or drainable abscess in the anterior left lower eyelid. The inflammatory signs worsened over the next day, and there was purulent discharge from the left lower eyelid and an abscess and necrosis of the lower eyelid skin. He did well following surgical debridement and treatment with intravenous antibiotics. His course highlights the difficulty in diagnosing necrotizing fasciitis and the necessity for prompt surgical debridement and empirical broad-spectrum antibiotic therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

Eyelid-openness and mouth curvature influence perceived intelligence beyond attractiveness.

PubMed

Talamas, Sean N; Mavor, Kenneth I; Axelsson, John; Sundelin, Tina; Perrett, David I

2016-05-01

Impression formation is profoundly influenced by facial attractiveness, but the existence of facial cues which affect judgments beyond such an "attractiveness halo" may be underestimated. Because depression and tiredness adversely affect cognitive capacity, we reasoned that facial cues to mood (mouth curvature) and alertness (eyelid-openness) affect impressions of intellectual capacity. Over 4 studies we investigated the influence of these malleable facial cues on first impressions of intelligence. In Studies 1 and 2 we scrutinize the perceived intelligence and attractiveness ratings of images of 100 adults (aged 18-33) and 90 school-age children (aged 5-17), respectively. Intelligence impression was partially mediated by attractiveness, but independent effects of eyelid-openness and subtle smiling were found that enhanced intelligence ratings independent of attractiveness. In Study 3 we digitally manipulated stimuli to have altered eyelid-openness or mouth curvature and found that each independent manipulation had an influence on perceptions of intelligence. In a final set of stimuli (Study 4) we explored changes in these cues before and after sleep restriction, to examine whether natural variations in these cues according to sleep condition can influence perceptions. In Studies 3 and 4 variations with increased eyelid-openness and mouth curvature were found to relate positively to intelligence ratings. These findings suggest potential overgeneralizations based on subtle facial cues that indicate mood and tiredness, both of which alter cognitive ability. These findings also have important implications for students who are directly influenced by expectations of ability and teachers who may form expectations based on initial perceptions of intelligence. (c) 2016 APA, all rights reserved).

Topographic measurements of eyelids and orbit in enucleated eyes with hydroxyapatite integrated implant versus PMMA implant.

PubMed

Gradinaru, S; Totir, M; Iancu, R; Leasu, C; Pricopie, S; Yasin, S; Ciuluvica, R; Ungureanu, E

2014-01-01

This study reports our results relating to palpebral eyelid fissure and orbital measurements following evisceration with orbital implantation of hydroxyapatite integrated implant and PMMA implant. This study is a prospective study of 43 patients that underwent evisceration for different ocular affections at University Emergency Hospital Bucharest, Ophthalmology department between January 2009 and September 2010 (Group A comprising of twenty patients had the coralline hydroxyapatite implant -Integrated Ocular Implants, USA and Group B comprising of twenty-three received non-integrated PMMA ocular implants) .The outcomes measured were the degree of exo /enophthalmos, horizontal eyelid fissure and palpebral fissure height at 4 years after surgical intervention related to measurement to the contralateral eye. Horizontal eyelid fissure (HEF) was suffering a shortening of 7.4% in the group B versus the contralateral eye, and only 1.9% in the group A related to the contralateral eye. Eyelid fissure height was greater in the group B with 5.2% regarding the contralateral eye, and 1.2% in group A. The degree of enophthalmia was higher in the group B of 4 mm versus the contralateral eye and lower in group A 1.5 mm regarding the contralateral eye. . Although a hydroxyapatite implant may be not as economic as a PMMA implant, a patient must be warned about the effect on its ocular structures in time and that cosmetic appearance over years will change more dramatically than in the fellow normal eye. Therefore preoperative counseling of the patient is crucial in long term patient satisfaction.

Evaluation of muscle hyperactivity of the grimacing muscles by unilateral tight eyelid closure and stapedius muscle tone.

PubMed

Shiba, Masato; Matsuo, Kiyoshi; Ban, Ryokuya; Nagai, Fumio

2012-10-01

Muscle hyperactivity of grimacing muscles, including the orbicularis oculi and corrugator supercilii muscles that cause crow's feet and a glabellar frown line with ageing, cannot be accurately evaluated by surface observation. In 71 subjects, this study investigated the extent to which grimacing muscles are innervated by the bilateral motor cortices, whether the corticofacial projection to the grimacing muscles affects the facially innervated stapedius muscle tone by measuring static compliance of the tympanic membrane, and whether unilateral tight eyelid closure with contraction of the grimacing muscles changes static compliance. Unilateral tight eyelid closure and its subsequent change in the contralateral vertical medial eyebrow position revealed that motor neurons of the orbicularis oculi and corrugator supercilii muscles were innervated by the bilateral motor cortices with weak-to-strong contralateral dominance. The orbicularis oculi, corrugator supercilii, and stapedius muscles innervated by the bilateral motor cortices had increased muscle hyperactivity, which lowered the vertical medial eyebrow position and decreased the static compliance of the tympanic membrane more than those innervated by the unilateral motor cortex. Unilateral enhanced tight eyelid closure with contraction of the grimacing muscles in certain subjects ipsilaterally decreased the static compliance with increased contraction of the stapedius muscle, which probably occurs to immobilise the tympanic membrane and protect the inner ear from loud sound. Evaluation of unilateral tight eyelid closure and the subsequent change in the contralateral vertical medial eyebrow position as well as a measurement of the static compliance for the stapedius muscle tone has revealed muscle hyperactivity of grimacing muscles.

Persistent activity in a cortical-to-subcortical circuit: bridging the temporal gap in trace eyelid conditioning

PubMed Central

Kalmbach, Brian; Chitwood, Raymond A.; Mauk, Michael D.

2012-01-01

We have addressed the source and nature of the persistent neural activity that bridges the stimulus-free gap between the conditioned stimulus (CS) and unconditioned stimulus (US) during trace eyelid conditioning. Previous work has demonstrated that this persistent activity is necessary for trace eyelid conditioning: CS-elicited activity in mossy fiber inputs to the cerebellum does not extend into the stimulus-free trace interval, which precludes the cerebellar learning that mediates conditioned response expression. In behaving rabbits we used in vivo recordings from a region of medial prefrontal cortex (mPFC) that is necessary for trace eyelid conditioning to test the hypothesis that neurons there generate activity that persists beyond CS offset. These recordings revealed two patterns of activity during the trace interval that would enable cerebellar learning. Activity in some cells began during the tone CS and persisted to overlap with the US, whereas in other cells, activity began during the stimulus-free trace interval. Injection of anterograde tracers into this same region of mPFC revealed dense labeling in the pontine nuclei, where recordings also revealed tone-evoked persistent activity during trace conditioning. These data suggest a corticopontine pathway that provides an input to the cerebellum during trace conditioning trials that bridges the temporal gap between the CS and US to engage cerebellar learning. As such, trace eyelid conditioning represents a well-characterized and experimentally tractable system that can facilitate mechanistic analyses of cortical persistent activity and how it is used by downstream brain structures to influence behavior. PMID:21957220

Temporal patterns of inputs to cerebellum necessary and sufficient for trace eyelid conditioning.

PubMed

Kalmbach, Brian E; Ohyama, Tatsuya; Mauk, Michael D

2010-08-01

Trace eyelid conditioning is a form of associative learning that requires several forebrain structures and cerebellum. Previous work suggests that at least two conditioned stimulus (CS)-driven signals are available to the cerebellum via mossy fiber inputs during trace conditioning: one driven by and terminating with the tone and a second driven by medial prefrontal cortex (mPFC) that persists through the stimulus-free trace interval to overlap in time with the unconditioned stimulus (US). We used electric stimulation of mossy fibers to determine whether this pattern of dual inputs is necessary and sufficient for cerebellar learning to express normal trace eyelid responses. We find that presenting the cerebellum with one input that mimics persistent activity observed in mPFC and the lateral pontine nuclei during trace eyelid conditioning and another that mimics tone-elicited mossy fiber activity is sufficient to produce responses whose properties quantitatively match trace eyelid responses using a tone. Probe trials with each input delivered separately provide evidence that the cerebellum learns to respond to the mPFC-like input (that overlaps with the US) and learns to suppress responding to the tone-like input (that does not). This contributes to precisely timed responses and the well-documented influence of tone offset on the timing of trace responses. Computer simulations suggest that the underlying cerebellar mechanisms involve activation of different subsets of granule cells during the tone and during the stimulus-free trace interval. These results indicate that tone-driven and mPFC-like inputs are necessary and sufficient for the cerebellum to learn well-timed trace conditioned responses.

[Management of eyelid carcinomas: Retrospective bicentric study of 64 cases and review of the literature].

PubMed

Echchaoui, A; Benyachou, M; Houssa, A; Kajout, M; Oufkir, A A; Hajji, C; Daoudi, R; Hafidi, J; El Mazouz, S; Gharib, N; Abbassi, A

2016-02-01

To study the epidemiologic, clinical and histological aspects of eyelid carcinomas in our context, and to evaluate our surgical management on an oncological, functional and aesthetic level. This work is a retrospective bicentric study extended over a 5-year period between January 2009 and December 2013, including 64 patients with eyelid carcinoma undergoing surgery in the Plastic and Reconstructive Surgery Department at the Avicenne University Hospital of Rabat and in the ENT/Head and Neck Surgery Department at the Hassan II University Hospital of Fez. The study included 25 men and 39 women with a mean age of 60.6 ± 15.33 years. Advanced age and chronic sun exposure were the most important risk factors. The most commonly involved site was the lower eyelid (53%). Histological examination emphasized the very high prevalence of basal cell carcinoma (90.62%). Surgical treatment was performed in all our patients followed by an extemporaneous and/or standard histological examination of the surgical specimen. Exenteration was performed in one patient with adjuvant radiation therapy. Reconstruction incorporated a variety of techniques, of which total skin graft and Mustardé flap were the most common in our series. Aside from a few complications, the postoperative results were satisfactory for the majority of our patients. Malignant tumors of the eyelids, of which basal cell carcinoma is the most common, pose a therapeutic problem where surgery remains the most utilized treatment option. The best treatment is prevention and diagnosis of early lesions to improve prognosis and to avoid worse outcomes. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Blink Prosthesis For Facial Paralysis Patients

DTIC Science & Technology

2016-10-01

predisposes patients to corneal exposure and dry eye complications that are difficult to effectively treat. The proposed innovation will provide a...aesthetic and functional use of the paralyzed eyelid by preventing painful dry eye complications and profound facial disfiguration. The goal of this program... eye blink in patients with unilateral facial nerve paralysis. The system will electrically stimulate the paretic eyelid when EMG electrodes detect

Camera-Based Microswitch Technology to Monitor Mouth, Eyebrow, and Eyelid Responses of Children with Profound Multiple Disabilities

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Bellini, Domenico; Oliva, Doretta; Singh, Nirbhay N.; O'Reilly, Mark F.; Lang, Russell; Didden, Robert

2011-01-01

A camera-based microswitch technology was recently used to successfully monitor small eyelid and mouth responses of two adults with profound multiple disabilities (Lancioni et al., Res Dev Disab 31:1509-1514, 2010a). This technology, in contrast with the traditional optic microswitches used for those responses, did not require support frames on…

Camera-Based Microswitch Technology for Eyelid and Mouth Responses of Persons with Profound Multiple Disabilities: Two Case Studies

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Bellini, Domenico; Oliva, Doretta; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff

2010-01-01

These two studies assessed camera-based microswitch technology for eyelid and mouth responses of two persons with profound multiple disabilities and minimal motor behavior. This technology, in contrast with the traditional optic microswitches used for those responses, did not require support frames on the participants' face but only small color…

[Palpebral cryptococcosis: case report].

PubMed

Souza, Murilo Barreto; Melo, Carlos Sergio Nascimento; Silva, Cristiana Silveira; Santo, Ruth Miyuki; Matayoshi, Suzana

2006-01-01

This paper is about a patient with acquired immunodeficiency syndrome empirically treated for miliary tuberculosis. During the clinical evolution the patient presented lesions compromising the right eyelid and tarsal conjunctiva. The initial diagnostic hypothesis was ocular tuberculosis with conjunctival and eyelid involvement. The biopsy of the conjunctival lesion identified an encapsulated yeast-like fungus: Criptococcus neoformans. After starting treatment with B anfotericin, the cutaneus lesions cleared.

[A cutaneous horn of the free margin of the eyelid: an anatomical and clinical observation].

PubMed

D'Hermies, F; Gerolami-Favreul, I; Meyer, A; Morel, X; Halhal, M; Sam, H; Elmaleh, C; Renard, G; Behar-Cohen, F

2003-05-01

A cutaneous horn was observed close to the free margin of the inferior right eyelid in a 26-year-old-male patient. A minimal resection was primarily performed. Histopathologic study disclosed a precancerous keratosis. As the tumor had not been entirely excised, a complementary resection was performed secondarily to obtain the entire resection of the tumor.

Eyelid contour detection and tracking for startle research related eye-blink measurements from high-speed video records.

PubMed

Bernard, Florian; Deuter, Christian Eric; Gemmar, Peter; Schachinger, Hartmut

2013-10-01

Using the positions of the eyelids is an effective and contact-free way for the measurement of startle induced eye-blinks, which plays an important role in human psychophysiological research. To the best of our knowledge, no methods for an efficient detection and tracking of the exact eyelid contours in image sequences captured at high-speed exist that are conveniently usable by psychophysiological researchers. In this publication a semi-automatic model-based eyelid contour detection and tracking algorithm for the analysis of high-speed video recordings from an eye tracker is presented. As a large number of images have been acquired prior to method development it was important that our technique is able to deal with images that are recorded without any special parametrisation of the eye tracker. The method entails pupil detection, specular reflection removal and makes use of dynamic model adaption. In a proof-of-concept study we could achieve a correct detection rate of 90.6%. With this approach, we provide a feasible method to accurately assess eye-blinks from high-speed video recordings. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Visual sensation during pecking in pigeons.

PubMed

Ostheim, J

1997-10-01

During the final down-thrust of a pigeon's head, the eyes are closed gradually, a response that was thought to block visual input. This phase of pecking was therefore assumed to be under feed-forward control exclusively. Analysis of high resolution video-recordings showed that visual information collected during the down-thrust of the head could be used for 'on-line' modulations of pecks in progress. We thus concluded that the final down-thrust of the head is not exclusively controlled by feed-forward mechanisms but also by visual feedback components. We could further establish that as a rule the eyes are never closed completely but instead the eyelids form a slit which leaves a part of the pupil uncovered. The width of the slit between the pigeon' eyelids is highly sensitive to both, ambient luminance and the visual background against which seeds are offered. It was concluded that eyelid slits increase the focal depth of retinal images at extreme near-field viewing-conditions. Applying pharmacological methods we could confirm that pupil size and eyelid slit width are controlled through conjoint neuronal mechanisms. This shared neuronal network is particularly sensitive to drugs that affect dopamine receptors.

Desensitization of the Mechanoreceptors in Müller's Muscle Reduces the Increased Reflex Contraction of the Orbicularis Oculi Slow-Twitch Fibers in Blepharospasm.

PubMed

Matsuo, Kiyoshi; Ban, Ryokuya; Ban, Midori

2014-01-01

Although the mixed orbicularis oculi muscle lacks the muscle spindles required to induce reflex contraction of its slow-twitch fibers, the mechanoreceptors in Müller's muscle function as extrinsic mechanoreceptors to induce reflex contraction. We hypothesize that strong stretching of these mechanoreceptors increases reflex contraction of the orbicularis oculi slow-twitch muscle fibers, resulting in blepharospasm. We examined a 71-year-old man with right blepharospasm and bilateral aponeurosis-disinserted blepharoptosis to determine whether the patient's blepharospasm was worsened by increased trigeminal proprioceptive evocation via stretching of the mechanoreceptors in Müller's muscle owing to a 60° upward gaze and serrated eyelid closure, and whether local anesthesia of the mechanoreceptors via lidocaine administration to the upper fornix as well as surgical disinsertion of Müller's muscle from the tarsus and fixation of the disinserted aponeurosis to the tarsus decreased trigeminal proprioceptive evocation and improved patient's blepharospasm. Before pharmacological desensitization, 60° upward gaze and serrated eyelid closure exacerbated the patient's blepharospasm. In contrast, these maneuvers did not worsen his blepharospasm following lidocaine administration. One year after surgical desensitization, the blepharospasm had disappeared and a 60° upward gaze did not induce blepharospasm. Strong stretching of the mechanoreceptors in Müller's muscle appeared to increase reflex contraction of the orbicularis oculi slow-twitch muscle fibers, resulting in blepharospasm. In addition to botulinum neurotoxin injections into the involuntarily contracted orbicularis oculi muscle and myectomy, surgical desensitization of the mechanoreceptors in Müller's muscle may represent an additional procedure to reduce blepharospasm.

Desensitization of the Mechanoreceptors in Müller's Muscle Reduces the Increased Reflex Contraction of the Orbicularis Oculi Slow-Twitch Fibers in Blepharospasm

PubMed Central

Ban, Ryokuya; Ban, Midori

2014-01-01

Objective: Although the mixed orbicularis oculi muscle lacks the muscle spindles required to induce reflex contraction of its slow-twitch fibers, the mechanoreceptors in Müller's muscle function as extrinsic mechanoreceptors to induce reflex contraction. We hypothesize that strong stretching of these mechanoreceptors increases reflex contraction of the orbicularis oculi slow-twitch muscle fibers, resulting in blepharospasm. Methods: We examined a 71-year-old man with right blepharospasm and bilateral aponeurosis-disinserted blepharoptosis to determine whether the patient's blepharospasm was worsened by increased trigeminal proprioceptive evocation via stretching of the mechanoreceptors in Müller's muscle owing to a 60° upward gaze and serrated eyelid closure, and whether local anesthesia of the mechanoreceptors via lidocaine administration to the upper fornix as well as surgical disinsertion of Müller's muscle from the tarsus and fixation of the disinserted aponeurosis to the tarsus decreased trigeminal proprioceptive evocation and improved patient's blepharospasm. Results: Before pharmacological desensitization, 60° upward gaze and serrated eyelid closure exacerbated the patient's blepharospasm. In contrast, these maneuvers did not worsen his blepharospasm following lidocaine administration. One year after surgical desensitization, the blepharospasm had disappeared and a 60° upward gaze did not induce blepharospasm. Conclusions: Strong stretching of the mechanoreceptors in Müller's muscle appeared to increase reflex contraction of the orbicularis oculi slow-twitch muscle fibers, resulting in blepharospasm. In addition to botulinum neurotoxin injections into the involuntarily contracted orbicularis oculi muscle and myectomy, surgical desensitization of the mechanoreceptors in Müller's muscle may represent an additional procedure to reduce blepharospasm. PMID:25328566

Surgical Outcomes of Deep Superior Sulcus Augmentation Using Acellular Human Dermal Matrix in Anophthalmic or Phthisis Socket.

PubMed

Cho, Won-Kyung; Jung, Su-Kyung; Paik, Ji-Sun; Yang, Suk-Woo

2016-07-01

Patients with anophthalmic or phthisis socket suffer from cosmetic problems. To resolve those problems, the authors present the surgical outcomes of deep superior sulcus (DSS) augmentation using acellular dermal matrix in patients with anophthalmic or phthisis socket. The authors retrospectively reviewed anophthalmic or phthisis patients who underwent surgery for DSS augmentation using acellular dermal matrix. To evaluate surgical outcomes, the authors focused on 3 aspects: the possibility of wearing contact prosthesis, the degree of correction of the DSS, and any surgical complications. The degree of correction of DSS was classified as excellent: restoration of superior sulcus enough to remove sunken sulcus shadow; fair: gain of correction effect but sunken shadow remained; or fail: no effect of correction at all. Ten eyes of 10 patients were included. There was a mean 21.3 ± 37.1-month period from evisceration or enucleation to the operation for DSS augmentation. All patients could wear contact prosthesis after the operation (100%). The degree of correction was excellent in 8 patients (80%) and fair in 2. Three of 10 (30%) showed complications: eyelid entropion, upper eyelid multiple creases, and spontaneous wound dehiscence followed by inflammation after stitch removal. Uneven skin surface and paresthesia in the forehead area of the affected eye may be observed after surgery. The overall surgical outcomes were favorable, showing an excellent degree of correction of DSS and low surgical complication rates. This procedure is effective for patients who have DSS in the absence or atrophy of the eyeball.

Ocular Manifestations of Oblique Facial Clefts

PubMed Central

Ortube, Maria Carolina; Dipple, Katrina; Setoguchi, Yoshio; Kawamoto, Henry K.; Demer, Joseph L.

2014-01-01

Introduction In the Tessier classification, craniofacial clefts are numbered from 0 to 14 and extend along constant axes through the eyebrows, eyelids, maxilla, nostrils, and the lips. We studied a patient with bilateral cleft 10 associated with ocular abnormalities. Method Clinical report with orbital and cranial computed tomography. Results After pregnancy complicated by oligohydramnios, digoxin, and lisinopril exposure, a boy was born with facial and ocular dysmorphism. Examination at age 26 months showed bilateral epibulbar dermoids, covering half the corneal surface, and unilateral morning glory anomaly of the optic nerve. Ductions of the right eye were normal, but the left eye had severely impaired ductions in all directions, left hypotropia, and esotropia. Under anesthesia, the left eye could not be rotated freely in any direction. Bilateral Tessier cleft number 10 was implicated by the presence of colobomata of the middle third of the upper eyelids and eyebrows. As the cleft continued into the hairline, there was marked anterior scalp alopecia. Computed x-ray tomography showed a left middle cranial fossa arachnoid cyst and calcification of the reflected tendon of the superior oblique muscle, trochlea, and underlying sclera, with downward and lateral globe displacement. Discussion Tessier 10 clefts are very rare and usually associated with encephalocele. Bilateral 10 clefts have not been reported previously. In this case, there was coexisting unilateral morning glory anomaly and arachnoid cyst of the left middle cranial fossa but no encephalocele. Conclusions Bilateral Tessier facial cleft 10 may be associated with alopecia, morning glory anomaly, epibulbar dermoids, arachnoid cyst, and restrictive strabismus. PMID:20856062

Basal cell adenocarcinoma in the gland of the third eyelid of a brown bear (Ursus arctos)

PubMed Central

SAKAI, Hiroki; GOTO, Minami; KOMATSU, Takeshi

2017-01-01

The right third eyelid of an adult female brown bear (c) was swollen and removed. Histopathology revealed a tumor exhibiting proliferation with mild infiltration, consisting of multi-stratified glandular structures of the innermost laminal neoplastic cells and the basaloid neoplastic cells, and with eosinophilic thick basal lamina material around the glandular structures. Both types of neoplastic cells exhibited moderate anisokaryosis, and mitotic figures were observed in the basaloid neoplastic cells. The laminal neoplastic cells were cytokeratin (CK) 8/18-positive. In contrast, the basaloid neoplastic cells were CK14- and p63-positive, but α-smooth muscle actin- and calponin-negative. The case described herein is the first report of basal cell adenocarcinoma in the gland of the third eyelid of a bear. PMID:28637946

Delayed resolution of eyelid swelling in preseptal cellulitis in a child: beware of causing occlusion amblyopia.

PubMed

Upendran, Muralidharan R; McLoone, Eibhlin

2013-03-08

A 7-month-old child presented with a 6-day history of right eyelid swelling and redness. She was being treated with chloramphenicol ointment and oral flucloxacillin by the general practitioner. Clinical examination revealed features of preseptal cellulitis. There was no evidence of orbital involvement and the child was generally well otherwise. Her oral antibiotics were changed and she was adviced to attend for a review in 2 days time. However, the child did not return for a review. Three weeks later following resolution of the eyelid swelling, the child represented with a divergent squint in the right eye. Clinical and orthoptic investigations suggested occlusion amblyopia. The child is currently receiving patching treatment for the amblyopia and is awaiting surgery for squint eye.

Fish-hook injuries: a risk for fishermen

PubMed Central

2010-01-01

Fishing is one of the best known and practiced human activities. However, you should remember that, when casting the hook from the riverbank or grasping it to add bait, fishermen run a real risk of injury if the hook punctures the skin. Briefly we describe a case where a young, 32-year-old fisherman who was reeling the hook back to shore when it hit him in the face and embedded itself in his upper eyelid. Upon examination, the eye was found to be unharmed and the hook was removed through a small incision and the aid of a local anesthetic. In the light of this case report, we think it a good idea to advise our friends and patients who we know to be fishermen to wear some form of eye protection as a precaution. PMID:21156039

Management of enophthalmos and superior sulcus deformity induced by the silent sinus syndrome.

PubMed

Ando, Andre; Cruz, Antonio Augusto Velasco

2005-01-01

Silent sinus syndrome is a dysfunction of the maxillary sinus that induces a progressive and asymptomatic enophthalmos with prominent deep superior sulcus deformity. Two cases of silent sinus syndrome are reported, and the simultaneous management of both enophthalmos and superior sulcus deformity caused by this syndrome is discussed. The patients underwent surgical endoscopic maxillary meatotomy and transconjunctival subperiosteal implantation of porous polyethylene sheets. The treatment successfully corrected both the enophthalmos and the upper eyelid sulcus deformity. However, small degrees of vertical eye dystopia were observed. Silent sinus syndrome is a rare cause of enophthalmos and superior sulcus deformity. Orbital floor implants can be used to increase the volume of the orbital contents, but vertical eye dystopia is likely to be induced if this method of treatment is the only option chosen.

Tinea faciei on the right eyebrow caused by Trichophyton interdigitale.

PubMed

Zhuang, Kai Wen; Dai, Ya Ling; Ran, Yu Ping; Lama, Jebina; Fan, Yi Ming

2016-01-01

Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical clinical symptoms, usually misdiagnosed and treated with corticosteroids. The authors describe a case of tinea faciei on the right eyebrow caused by Trichophyton interdigitale. The patient was an 18-year-old girl, who had an inflammatory plaque with a scaly, pustular surface on the right eyebrow and upper eyelid, which had persisted for over 1 month. She was once misdiagnosed as having eczema and was treated using corticosteroid cream. A diagnosis of tinea faciei was made based on direct microscopy and culture. The sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the isolate established its T. interdigitale lineage. The patient was cured by treatment with systemic terbinafine in combination with topical application of 1% naftifine-0.25% ketaconazole cream for 2 weeks.

Tinea faciei on the right eyebrow caused by Trichophyton interdigitale*

PubMed Central

Zhuang, Kai Wen; Dai, Ya Ling; Ran, Yu Ping; Lama, Jebina; Fan, Yi Ming

2016-01-01

Tinea faciei is a relatively uncommon dermatophyte infection entailing atypical clinical symptoms, usually misdiagnosed and treated with corticosteroids. The authors describe a case of tinea faciei on the right eyebrow caused by Trichophyton interdigitale. The patient was an 18-year-old girl, who had an inflammatory plaque with a scaly, pustular surface on the right eyebrow and upper eyelid, which had persisted for over 1 month. She was once misdiagnosed as having eczema and was treated using corticosteroid cream. A diagnosis of tinea faciei was made based on direct microscopy and culture. The sequencing of the nuclear ribosomal ITS region and β-tubulin gene of the isolate established its T. interdigitale lineage. The patient was cured by treatment with systemic terbinafine in combination with topical application of 1% naftifine-0.25% ketaconazole cream for 2 weeks. PMID:28099612

Cavernous hemangioma of the orbit: an unusual acute presentation

PubMed Central

Louisraj, Sophia; Ponnudurai, Thendral; Rodriguez, Dominic; Thomas, Philip A; Nelson Jesudasan, Christadoss Arul

2017-01-01

We report an unusual presentation of an orbital cavernous hemangioma in a 26-year-old female, who noted sudden redness and swelling of the left eye (LE) on waking up. At presentation, upper eyelid edema with periorbital ecchymosis and subconjunctival hemorrhage were noted in the LE. Although there was transient symptomatic relief with topical medications, blurring of vision developed in the LE. When seen 10 days later, the patient’s LE showed axial proptosis. Magnetic resonance imaging revealed an intraconal soft tissue mass in the superomedial quadrant of the left orbit. Superior orbitotomy with mass excision was done; histopathological examination of the excised mass revealed a cavernous hemangioma. The patient had complete visual recovery following surgery. To our knowledge, an acute presentation of an orbital cavernous hemangioma with subconjunctival hemorrhage and periorbital ecchymosis has not previously been reported. PMID:28769595

De Novo 3q22.3q24 Microdeletion in a Patient With Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome, Dandy-Walker Malformation, and Wisconsin Syndrome.

PubMed

Ramineni, Anand; Coman, David

2016-01-01

Interstitial deletions affecting the long arm of chromosome 3 have been associated with a broad phenotype. This has included the features of blepharophimosis-ptosis-epicanthus inversus syndrome, Dandy-Walker malformation, and the rare Wisconsin syndrome. The authors report a young female patient presenting with features consistent with all 3 of these syndromes. This has occurred in the context of a de novo 3q22.3q24 microdeletion including FOXL2 , ZIC1 , and ZIC4 . This patient provides further evidence for the role of ZIC1 and ZIC4 in Dandy-Walker malformation and is the third reported case of Dandy-Walker malformation to have associated corpus callosum thinning. This patient is also only the seventh to be reported with the rare Wisconsin syndrome phenotype.

WAGR(O?) syndrome and congenital ptosis caused by an unbalanced t(11;15)(p13;p11.2)dn demonstrating a 7 megabase deletion by FISH.

PubMed

Lennon, P A; Scott, D A; Lonsdorf, D; Wargowski, D S; Kirkpatrick, S; Patel, A; Cheung, S W

2006-06-01

Aniridia usually occurs in isolation, but may also occur as part of the WAGR contiguous gene deletion syndrome, which includes Wilms tumor, aniridia, genitourinary abnormalities, and mental retardation. The aniridia and predisposition for Wilms tumor seen in WAGR are caused by haploinsufficiency for PAX 6 and WT1, respectively. We present a female infant with aniridia, bilateral ptosis, bilateral posterior capsular cataracts, nystagmus, left-sided glaucoma, microcephaly, mild unilateral hydronephrosis, poor linear growth, and gross motor delay consistent with a clinical diagnosis of WAGR syndrome. In addition, weight-for-height ratio at 12 months is at the 94th centile, raising the possibility of a diagnosis of WAGRO (WAGR + Obesity). Chromosome analysis revealed a translocation (11;15)(p13;p11.2) which has not been previously associated with a diagnosis of WAGR. Subsequent clinical WAGR fluorescent in situ hybridization (FISH) analysis demonstrated a deletion of 11p13 including PAX6 and WT1. A complete FISH-mapping of the breakpoints on chromosome 11 revealed a 7 Mb deletion within 11p13-11p14. The patient is examined in light of other reported patients with deletions and/or translocations involving the regions between 11p12 --> 11p14 including patients with WAGR + obesity (WAGRO) as well as with other reported patients with aniridia and congenital ptosis. Copyright 2006 Wiley-Liss, Inc.

Facial Asymmetry: Brow and Ear Position.

PubMed

Perumal, Balaji; Meyer, Dale R

2018-04-01

The purpose of the current study was to analyze brow and ear position, and examine the relationship between these structures in patients presenting for blepharoplasty evaluation. A retrospective chart review was performed, which included all patients presenting to one oculoplastic physician for a blepharoplasty evaluation from November, 2012 to March, 2014. The prevalence of brow ptosis and brow and ear asymmetry was calculated; the proportional distribution was determined, and chi-square analysis and the z-test of proportions were used to calculate the significance. Institutional Review Board approval was obtained for this study. A total of 133 patients met the inclusion criteria. Some degree of brow ptosis was noted in 83% of patients. Brow asymmetry was found in 88% of patients, and ear asymmetry in 77%. Of those patients who had asymmetry, 61% had the right brow lower and 75% had the right ear lower; 73% of all patients had the brow and ear lower on the same side ( p  < 0.001). In this study, brow ptosis and asymmetry were quite common. In addition, the side of the lower brow correlated strongly with the side of the lower ear, and the right side structures were lower more often than the left. Patients presenting for blepharoplasty evaluation may have an element of generalized facial asymmetry which includes the brows and ears. These observations can be important for preoperative planning and patient counseling. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The significance of orbital anatomy and periocular wrinkling when performing laser skin resurfacing.

PubMed

Trelles, M A; Pardo, L; Benedetto, A V; García-Solana, L; Torrens, J

2000-03-01

Knowledge of orbital anatomy and the interaction of muscle contractions, gravitational forces and photoagingis fundamental in understanding the limitations of carbon dioxide (CO2) laser skin resurfacing when rejuvenating the skin of the periocular area. Laser resurfacing does not change the mimetic behavior of the facial muscles nor does it influence gravitational forces. When resurfacing periocular tissue, the creation of scleral show and ectropion are a potential consequence when there is an over zealous attempt at improving the sagging malar fat pad and eyelid laxity by performing an excess amount of laser passes at the lateral portion of the lower eyelid. This results in an inadvertent widening of the palpebral fissure due to the lateral pull of the Orbicularis oculi. Retrospectively, 85 patients were studied, who had undergone periorbital resurfacing with a CO2 laser using anew treatment approach. The Sharplan 40C CO2 Feather Touchlaser was programmed with a circular scanning pattern and used just for the shoulders of the wrinkles. A final laser pass was performed with the same program over the entire lower eyelid skin surface, excluding the outer lateral portion (e.g. a truncated triangle-like area),corresponding to the lateral canthus. Only a single laser pass was delivered to the lateral canthal triangle to avoid widening the lateral opening of the eyelid, which might lead to the potential complications of scleral show and ectropion. When the area of the crows' feet is to be treated, three passes on the skin of this entire lateral orbital surface are completed by moving laterally and upward toward the hairline. Patients examined on days 1, 7, 15, 30, 60, and one year after laser resurfacing showed good results. At two months after treatment, the clinical improvement was rated by the patient and physician as being "very good" in 81 of the 85 patients reviewed. These patients underwent laser resurfacing without complications. The proposed technique of periocular resurfacing prevents complications of scleral show and laxity in the lateral eyelid opening and even ectropion, because treatment conforms to the osseo-muscular anatomical relationship of eyelid structures.

Dysport (botulinum toxin type A) in routine therapeutic usage: a telephone needs assessment survey of European physicians to evaluate current awareness and adherence to product labeling changes.

PubMed

Hubble, Jean; Schwab, Joseph; Hubert, Catherine; Abbott, Chandra Coleman

2013-01-01

Botulinum neurotoxin type A is a well-established treatment for a number of conditions involving muscle hyperactivity. Dysport (Ipsen Ltd, Wrexham, United Kingdom) is a botulinum neurotoxin type A preparation that has been available for a number of therapeutic uses for over 20 years in the European Union (EU). This survey was part of the EU botulinum toxin risk management plan to identify potential educational needs of injectors by collecting data on their routine practice administration of Dysport and their awareness of potential adverse events (AEs) that are included in the current product labeling. Dysport-experienced injectors in 5 EU countries were surveyed via telephone about their experience of Dysport in patients with cervical dystonia, adult upper and lower limb spasticity, pediatric cerebral palsy, and blepharospasm/hemifacial spasm. The reconstitution dilution volume most often used was 2.5 mL per 500 U for all indications. The mean total dose ranged from 387 to 530 U for cervical dystonia, 508 to 773 U for upper limb spasticity, 600 to 832 U for lower limb spasticity, 375 to 700 U for pediatric cerebral palsy, and 54 to 213 U for blepharospasm/hemifacial spasm. The potential AEs most commonly mentioned by surveyed physicians were dysphagia for cervical dystonia, arm muscle weakness for upper limb spasticity, leg muscle weakness for lower limb spasticity, and pediatric cerebral palsy and ptosis for blepharospasm/hemifacial spasm. The results indicate that product-labeling recommendations are generally applied in clinical practice and that there is a good familiarity with potential AEs based on clinical condition. Nevertheless, the survey shows that experienced injectors do sometimes deviate from the manufacturers labeling recommendations, highlighting the importance of ongoing education.

Management of hypotrichosis of the eyelashes: Focus on bimatoprost

PubMed Central

Fagien, Steven

2010-01-01

Prominent eyelashes are generally recognized as enhancing beauty and are often desired by women. Until recently, the options available to augment the prominence of eyelashes were limited to makeup, over-the-counter products, artificial eyelashes, and eyelash transplantation. Originally approved for the treatment of ocular hypertension, the prostamide, bimatoprost, is now approved for the treatment of hypotrichosis of the eyelashes. Bimatoprost ophthalmic solution 0.03%, applied once daily to the skin of the upper eyelid margin using sterile single-use-per-eye applicators, increases eyelash growth, including length, thickness, and darkness. The effectiveness of bimatoprost for eyelash growth has been demonstrated by clinician ratings, digital image analysis, and patient-reported measures of satisfaction. The effects of bimatoprost treatment on eyelash length, thickness, and darkness are believed to result from longer anagen duration, increased hair bulb thickness, and increased melanogenesis, respectively. Dermally applied bimatoprost appears to be associated with a lower incidence of adverse events than administration of the medication as an eyedrop. This more favorable safety and tolerability profile is likely mediated by decreased exposure of ocular tissues to bimatoprost when applied dermally. Taken together, available data suggest that cutaneous application of bimatoprost ophthalmic solution 0.03% safely and effectively enhances upper eyelash growth. PMID:21437058

Paralysis of the orbicularis muscle of the eye using botulinum toxin type A in the treatment for dry eye.

PubMed

Serna-Ojeda, Juan Carlos; Nava-Castaneda, Angel

2017-03-01

To evaluate the efficacy of botulinum toxin type A injection to cause orbicularis eyelid muscle paralysis to improve dry eye signs and symptoms. A prospective, randomized, comparative eye-to-eye and interventional study was performed. Patients with dry eye symptoms and positive fluorescein corneal staining were included. Randomly one eyelid received a subcutaneous injection of botulinum toxin in the medial orbicularis muscle portion of the lower eyelid, and the other eye received placebo. The subjective evaluation was achieved with a questionnaire assessing symptoms, quality of vision and ocular comfort level. The objective evaluation included the measurement of the tear film break-up time (TBUT), Schirmer's test and corneal and conjunctival staining. Twenty patients were included with a mean age of 59.5 years. Two weeks after the botulinum toxin injection, all patients showed a decrease in the horizontal movement of the lower eyelid when blinking. The eyes in the active treatment group showed better scores compared with the sham group in four symptoms 4 weeks after the treatment. The TBUT was higher at 1 and 3 months in the active treatment group. The corneal and conjunctival staining were significantly lower in the active treatment group at 1 and 3 months, and the Schirmer's test showed better measurements in the same group at 2 weeks, 1 month and 3 months. There were no adverse events reported. The injection of botulinum toxin A in the medial part of the lower eyelid is an effective and safe procedure that temporally improves some of the signs and symptoms of patients with dry eye. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

In-vivo heat retention comparison of eyelid warming masks.

PubMed

Bitton, Etty; Lacroix, Zoé; Léger, Stéphanie

2016-08-01

Meibomian gland dysfunction (MGD) is one of the most common causes of evaporative dry eye. Warm compresses (WC) are recommended as adjunct therapy to slowly transfer heat to the meibomian glands to melt or soften the stagnant meibum with targeted temperatures of 40-45°C. This clinical study evaluated the heat retention profiles of commercially available eyelid warming masks over a 12-min interval. Five eyelid-warming masks (MGDRx Eyebag(®), EyeDoctor(®), Bruder(®), Tranquileyes XR™, Thera°Pearl(®)) were heated following manufacturer's instructions and heat retention was assessed at 1-min intervals for 12min. A facecloth warmed with hot tap water was used as comparison. Twelve (n=12) subjects participated in the study (10F:2M, ranging in age from 21 to 30 with an average of 23.2±3.8years). Each mask demonstrated a unique heat retention profile, reaching maximum temperature at different times and having a different final temperature at the end of the 12-min evaluation. After heating, all eyelid warming masks reached a temperature near 37°C within the first minute. The facecloth was significantly cooler than all other masks as of the 2-min mark (p<0.05). Reusability, availability and heat retention profiles should be considered when selecting an eyelid warming masks for adjunct WC therapy in the management of MGD. All masks tested, with the exception of the facecloth, demonstrated stable heat retention throughout the 12min, bringing further awareness that patient education is required to discuss the shortcomings of the heat retention of the facecloth, if only heated once. Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Investigations on the conjunctival goblet cells and the characteristics of the glands associated with the eye in chinchillas (Chinchilla Laniger).

PubMed

Voigt, Susanne; Fuchs-Baumgartinger, Andrea; Egerbacher, Monika; Tichy, Alexander; Nell, Barbara

2012-09-01

To investigate the density and distribution of conjunctival goblet cells (GC) and study the anatomy and microscopic characteristics of glands associated with the eye in chinchillas (Chinchilla Laniger). 12 chinchillas were included in the study. Conjunctiva (divided into four regions), eyelids, and glands were embedded in paraffin wax, sectioned, stained, and analyzed. Highest GC densities were found in the palpebral region of the nasal and temporal conjunctiva of both eyelids (GC index: 25.1-18.2%), and lowest densities, in the bulbar and marginal region of the nasal and temporal conjunctiva of both eyelids (GC index: 1.5-0.0%). Meibomian glands extend along the entire length of both eyelids, and the whole glandular complex broadens toward the temporal canthus. This is macroscopically visible through the conjunctiva. The openings of the Meibomian glands are macroscopically not discernible. The light pink, smooth, and crescent-shaped lacrimal gland lies next to the aforementioned broadened part of the Meibomian glands in the temporal canthus. The whitish, 0.9-cm-long, smooth Harderian gland is firmly attached to the posterior part of the globe and extends nasally from the optic nerve to the equator. Furthermore, chinchillas possess two lacrimal puncta, situated on the inner conjunctival surface of both eyelids near the medial canthus. A pigmented lacrimal canaliculus originates from each punctum. The vestigial nictitating membrane is supported by a hyaline cartilage and is pigmented at its free margin. Chinchillas possess a Harderian gland, a lacrimal gland, and Meibomian glands. The GC density in the nasal and temporal palpebral conjunctiva is higher than in guinea pigs. © 2012 American College of Veterinary Ophthalmologists.

Merkel cell carcinoma of the eyelid. A series of 5 cases and review of the literature.

PubMed

Riesco, B; Cárdenas, N; Sáez, V; Torres, G; Gallegos, I; Dassori, J; Saldías, N

2016-02-01

Presentation of 5 clinical cases of Merkel cell carcinoma of the eyelid, highlighting the clinical, histopathological, management, and monitoring features. Review of related literature. Retrospective review of clinical records and telephone interview of the 5 patients treated for Merkel cell carcinoma between 2006 and 2013, in the Orbit and Oculoplastic Department, Clinical Hospital of the University of Chile. Five patients (2 men, 3 women); 79.2 years (range 64-94 years), with a mean onset of 10 weeks (range 5-16 weeks), tumour size reaching a mean of 2.5×2×2.1cm at the time of surgery. Described as a nodular mass, exophytic, solid, reddish coloured. With no infiltrated lymph nodes or metastases in the first match. Staging as T2N0M0, after the first surgery with oncological criteria. Two lymph node recurrences detected during monitoring. Distant metastasis was found in one patient. The histopathological diagnosis was confirmed by immunohistochemical study of the biopsy. The surgical strategy was full excision, control of surgical margins in the intraoperative period, and eyelid reconstruction with Hughes flap, Cutler/Beard flap or primary closure, depending on the case. Early diagnosis, wide excision of the tumour with intraoperative control of clear margins with conventional or Mohs surgery, and proper eyelid reconstruction are adequate for a good survival in elderly patients with this eyelid tumour. The study of sentinel lymph node biopsy in primary intervention is recommended; with subsequent radiotherapy to decrease the recurrence and increase survival. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

[Multi-wall orbital decompression for disfiguring proptosis in patients with mild or moderate thyroid eye disease].

PubMed

Wang, Y; Yang, N; Li, Y Y; Xiao, L H

2017-02-11

Objective: To evaluate the efficacy of orbital decompression by transconjunctival medial and inferior wall combined transpalpebral lateral wall for disfiguring proptosis with mild or moderate thyroid eye disease (TED). Methods: It is a retrospective case series study. The clinical data of 18 TED cases (28 orbits) between Dec 2013 and Dec 2015 at the Institute of Orbital Diseases of the General Hospital of the Armed Police were reviewed. All the patients underwent mulit-wall orbital decompression to relieve remarkable proptosis, widen eyelid fissure, and swollen eyelid. 1. Hertel value was 14-23 mm or over 2-7 mm than contralateral eye; 2.Orbitalpathy has been inactive with normal thyroid function for at least 6 months; 3.Orbital pressure is normal or (+). Clinical outcomes were recorded including best-corrected visual acuity, exophthalmometry, margin-to-central distance of upper and lower lids, diplopia, and CT scans before and 3 months after surgery. Results: The mean protosis of pre-and postoperation were (19.2±2.3) mm and (14.7±1.4) mm with mean reduction was (4.6±1.7) mm ( t= 14.08, P< 0.01). Margin-to-central distance of the upperlid of pre- and postoperation were (5.1±1.2) mm and (4.9±1.3) mm with mean reduction was (0.2±0.5) mm ( t= 1.73, P= 0.095). Margin-to-central distance of the lowerlid of pre-and postoperation were (5.9±0.9) mm and 4.3±0.7 mm with mean reduction was (1.6±0.8) mm ( t= 10.09, P< 0.01). The difference of bilateral exophthalmos after surgery is 0-2.5 mm (media n= 1 mm). None of the patients showed new-onset diplopia at primary gaze and two patient showed surrounding gaze diplopia postoperatively. Two patients with diplopia relieved after surgery ( Z= 743.00, P= 0.458). Conclusions: Transconjunctival and transpalpebral medial, inferior, and lateral walls decompression with a hidden incision was a controllable, safe, effective technique with minimal complications in relieving not only mild, moderate proptosis, but also retraction of lowerlid, and swollen eyelids. (Chin J Ophthalmol, 2017, 53: 128-135) .

Eyes open versus eyes closed - Effect on human rotational responses

NASA Technical Reports Server (NTRS)

Wall, Conrad, III; Furman, Joseph M. R.

1989-01-01

The effect of eyelid closure on the response to rotational vestibular stimulation was assessed by evaluating 16 normal human subjects with both earth vertical axis (EVA) and earth horizontal axis (EHA) yaw rotations with either eyes closed (EC) or eyes open in the dark (EOD). Results indicated that for EVA rotation, the subjects' responses were of larger magnitude and less variable with EOD than with EC. However, for EHA rotation, responses were of larger magnitude and equally variable with EC as compared to EOD. Data also indicated that the quality of the EHA response with EC was altered because eyelid closure influenced the amount of periodic gaze. It is concluded that eyelid closure has an effect upon both canalocular and otolithocular reflexes and it is suggested that both EVA and EHA rotational testing be performed with EOD rather than with EC.

The Changes in Corneal Astigmatism after Botulinum Toxin-A Injection in Patients with Blepharospasm

PubMed Central

Moon, Nam Ju; Lee, Hyeon Il

2006-01-01

To determine if the involuntary contractions of eyelids may have any effects on the development of corneal astigmatism, we performed this prospective study which includes 19 patients with either essential blepharospasm or hemifacial spasm. In hemifacial spasm, the degree of corneal astigmatism was evaluated between two eyes. Then the topographic changes were checked using vector analysis technique before and after passively opening the eyelids. They were also measured before and at 1 and 6 months after the injection of Botulinum toxin. Resultantly, 20 eyes had the with-the-rule (group1) and 9 eyes against-the-rule (group2) astigmatism. In hemifacial spasm, significantly more astigmatism was found at spastic eyes. The corneal topographic changes after passively opening the eyelids showed 10 eyes with the astigmatic shift to the with-the-rule, while the remaining 19 to the against-the-rule. At 1 month after injection of Botulinum toxin, group 1 showed reduced average corneal astigmatism, whereas group 2 showed increased astigmatism. The astigmatic change vector showed significantly more against-the-rule. In the contrary, 6 months after treatment, corneal astigmatism again increased in group 1 and decreased in group 2. So they took on the appearance of pretreatment astigmatic status eventually. Conclusively eyelids may play an important role in corneal curvature. PMID:16479079

Separate Primary Melanomas of the Bulbar Conjunctiva and Eyelid Skin: Clinical Implications of Multiple Primary Melanomas.

PubMed

Jacinto, Frances A; Fisher, George H; Espana, Edgar M; Leyngold, Ilya M; Margo, Curtis E

2016-10-01

We report a patient with previous in situ melanoma of the forehead skin who was referred for treatment of a bulbar conjunctival melanoma and a separate superficially invasive melanoma of the eyelid skin, and we offer a review of the biological and clinical implications of patients who have multiple primary melanomas. This article offers a clinicopathological correlation with a review of the relevant literature. An 80-year-old white man was referred for evaluation of a suspicious conjunctival tumor and a lower-eyelid lesion. Excisional biopsies revealed that both were primary melanomas arising within in situ disease. Over the span of 25 years, the patient had three separate foci of in situ melanoma, two of which spawned invasive melanoma. Separate melanomas arising from the bulbar conjunctiva and eyelid skin have rarely been reported. Multiple primary melanomas of the skin, however, are not uncommon. Based on studies of persons with multiple cutaneous melanomas, the prognosis is best predicted by the tumor with the greatest depth of invasion. Patients with multiple melanomas should be examined for dysplastic nevi, additional cutaneous melanomas, and screened periodically for future lesions. Ongoing studies enrolling patients with multiple primary melanomas are attempting to generate insights into low-penetrance susceptibility genes.

A well-known lesion in an unusual location: infantile myofibroma of the eyelid: a case report and review of literature.

PubMed

Asadi Amoli, Fahimeh; Sina, Amir Hossein; Kasai, Aboulfazl; Ayan, Zahra

2010-01-01

Myofibroma is a neoplasia of myofibroblasts that can be solitary or multiple and it is found most commonly in the head & neck region including scalp, forehead, parotid region and oral cavity. In the eyelid it is rarely reported. It has a benign course in the solitary form and fatal in its multiple form. A 4 month male infant referred to Farabi hospital -the referral center for eye diseases- with a 2 month history of a mass in his eyelid with gradual enlargement with no other complaints. The only abnormal physical finding was a 2.5 cm mass in the eyelid. This mass was excised and sent to the hospital pathology laboratory. When confronting a spindle cell lesion with a nodular or multinodular growth pattern which appears biphasic due to alteration of light and dark staining areas, the surgical pathologist should think to the possibility of myofibroma. Its pattern of growth and architecture rules out the other differential diagnoses like nodular fasciitis, fibrous histiocytoma, infantile fibromatosis, and peripheral primitive neuroectodermal tumor, mesenchymal chondrosarcoma, malignant hemangiopericytoma, juvenile fibrosarcoma and poorly differentiated synovial sarcoma. In difficult cases immunohistochemical staining is helpful that is Vimentin & Actin positivity & Desmin, CK, EMA & S100 negativity.

Ultrathin flexible piezoelectric sensors for monitoring eye fatigue

NASA Astrophysics Data System (ADS)

Lü, Chaofeng; Wu, Shuang; Lu, Bingwei; Zhang, Yangyang; Du, Yangkun; Feng, Xue

2018-02-01

Eye fatigue is a symptom induced by long-term work of both eyes and brains. Without proper treatment, eye fatigue may incur serious problems. Current studies on detecting eye fatigue mainly focus on computer vision detect technology which can be very unreliable due to occasional bad visual conditions. As a solution, we proposed a wearable conformal in vivo eye fatigue monitoring sensor that contains an array of piezoelectric nanoribbons integrated on an ultrathin flexible substrate. By detecting strains on the skin of eyelid, the sensors may collect information about eye blinking, and, therefore, reveal human’s fatigue state. We first report the design and fabrication of the piezoelectric sensor and experimental characterization of voltage responses of the piezoelectric sensors. Under bending stress, the output voltage curves yield key information about the motion of human eyelid. We also develop a theoretical model to reveal the underlying mechanism of detecting eyelid motion. Both mechanical load test and in vivo test are conducted to convince the working performance of the sensors. With satisfied durability and high sensitivity, this sensor may efficiently detect abnormal eyelid motions, such as overlong closure, high blinking frequency, low closing speed and weak gazing strength, and may hopefully provide feedback for assessing eye fatigue in time so that unexpected situations can be prevented.

Prosthesis for blepharospasm.

PubMed

Moss, H L

1983-12-01

Following several years of experience with a newly designed spectacle-supported ptosis crutch for ptosis and blepharospasm, the author has developed a new approach to these conditions. In mild to moderate blepharospasm cases, the spectacle-supported prosthesis can still produce satisfactory results. However, in moderate to severe blepharospasm, the force of the spasm moves the entire device forward and downward, making it ineffective or too uncomfortable to wear. To create greater stability and a more effective counterforce to the blepharospasm, the author has developed a simple headband-supported device which does not use a spectacle frame for support. This new prosthesis is constructed of varying diameters of spring tempered diamond drawn stainless steel orthodontic wire, partially or completely covered by Teflon tubing. A silicon rubber cylinder is placed over the center which becomes a bridge and the main support for the device. An elastic head band completes the prosthesis.

46,XY hypergonadotropic hypogonadism and myasthenia gravis.

PubMed

Lichiardopol, Corina; Herlea, V; Ioan, Virginia; Tomulescu, V; Mixich, F

2006-01-01

Both hypergonadotropic hypogonadism and myasthenia gravis can be parts of type II autoimmune polyendocrine syndrome and association between the two disorders has been reported in few cases. A 14 year old male patient with a personal history of bilateral cryptorchidism and ptosis was referred for delayed puberty. Clinical examination revealed eunuchoid habitus, small, soft testes, gynecomastia, ptosis, a myasthenic deficit score of 22.5 points and an IQ of 84 points. Decreased testosterone (0.064 ng/mL) and elevated LH (64.5 mUI/mL) were consistent with hypergonadotropic hypogonadism and karyotype was normal: 46,XY. Thyroid function, haematologic evaluation, BUN, electrolytes, and glycemia were in the normal range. Therapy consisted of anticholinesterase inhibitors, immunosuppressants, corticotherapy, testosterone; thoracoscopic thymectomy was performed showing thymic lymphoid hyperplasia on histopathologic examination. Myasthenic score improved (12.5 points), progressive virilization occurred, and a year later the patient presented with cushingoid features and obesity.

355 Ocular Muscles Myopathy Associated with Autoimmune Thyroiditis. Case Reports

PubMed Central

Vargas-Camaño, Eugenia; Castrejon-Vázquez, Isabel; Plazola-Hernández, Sara I.; Moguel-Ancheita, Silvia

2012-01-01

Background Thyroid-associated orbitopathy is commonly associated with Graves' disease with lid retraction, exophthalmos, and periorbital swelling, but rarely with autoimmune thyroiditis or euthyroid state. We reviewed 3 cases from our hospital whose antibodies to anti-receptor of TSH were normal. Methods Case 1: 60 year-old non-diabetic woman with bilateral glaucoma in treatment, recurrent media otitis and euthyroidism, acute onset of painless diplopia, and lid ptosis in the left eye. MRI of orbit showed increased size of the III right cranial pair and high levels of thyroid autoantibodies (Tab) anti-tiroglobulin (ATG) 115.1, anti-thyroid peroxidase (ATPO) 1751 U/mL. She started oral deflazacort 30 mg each 3 days. Sixty days later, complete remission of eye symptoms correlated with lower auto-antibodies level (ATG 19 ATPO 117). Case 2: 10 year-old girl. At age 8, she had diplopia, lid ptosis and limitations of upper gaze in the left eye. The neurological study discarded ocular myasthenia; with thyroid goitier, and hypothyrodism, she started oral levothyroxin. At age 10 with normal IRM Botulinic toxin was injected, without change. High levels of Tab were found, ATG 2723, ATPO 10.7. She started oral deflazacort 30 mg each 3 days, azathioprin 100 mg, daily. Actually, Tab levels are almost normal, but she remains with ocular alterations. Case 3: 56 year-old woman, Grave´s disease with exophtalmos in 1990, treated with I131 and immunosupression, with good outcome; obesity, hypertension and bilateral glaucoma in treatment. She suddenly presented diplopia and IV pair paresia of the right eye. A year later, ATb were found slightly elevated, ATG 100 years ATPO 227; despite prednisone 50 mg, each 3 days and azathioprin 150 mg/daily treatment, a surgical procedure was required for relieve the ocular symptoms. Results We found only 3 cases previously reported with this type of eye thyroid disease. Is important to note that awareness of this atypical form of orbitopathy Conclusions Early recognition facilitates successful treatment (Case 1) or persistent disease when diagnosis is delayed (Cases 2 and 3).

Eyelid dermatitis.

PubMed

Beltrani, V S

2001-07-01

Cosmetic alteration of a patient's orbital skin is a common reason for professional consultation. This review presents the differential diagnosis and recommended evaluation of inflamed eyelids. To better understand the diseases, each is individually addressed clinically, pathogenetically, and therapeutically. It is critical to recognize the lesions correctly and to have full knowledge of the putative clinical disease process. An algorithm for an appropriate work-up for each disease is offered. With this background, a successful therapeutic response can be anticipated.

Irradiated homologous tarsal plate banking: A new alternative in eyelid reconstruction. Part I. Technique and animal research

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jordan, D.R.; Tse, D.T.; Anderson, R.L.

1990-01-01

Reconstruction of full thickness eyelid defects requires the correction of both posterior lamella (tarsus, conjunctiva) and anterior lamella (skin, muscle). Tarsal substitutes including banked sclera, nasal cartilage, ear cartilage, and periosteum can be beneficial for posterior lamellar repair, while anterior lamellar replacement, including skin grafts, pedicle flaps, advancement flaps, etc., is important to cover the posterior reconstructed portion. At times, due to extensive tissue loss, the eyelid reconstruction can be particularly challenging. We have found an alternative posterior lamellar reconstructive technique utilizing irradiated homologous tarsal plate that can be particularly useful in selected cases of severe tissue loss. The experimentalmore » surgical procedure in monkeys and the histological fate of the implanted tarsus is described in Part I, and followed in Part II by our experience with this tissue in six human patients.« less

Management of injuries of the eye and its adnexa.

PubMed

Lipke, K J; Gümbel, H O C

2013-08-01

The face plays the main role in interpersonal communication and in aesthetic perception. What is more, on account of the complex eyelid anatomy required to ensure the functioning of the eye, the treatment of periocular injuries requires a profound knowledge of anatomy and plastic reconstructive surgery, even if a loss of soft tissue is involved. Many methods for the reconstruction of eyelid defects have been described in the current literature. These methods must be guided by the site and extent of the defect on the one hand and by cosmetic requirements on the other to produce best results in terms of form and function. The treatment of injuries in the area of the eyelid involves some peculiarities that must be considered. The management of large defects in particular requires the cooperation of all head surgery disciplines. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A rare cause of severe periorbital edema and dermonecrotic ulcer of the eyelid in a child: brown recluse spider bite.

PubMed

Taşkesen, Mustafa; Akdeniz, Sedat; Taş, Taşkin; Keklikçi, Uğur; Taş, Mehmet Ali

2011-01-01

Spider bites are a worldwide problem. Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal failure, and death. Eyelid bites from brown recluse spiders are rare. We report a child with severe facial edema and a dermonecrotic ulcer on the eyelid. Upon laboratory examination, leukocytosis with a significant left shift was detected. The patient was treated with antibiotics, systemic corticosteroid and conservative therapy that included saline compresses and ocular lubrication. No surgical excision was required. Vision was not impaired. A dermonecrotic ulcer is a severe complication of brown recluse spider bites. Since the diagnosis is difficult, clinical and epidemiological findings and a detailed history are important for an accurate diagnosis.

Radiotelemetry recording of electroencephalogram in piglets during rest.

PubMed

Saito, Toshiyuki; Watanabe, Yasuko; Nemoto, Tetsu; Kasuya, Etsuko; Sakumoto, Ryosuke

2005-04-13

A wireless recording system was developed to study the electroencephalogram (EEG) in unrestrained, male Landrace piglets. Under general anesthesia, ball-tipped silver/silver chloride electrodes for EEG recording were implanted onto the dura matter of the parietal and frontal cortex of the piglets. A pair of miniature preamplifiers and transmitters was then mounted on the surface of the skull. To examine whether other bioelectrical activities interfere with the EEG measurements, an electrocardiogram (ECG) or electromyogram (EMG) of the neck was simultaneously recorded with the EEG. Next, wire electrodes for recording movement of the eyelid were implanted with EEG electrodes, and EEG and eyelid movements were simultaneously measured. Power spectral analysis using a Fast Fourier Transformation (FFT) algorithm indicates that EEG was successfully recorded in unrestrained piglets, at rest, during the daytime in the absence of interference from ECG, EMG or eyelid movements. These data indicate the feasibility of using our radiotelemetry system for measurement of EEG under these conditions.

[Black bone disease of the skull and facial bones].

PubMed

Laure, B; Petraud, A; Sury, F; Bayol, J-C; Marquet-Van Der Mee, N; de Pinieux, G; Goga, D

2009-11-01

We report the case of a patient with a craniofacial black bone disease. This was discovered accidentally during a coronal approach. A 38-year-old patient was referred to our unit for facial palsy having appeared 10 years before. Rehabilitation of the facial palsy was performed with a lengthening temporal myoplasty and lengthening of the upper eyelid elevator. An unusual black color of the skull was observed at incision of the coronal approach. Subperiostal dissection of skull and malars confirmed the presence of a black bone disease. A postoperative history revealed minocycline intake (200mg per day) during 3 years. This craniofacial black bone disease was caused by minocycline intake. The originality of this case is to see directly the entire craniofacial skeleton black. This abnormal pigmentation may affect various organs or tissues. Bone pigmentation is irreversible unlike that of the mouth mucosa or of the skin. This abnormal pigmentation is usually discovered accidentally.

Isolated orbital mass as the primary presentation of a triple-hit lymphoma transformed from a systemic follicular lymphoma.

PubMed

Zhou, Xiao Yi; Lu, Xinyan; Raparia, Kirtee; Chen, Yi-Hua

2018-06-01

Triple-hit lymphoma is a highly aggressive B-cell lymphoma. We report a case of triple-hit lymphoma transformed from systemic follicular lymphoma (FL) after 9-year remission and presented primarily as an isolated orbital mass without systemic symptoms or lymphadenopathy. A 58-year-old female presented with intermittent vertical binocular diplopia, left upper eyelid swelling and pain and was found to have a 2.9 cm orbital mass. Histological section revealed a CD10-positive large B-cell lymphoma, consistent with transformation of FL. Fluorescent in situ hybridization (FISH) analysis demonstrated rearrangements involving C-MYC, BCL-2 and BCL-6 genes, indicating a high grade, triple-hit lymphoma. Triple-hit lymphoma transformed from a low-grade lymphoma may initially present as an isolated orbital mass without systemic evidence of transformation. Early recognition of double or triple-hit lymphomas is important since these patients require aggressive chemotherapy.

Anterior segment dysgenesis (Peters' anomaly) in two snow leopard (Panthera uncia) cubs.

PubMed

Hamoudi, Hassan; Rudnick, Jens-Christian; Prause, Jan U; Tauscher, Kerstin; Breithaupt, Angele; Teifke, Jens P; Heegaard, Steffen

2013-07-01

Two sibling snow leopards, a male and a female, with bilateral anterior segment dysgenesis (ASD), are reported. Both snow leopards also had colobomas of both upper eyelids. All eyes exhibited a central corneal opacity associated with a defect in posterior corneal stroma, endothelium and Descemet's membrane. Iris strands were present attached to the termination of Descemet's membrane and to the periphery of the posterior corneal defect. The iris was hypoplastic, and cataract was present in all four eyes. The left eye of the female was microphthalmic, with no trabecular meshwork and with persistent remnant of the hyaloid artery. The male had hydrocephalus and thus some of the features of Peters' plus syndrome (Peters' anomaly in addition to systemic malformations). The histological findings in the eyes of these snow leopard siblings are identical with those described in humans with Peters' anomaly. © 2012 American College of Veterinary Ophthalmologists.

Management of orbital emphysema secondary to rhegmatogenous retinal detachment repair with hyperbaric oxygen therapy.

PubMed

Iniesta-Sanchez, Dante L; Romero-Caballero, Fatima; Aguirre-Alvarado, Adriana; Rebollo-Hurtado, Victoria; Velez-Montoya, Raul

2016-04-01

To describe the case of orbital subcutaneous emphysema who was successfully treated with hyperbaric oxygen therapy. Case report. Retrospective analysis of medical records and computer tomography images. A 40 years-old female, with retinal detachment who was seen at the emergency department, two weeks after undergoing a combined procedure of pars plana vitrectomy, scleral buckle and Sulfur hexafluoride tamponade. The patient complained of pain, decrease eye movement and edema of the upper eyelid. Clinical examination revealed periorbital crepitus. She was treated immediately with soft tissue decompression with small-gauge needle. Orbital emphysema recurred quickly, indicating possible gas trapped in the soft tissue. Using the US NAVY decompression protocol we were able to achieve fast clinical improvement. The protocol was repeated in several occasions until complete resolution. Hyperbaric oxygen therapy is an effective treatment for orbital and periorbital emphysema, due to its property of helping accelerate N 2 elimination from adipose tissue.

[Surgical approach of internal fixation of maxillofacial fracture].

PubMed

Liu, Dashun; Zhang, Ruizhen; Dong, Xiao

2013-11-01

By summary and analysis of rigid internal fixation for the treatment of maxillofacial fractures incision and exposure, investigate the plate reasonable surgical approach of fracture reduction and fixation titanium. Summary of the 76 surgical cases, Counting the statistics of the number that the surgery ways choose by facial incision and fractures location, analysis of the indications for surgery and the advantages and disadvantages of various surgical approaches. Followed up for more than six months, in order to observe the recovery of occlusal function and the facial cosmetic results. The upper jaw or cheek bone has the more possibility in facial fracture, which used of a small incision hidden under the lip gingival sulcus and lower eyelid. After six months, the facial wound healing recover in good occlusal with no obvious scarring. Reasonable choice of surgical incision can make the fracture site exposure and the facial aesthetic effect into account.

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA)--a rare cause of fulminant orbital cellulitis.

PubMed

Shome, Debraj; Jain, Vandana; Natarajan, Sundaram; Agrawal, Shyam; Shah, Kiran

2008-01-01

We report a 55-year-old female patient who developed a severe right-sided orbital cellulitis. Past history was significant for a boil on the right upper eyelid 2 days prior. Visual acuity at presentation was perception of light with inaccurate projection. Orbital computed tomography (CT) scan and routine blood investigations, including blood culture, urine examination, and urine culture, were performed. CT scan showed a superonasal orbital mass suggestive of an abscess. Abscess drainage followed by pus culture, sensitivity, and pulsed-field gel electrophoresis revealed community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) resistant to all antibiotics except vancomycin, cotrimoxazole, and amikacin. The condition completely resolved post antibiotic and steroid therapy. At 3 months follow-up, the vision in the right eye was 6/9. We report this case to highlight CAMRSA as a rare but virulent cause of orbital cellulitis; empiric antibiotic therapy should include coverage for CAMRSA until susceptibilities come back.

Bee sting of the cornea: a case study and review of the literature.

PubMed

Caça, Ihsan; Ari, Seyhmus; Ulü, Kaan; Ayata, Ali

2006-01-01

Bee stings of the cornea are rarely reported, but have the potential for causing serious ophthalmological injuries. We present a case of corneal bee sting with retained stinger apparatus. A 35-year-old patient presented with an acute, corneal bee sting of the right eye 12 hours after he was stung. The patient suffered from pain, blurred vision, and epiphora. The right eye showed edema of the upper and lower eyelid, conjunctival hyperemia, chemosis, and striate keratitis of the paracentral cornea by biomicroscopic examination. The stinger was identified in the depth of the corneal infiltration. Visual acuity was 5/10. It was removed surgically. After 2 months, the eye only showed a minimal residual corneal opacification. Visual acuity was 10/10. We present a case of bee sting to the cornea with retained stinger apparatus and treatment of this unusual presentation.

Progressive supranuclear palsy: neuropathologically based diagnostic clinical criteria.

PubMed Central

Collins, S J; Ahlskog, J E; Parisi, J E; Maraganore, D M

1995-01-01

All cases examined postmortem at the Mayo Clinic that met the classic neuropathological criteria for progressive supranuclear palsy (PSP) were identified for retrospective clinical analyses. The necropsy material was re-examined by a second neuropathologist to confirm the pathological diagnosis of PSP, yielding 12 cases. A range of clinical signs were documented in these patients, with numerous findings beyond those noted in the original descriptions of this disorder. Atypical clinical findings included absence of supranuclear gaze palsy (two cases), prominent asymmetry (two), arm dystonia (two), upper limb apraxia (two), myoclonus (two), chorea (one), eyelid opening apraxia (one), and respiratory disturbance (one). A definite clinical diagnosis of PSP had been made during life in only eight of the 12 patients. From the retrospective analysis of these 12 cases, a set of clinical criteria were developed for the premortem diagnosis of PSP emphasising differences from other akinetic-rigid disorders. PMID:7876846

A new species of Leptolalax (Anura: Megophryidae) from Gunung Mulu National Park, Sarawak, East Malaysia (Borneo).

PubMed

Dehling, J Maximilian; Matsui, Masafumi

2013-01-01

We describe a new species of Leptolalax from Gunung Mulu National Park in eastern Sarawak, Malaysian Borneo. The new species had been assigned to Leptolalax dringi and Leptolalax gracilis in the past. It is shown to differ from both these species and from all other species of the genus by a unique combination of morphological characters including large body size, rounded snout, interorbital distance being smaller than width of upper eyelid, bipartite subgular vocal sac in males, basal toe webbing, shagreened skin with tiny tubercles on dorsum and dorsal side of head, angled supratympanic fold, small pectoral glands, absence of supraaxillary glands and ventrolateral glandular ridges, spotted venter, advertisement call consisting of long series of 8-289 notes, each composed of three or four pulses, and dominant frequency at 7225-9190 Hz, with prominent frequency modulation.

Demodex folliculorum and Demodex brevis as a cause of chronic marginal blepharitis.

PubMed

Czepita, Damian; Kuźna-Grygiel, Wanda; Czepita, Maciej; Grobelny, Andrzej

2007-01-01

Intensive long-term studies of Demodex spp. (D.) and its role in chronic blepharits have been carried out in recent years by scientists from the Pomeranian Medical University in Szczecin. It has resulted in numerous publications, spurring a lot of interest worldwide. A few of the papers have been cited in leading American medical journals. In recent years many papers dealing with demodicosis of the eyelids have been published worldwide. Based on the growing interest in the role of Demodex spp. in chronic blepharitis we decided to present and discuss the results of the latest experimental and clinical studies. A review of the literature concerning the role of D. folliculorum and D. brevis in the pathogenesis of chronic blepharitis was done. Demodex spp. are intradermal parasites, which thrive in follicles and sebaceous glands of humans and animals. D. is spread by direct contact and probably by dust containing eggs (figs. 1, 2, 3). Currently, it is thought that pathological changes in the course of demodicosis of the eyelids are consequences of: (1) blockage of follicles and leading out tubules of sebaceous glands by the mites and by reactive hyperkeratinization and epithelial hyperplasia; (2) a mechanical vector role of bacteria; (3) host's inflammatory reaction to the presence of parasite's chitine as a foreign body; and (4) stimulation of the host's humoral responses and cell-mediated immunological reactions under the influence of the mites and their waste products. It has been established that: (1) D. folliculorum and D. brevis are cosmopolitan in terms of their distribution; (2) Infection of Demodex spp. often occurs in the course of chronic blepharitis; (3) With the increase in age, the prevalence rate of eyelid demodicosis rises; (4) Demodicosis of the eyelids may be the effect of the decrease of immunity of some patients. Treatment of demodicosis of the eyelids as a general rule lasts a few months. The use of yellow mercurial ointment, sulphur ointment, camphorated oil, crotamiton, choline esterase inhibitors, sulfacetamide, steroids, antibiotics, as well as antimycotic drugs offers some improvement. A good response has been observed after oral application of ivermectin along with topical application of cream permethrin. However, the best results were obtained after 2% metronidazole gel or ointment treatment. Medical University in Szczecin. It has resulted in numerous publications, spurring a lot of interest worldwide. A few of the papers have been cited in leading American medical journals. In recent years many papers dealing with demodicosis of the eyelids have been published worldwide. Based on the growing interest in the role ofDemodex spp. in chronic blepharitis we decided to present and discuss the results of the latest experimental and clinical studies. Material and methods: A review of the literature concerning the role of D. folliculorum and D. brevis in the pathogenesis of chronic blepharitis was done. Results: Demodex spp. are intradermal parasites, which thrive in follicles and sebaceous glands of humans and animals. D. is spread by direct contact and probably by dust containing eggs (figs. 1, 2, 3). Currently, it is thought that pathological changes in the course of demodicosis of the eyelids are consequences of: (1) blockage of follicles and leading out tubules of sebaceous glands by the mites and by reactive hyperkeratinization and epithelial hyperplasia; (2) a mechanical vector role of bacteria; (3) host's inflammatory reaction to the presence of parasite's chitine as a foreign body; and (4) stimulation of the host's humoral responses and cell-mediated immunological reactions under the influence of the mites and their waste products. It has been established that: (1) D. folliculorum and D. brevis are cosmopolitan in terms of their distribution; (2) Infection ofDemodex spp. often occurs in the course of chronic blepharitis; (3) With the increase in age, the prevalence rate of eyelid demodicosis rises; (4) Demodicosis of the eyelids may be the effect of the decrease of immunity of some patients. Treatment of demodicosis of the eyelids as a general rule lasts a few months. The use of yellow mercurial ointment, sulphur ointment, camphorated oil, crotamiton, choline esterase inhibitors, sulfacetamide, steroids, antibiotics, as well as antimycotic drugs offers some improvement. A good response has been observed after oral application of ivermectin along with topical application of cream permethrin. However, the best results were obtained after 2% metronidazole gel or ointment treatment.

Epicanthal Restoration Surgery with Scar Excision in Severe Epicanthal Scar.

PubMed

Chung, Yoon Jae; Koo, Mun Geun; Lee, Soo Hyang

2018-06-01

Medial epicanthoplasty is a common aesthetic surgery in Asia to remove the epicanthal fold. With increasing use of this surgery, unsatisfactory results have grown. Several methods have been developed to correct it. However, there are limitations in restoration if the patient has a severe scar or does not have enough skin for reconstruction. By aggressively removing scar tissue, the authors present a better reverse redraping epicanthoplasty. The procedure was performed on 512 patients who had complications of medial epicanthoplasty from May 2011 to October 2015. The mean age was 31.3 years. Those who had already undergone reconstruction were 15.4% (n = 79). Of these, 68 patients received a V-Y flap and the rest had V-Y modification surgery. After the design, the skin-muscle flap was dissected and elevated. The upper and lower eyelid skin was pulled medially. The previous scar tissue was widely excised while removing skin excess, and the new epicanthal fold was created without a rectangular shape. The mean interepicanthal distance has been increased from 32.8 to 36.6 mm. The mean lengthening effect is 3.8 mm. Lacrimal lake exposure, fierce and narrow appearance, and incomplete medial eyelid closure were improved. Medial epicanthoplasty is a common cosmetic surgery in the Asian population. A demand for an effective reconstructive method has grown in association with higher complication rates. The authors have better results to make a natural epicanthal fold through aggressive scar removal in the reverse redraping epicanthoplasty. 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 .

Transconjuctival Incision with Lateral Paracanthal Extension for Corrective Osteotomy of Malunioned Zygoma

PubMed Central

Chung, Jae-Ho; You, Hi-Jin; Hwang, Na-Hyun; Yoon, Eul-Sik

2016-01-01

Background Conventional correction of malunioned zygoma requires complete regional exposure through a bicoronal flap combined with a lower eyelid incision and an upper buccal sulcus incision. However, there are many potential complications following bicoronal incisions, such as infection, hematoma, alopecia, scarring and nerve injury. We have adopted a zygomaticofrontal suture osteotomy technique using transconjunctival incision with lateral paracanthal extension. We performed a retrospective review of clinical cases underwent correction of malunioned zygoma with the approach to evaluate outcomes following this method. Methods Between June 2009 and September 2015, corrective osteotomies were performed in 14 patients with malunioned zygoma by a single surgeon. All 14 patients received both upper gingivobuccal and transconjunctival incisions with lateral paracanthal extension. The mean interval from injury to operation was 16 months (range, 12 months to 4 years), and the mean follow-up was 1 year (range, 4 months to 3 years). Results Our surgical approach technique allowed excellent access to the infraorbital rim, orbital floor, zygomaticofrontal suture and anterior surface of the maxilla. Of the 14 patients, only 1 patient suffered a complication—oral wound dehiscence. Among the 6 patients who received infraorbital nerve decompression, numbness was gradually relieved in 4 patients. Two patients continued to experience persistent numbness. Conclusion Transconjunctival incision with lateral paracanthal extension combined with upper gingivobuccal sulcus incision offers excellent exposure of the zygoma-orbit complex, and could be a valid alternative to the bicoronal approach for osteotomy of malunioned zygoma. PMID:28913268

Immunoglobulin G4-positive lymphoplasmacytic infiltration in a sarcoidal eyelid mass.

PubMed

Kang, Hyera; Takahashi, Yasuhiro; Takahashi, Emiko; Kakizaki, Hirohiko

2018-05-01

A 62-year-old woman presented with a one month history of a hard, nonmobile subcutaneous mass along the right nasojugal fold. Hematological studies showed elevated serum immunoglobulin G4 levels. Histopathological examination of the biopsy sample disclosed immunoglobulin G4-positive lymphoplasmacytic infiltration with a storiform fibrosis, vein occlusion, and epithelioid granulomas with necrosis. Systemic review corresponded to a sarcoidosis. Without treatment, the eyelid mass did not recur six months after the excisional biopsy.

Clear cell hidradenocarcinoma of the eyelid: a case report with a review of the literature.

PubMed

Singh, Gurcharan; Narasimha, Aparna; Kumar, Harendra; Datti, Narendra

2013-04-01

Clear cell hidradenocarcinomas are extremely rare neoplasms, with very few well-documented cases reported in the literature. The most common sites are the head and neck regions. These tumors are histologically malignant but are not always aggressive. They are known for recurrence and may metastasize widely. Treatment is wide local resection. We report on a case of clear cell hidradenocarcinoma occurring over the eyelid together with a review of the literature.

Differentiation of sex chromosomes and karyotypic evolution in the eye-lid geckos (Squamata: Gekkota: Eublepharidae), a group with different modes of sex determination.

PubMed

Pokorná, Martina; Rábová, Marie; Ráb, Petr; Ferguson-Smith, Malcolm A; Rens, Willem; Kratochvíl, Lukáš

2010-11-01

The eyelid geckos (family Eublepharidae) include both species with temperature-dependent sex determination and species where genotypic sex determination (GSD) was suggested based on the observation of equal sex ratios at several incubation temperatures. In this study, we present data on karyotypes and chromosomal characteristics in 12 species (Aeluroscalabotes felinus, Coleonyx brevis, Coleonyx elegans, Coleonyx variegatus, Eublepharis angramainyu, Eublepharis macularius, Goniurosaurus araneus, Goniurosaurus lichtenfelderi, Goniurosaurus luii, Goniurosaurus splendens, Hemitheconyx caudicinctus, and Holodactylus africanus) covering all genera of the family, and search for the presence of heteromorphic sex chromosomes. Phylogenetic mapping of chromosomal changes showed a long evolutionary stasis of karyotypes with all acrocentric chromosomes followed by numerous chromosomal rearrangements in the ancestors of two lineages. We have found heteromorphic sex chromosomes in only one species, which suggests that sex chromosomes in most GSD species of the eyelid geckos are not morphologically differentiated. The sexual difference in karyotype was detected only in C. elegans which has a multiple sex chromosome system (X(1)X(2)Y). The metacentric Y chromosome evolved most likely via centric fusion of two acrocentric chromosomes involving loss of interstitial telomeric sequences. We conclude that the eyelid geckos exhibit diversity in sex determination ranging from the absence of any sexual differences to heteromorphic sex chromosomes, which makes them an interesting system for exploring the evolutionary origin of sexually dimorphic genomes.

Genetics Home Reference: blepharophimosis, ptosis, and epicanthus inversus syndrome

MedlinePlus

... features. Type I is also associated with an early loss of ovarian function (primary ovarian insufficiency) in women, which causes their menstrual periods to become less frequent and eventually stop before age 40. Primary ovarian insufficiency can lead to difficulty ...

Wiesner Nevus of the Eyelid.

PubMed

Somogyi, Marie; Lyons, Lance J; Durairaj, Vikram

A healthy 31-year-old female presented with an elevated vascular lesion on the right lower eyelid margin. Histology results from excisional biopsy demonstrated a range of intradermally nested atypical melanocytes with negative staining for BRCA1-associated protein 1, confirming the diagnosis of Wiesner nevus. Wiesner nevi may be a cutaneous hallmark of the BRCA1-associated protein 1-associated cancer susceptibility syndrome, and to our knowledge, this is the first report of such a lesion presenting anywhere on the ocular adnexa.

Three eyelid localized cutaneous anthrax cases.

PubMed

Esmer, Oktay; Karadag, Remzi; Bilgili, Serap Gunes; Gultepe, Bilge; Bayramlar, Huseyin; Karadag, Ayse Serap

2014-12-01

Anthrax is primarily seen in the developing countries, but it can be a worldwide medical concern due to bioterrorism threats. Palpebral anthrax is a rare form of cutaneous anthrax. Untreated cutaneous anthrax can be lethal. Patients with palpebral anthrax can develop complications including cicatrisation and ectropion. Thus, anthrax should be considered in differential diagnosis for patients presenting with preseptal cellulitis in high-risk regions. Herein, we report three anthrax cases (with different age) involving eyelids that were cured without any complications due to early diagnosis and treatment.

Late outcomes after grafting of the severely burned face: a quality improvement initiative.

PubMed

Philp, Lauren; Umraw, Nisha; Cartotto, Robert

2012-01-01

Many approaches to surgical management of the severely burned face are described, but there are few objective outcome studies. The purpose of this study was to perform a detailed evaluation of the late outcomes in adult patients who have undergone grafting using a standardized surgical and rehabilitation approach for full-thickness (FT) facial burns to identify areas for improvement in the treatment strategy of authors. This was a prospective observational study in which patients who had undergone grafting for FT facial burns by the senior investigator at a regional burn centre between 1999 and 2010 were examined by a single evaluator. The surgical approach included tangential excision based on the facial aesthetic units, temporary cover with allograft then autografting with scalp skin preferentially, split grafts for the upper eyelid, and FT grafts for the lower eyelid. Rehabilitation included compression (uvex and or soft cloth), scar massage, and silicone gel sheeting. Of 35 patients with facial grafts, 14 subjects (age 43 ± 16 years with 22 ± 21% TBSA burns) returned for late follow-up at 40 ± 33 months (range, 5-91 months). A mean of four facial aesthetic units per patient were grafted (range, 1-9 units), with six full facial grafts performed. Scalp was used as donor in 10 of 14 cases. Scalp donor sites were well tolerated with minor alopecia visible in only one case although the donor site visibly extended slightly past the hairline in two cases. Color match with native skin was rated at 8.8 ± 0.8 of 10 when scalp skin was used compared with 7.5 ± 1.6 with other donor sites (P = .06). On the lip and chin, hypertrophic scars were significantly worse compared with the rest of the facial grafts (Vancouver scar scale 8 ± 2 vs 3 ± 1, P < .01). Sensory recovery was poor with overall moving two-point discrimination at 11 ± 3 mm (range, 4-15 mm), and monofilament light touch was 3.8 ± 0.6. Graft borders were significantly more elevated than graft seams. On the forehead, the most notable problem was a gap between the graft and hairlines of the frontal scalp and eyebrows (range, 0-40 mm). Grafted eyelids required one or more subsequent ectropion releases in the majority of cases. The most common problem for the nose was asymmetry of the nostril apertures. The most problematic late outcomes that the authors identified after facial grafting for FT facial burns included relatively poor sensory return, elevation of graft edges, eyelid ectropion, gaps between grafts and hairline, and marked hypertrophic scarring around the mouth and chin. The results indicate that possible areas for quality improvement include greater attention to the limits of scalp harvest, more attention to pressure application to graft borders and the lip and chin during rehabilitation, greater accuracy in excision and graft placement on the forehead to avoid gaps with the hairlines, and counseling of the patient regarding the high probability of diminished facial sensation.

Facial paralysis

MedlinePlus

... a physical, speech, or occupational therapist. If facial paralysis from Bell palsy lasts for more than 6 to 12 months, plastic surgery may be recommended to help the eye close and improve the appearance of the face. Alternative Names Paralysis of the face Images Ptosis, drooping of the ...

19q13.32 microdeletion syndrome: three new cases.

PubMed

Castillo, Angela; Kramer, Nancy; Schwartz, Charles E; Miles, Judith H; DuPont, Barbara R; Rosenfeld, Jill A; Graham, John M

2014-01-01

A previous report described a unique phenotype associated with an apparently de novo 732 kb 19q13.32 microdeletion, consisting of intellectual disability, facial asymmetry, ptosis, oculomotor abnormalities, orofacial clefts, cardiac defects, scoliosis and chronic constipation. We report three unrelated patients with developmental delay and dysmorphic features, who were all found to have interstitial 19q13.32 microdeletions of varying sizes. Both the previously reported patient and our Patient 1 with a larger, 1.3-Mb deletion have distinctive dysmorphic features and medical problems, allowing us to define a recognizable 19q13.32 microdeletion syndrome. Patient 1 was hypotonic and dysmorphic at birth, with aplasia of the posterior corpus callosum, bilateral ptosis, oculomotor paralysis, down-slanting palpebral fissures, facial asymmetry, submucosal cleft palate, micrognathia, wide-spaced nipples, right-sided aortic arch, hypospadias, bilateral inguinal hernias, double toenail of the left second toe, partial 2-3 toe syndactyly, kyphoscoliosis and colonic atony. Therefore, the common features of the 19q13.32 microdeletion syndrome include facial asymmetry, ptosis, oculomotor paralysis, orofacial clefting, micrognathia, kyphoscoliosis, aortic defects and colonic atony. These findings are probably related to a deletion of some combination of the 20-23 genes in common between these two patients, especially NPAS1, NAPA, ARHGAP35, SLC8A2, DHX34, MEIS3, and ZNF541. These candidate genes are expressed in the brain parenchyma, glia, heart, gastrointestinal tract and musculoskeletal system and likely play a fundamental role in the expression of this phenotype. This report delineates the phenotypic spectrum associated with the haploinsufficiency of genes found in 19q13.32. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

The Relationship of Amount of Resection and Time for Recovery of Bell’s Phenomenon after Levator Resection in Congenital Ptosis

PubMed Central

Goel, Ruchi; Kishore, Divya; Nagpal, Smriti; Jain, Sparshi; Agarwal, Tushar

2017-01-01

Background: Recovery of Bell`s phenomenon after levator resection is unpredicatable. Delayed recovery can result in vision threatening corneal complications. Aim: To study the variability of Bell’s phenomenon and time taken for its recovery following levator resection for blepharoptosis and to correlate it with the amount of resection. Methods: A prospective observational study was conducted on 32 eyes of 32 patients diagnosed as unilateral simple congenital blepharoptosis who underwent levator resection at a tertiary care center between July 2013 and May 2015. Patients were followed up for 5 months and correction of ptosis, type of Bell`s, duration of Bell`s recovery and complications were noted. Results: The study group ranged from 16-25 years with 15:17 male: female ratio. There were 9 mild, 16 moderate and 7 severe ptosis. Satisfactory correction was achieved in all cases. Good Bell`s recovery occurred in 13 eyes on first post-op day, in 2-14 days in 19 eyes and 28 days in 1 eye. Inverse Bell`s was noted along with lid oedema and ecchymosis in 2 patients. Large resections (23-26mm) were associated with poor Bell`s on the first postoperative day (p=0.027, Fisher`s exact test). However, the duration required for recovery of Bell`s phenomenon did not show any significant difference with the amount of resection. (p=0.248, Mann Whitney test). Larger resections resulted in greater lagophthalmos (correlation=0.830, p<0.0001). Patients with recovery of Bell`s delayed for more than 7 days were associated with greater number of complications (p=0.001 Fisher`s Exact Test). Conclusion: Close monitoring for Bell`s recovery is required following levator resection. PMID:28584563

Cutaneous haemangiosarcoma of the lower eyelid in an elderly white cat.

PubMed

Hartley, Claudia; Ladlow, Jane; Smith, Ken C

2007-02-01

A case of cutaneous haemangiosarcoma of the left lower eyelid in a 15-year-old white domestic shorthair cat is reported. A protuberant red mass occupying one-third of the lower eyelid margin length was present. Intermittent haemorrhage occurred from the mass surface. Surgical biopsy had revealed a locally invasive tumour composed of numerous irregular blood-filled spaces lined by a single layer of plump endothelial cells and separated by thin fibrous septa. Mitotic activity was rare and the appearance was consistent with a low-grade haemangiosarcoma. The mass continued to enlarge and referral was sought. Due to financial constraints and the owner's wish for a single procedure, enucleation with an axial pattern flap based on the superficial temporal artery was undertaken. Histopathology of the excised tissue confirmed the presence of a well-differentiated haemangiosarcoma. Tumour-free excisional margins were confirmed, the surgical area healed uneventfully, and there has been no recurrence during the subsequent 16 months.

Ocular demodicosis as a potential cause of pediatric blepharoconjunctivitis.

PubMed

Liang, Lingyi; Safran, Steve; Gao, Yingying; Sheha, Hosam; Raju, V K; Tseng, Scheffer C G

2010-12-01

To report Demodex infestation in pediatric blepharoconjunctivitis. A retrospective review of 12 patients, with ages from 2.5-11 years, with chronic blepharoconjunctivitis who failed to respond to conventional treatments. Demodex was detected by lash sampling and microscopic examination. Patients were treated with 50% tea tree oil (TTO) eyelid scrubs or 5% TTO ointment eyelid massages for 4-6 weeks. Demodex mites were found in all, but 1 case had cylindrical dandruff in the lashes. After 1 week of TTO treatment, all patients showed dramatic resolution of ocular irritation and inflammation while Demodex counts dropped. All corneal signs resolved within 2 weeks except for a residual anterior stromal scar in 1 eye. During a follow-up period of 8.3 ± 4.6 months, 1 patient showed recurrent inflammation, which was successfully managed by a second round of TTO treatment. Demodicosis should be considered as a potential cause of pediatric refractory blepharoconjunctivitis. Eyelid scrubs or massage with TTO could be an effective treatment regimen in these cases.

[Cosmetic eyelid surgery].

PubMed

Ruban, J-M; Barbier, J; Malet, T; Baggio, E

2014-01-01

Cosmetic eyelid surgery is becoming increasingly popular. It can rejuvenate the patient's appearance with relatively minor side effects. Its risk/benefit ratio is one of the best in facial cosmetic surgery. However, the patient does not always accurately assess the aesthetic appearance of his or her eyelids. This underscores the importance of clinical examination in order to determine the patient's wishes, and then make an accurate diagnosis and potential surgical plan. We currently oppose, in general, surgical techniques involving tissue removal (skin-muscle and/or fat) in favor of those involving tissue repositioning and grafting (autologous fat pearl transposition, obtained by liposuction, and lipostructure). Furthermore, the place of adjuvant therapies to blepharoplasty is steadily increasing. They mainly include surface treatments (peels and lasers), dermal fillers and anti-wrinkle botulinum toxin injections. They are also increasingly used in isolation in novel ways. In all cases, a perfect knowledge of anatomy and relevant skills and experience remain necessary. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Multiple sites of extinction for a single learned response

PubMed Central

Mauk, Michael D.

2012-01-01

Most learned responses can be diminished by extinction, a process that can be engaged when a conditioned stimulus (CS) is presented but not reinforced. We present evidence that plasticity in at least two brain regions can mediate extinction of responses produced by trace eyelid conditioning, where the CS and the reinforcing stimulus are separated by a stimulus-free interval. We observed individual differences in the effects of blocking extinction mechanisms in the cerebellum, the structure that, along with several forebrain structures, mediates acquisition of trace eyelid responses; in some rabbits extinction was prevented, whereas in others it was largely unaffected. We also show that cerebellar mechanisms can mediate extinction when noncerebellar mechanisms are bypassed. Together, these observations indicate that trace eyelid responses can be extinguished via processes operating at more than one site, one in the cerebellum and one upstream in forebrain. The relative contributions of these sites may vary from animal to animal and situation to situation. PMID:21940608

Pattern of ophthalmic lesions at two histopathology centres in Ethiopia.

PubMed

Assegid, A

2001-05-01

To describe the distribution of ocular, orbital and eyelid lesions that required histopathologic analysis in Ethiopian children and adults. A retrospective study. Tikur Anbessa and Menelik II Teaching hospitals, Addis Ababa, Ethiopia, during 1995 and 1999 period. Two hundred and ninety ophthalmic specimens were examined, 20% of which came from children. Half of the lesions had epithelial origin, about 30% were malignant, 22.6% were benign and 16.4% were potentially malignant. Squamous cell carcinoma was the leading conjunctival (26%), eyelid (33%), orbital (33%) and ocular (20%) lesion among adults and elderly people whereas only 6% of eyelid lesion were basal cell carcinomas. In children the most frequent intra-ocular as well as orbital tumour was retinoblastoma, 39%, followed by miscellaneous benign lesions (24%). More than half of the request forms were incomplete. In Addis Ababa, squamous cell carcinoma and retinoblastoma should be considered when evaluating ophthalmic lesions in adults and children, respectively. Clinicians and pathologists should improve their communication by filling in request forms, providing clear reports and making dialogue.

Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation.

PubMed

Lenart, S B; Garrity, J A

2000-05-01

The presence of a corneal reflex and the ability to maintain eye closure are instrumental in protecting the cornea. Use of neuromuscular blocking agents or propofol can result in impaired eyelid closure and loss of corneal reflex, leading to corneal exposure. The cornea is then at risk for drying, infection, and scarring, which may lead to permanent visual loss. To determine whether applying artificial tear ointment to the eyes of paralyzed or heavily sedated patients receiving mechanical ventilation decreases the prevalence of exposure keratitis more than does passive closure of the eyelid. A prospective, randomized control trial was done. The sample was 50 patients in the intensive care unit receiving either neuromuscular blocking agents or propofol during mechanical ventilation. In each patient, artificial tear ointment was applied to one eye; passive closure of the eyelid was used for the other eye (control eye). Nine patients had evidence of exposure keratitis in the untreated eye, and 2 had corneal abrasions in both the treated and the control eyes. The remaining 39 patients did not have corneal abrasions in either eye. Use of the artificial tear ointment was more effective in preventing corneal exposure than was passive eyelid closure (P = .004). Eye care with a lubricating ointment on a regular, set schedule can effectively reduce the prevalence of corneal abrasions in patients who are either paralyzed or heavily sedated and thus can help prevent serious complications such as corneal ulceration, infection, and visual loss.

Influence of Meibomian Gland Expression Methods on Human Lipid Analysis Results.

PubMed

Kunnen, Carolina M E; Brown, Simon H J; Lazon de la Jara, Percy; Holden, Brien A; Blanksby, Stephen J; Mitchell, Todd W; Papas, Eric B

2016-01-01

To compare the lipid composition of human meibum across three different meibum expression techniques. Meibum was collected from five healthy non-contact lens wearers (aged 20-35 years) after cleaning the eyelid margin using three meibum expression methods: cotton buds (CB), meibomian gland evaluator (MGE) and meibomian gland forceps (MGF). Meibum was also collected using cotton buds without cleaning the eyelid margin (CBn). Lipids were analyzed by chip-based, nano-electrospray mass spectrometry (ESI-MS). Comparisons were made using linear mixed models. Tandem MS enabled identification and quantification of over 200 lipid species across ten lipid classes. There were significant differences between collection techniques in the relative quantities of polar lipids obtained (P<.05). The MGE method returned smaller polar lipid quantities than the CB approaches. No significant differences were found between techniques for nonpolar lipids. No significant differences were found between cleaned and non-cleaned eyelids for polar or nonpolar lipids. Meibum expression technique influences the relative amount of phospholipids in the resulting sample. The highest amounts of phospholipids were detected with the CB approaches and the lowest with the MGE technique. Cleaning the eyelid margin prior to expression was not found to affect the lipid composition of the sample. This may be a consequence of the more forceful expression resulting in cell membrane contamination or higher risk of tear lipid contamination as a result of reflex tearing. Copyright © 2016 Elsevier Inc. All rights reserved.

Aesthetic Total Reconstruction of Lower Eyelid Using Scapha Cartilage Graft on a Vascularized Propeller Flap.

PubMed

Uemura, Tetsuji; Watanabe, Hidekata; Masumoto, Kazuyuki; Kikuchi, Mamoru; Satake, Yoshiyasu; Yanai, Tetsu; Harada, Yoshimi; Ishihara, Yasuhiro; Yasuta, Masato

2016-04-01

The aim of this study was to review the results of a cohort of patients based on our experience with a new technique for total lower eyelid reconstruction after a large defect caused by malignant tumor and trauma. A scapha cartilage graft with small skin on a vascularized propeller flap was used for 16 cases requiring lower eyelid reconstruction. Patients were identified from a database, and a retrospective case note review was conducted. The scapha cartilage graft was sutured to the margin of the defect of the palpebral conjunctiva and tarsus. The propeller flap, rotated by a perforator-based lateral orbital flap or a subcutaneous-based nasolabial flap, was vascularized on the scapha cartilage graft as anterior lining of the lower eyelid. The follow-up, including results of slit-lamp examination, lasted for varying periods, but often it was for 12 months. The scapha cartilage graft with small skin on a vascularized propeller flap was viable in all cases. Slit-lamp examination detected no irritation or injury of the conjunctiva and cornea, and visual acuity was maintained in all cases. A deformity in the donor helix by this technique was also improved by getting a smaller skin harvested from the scapha. Use of the scapha cartilage graft with small skin on a vascularized propeller flap allows for a good fit to the orbit, short operative time under local anesthesia, good graft viability, and a good esthetic result with minimal donor site morbidity.

Characterization of the mucocutaneous junction of the human eyelid margin and meibomian glands with different biomarkers.

PubMed

Tektaş, Ozan Yüksel; Yadav, Ajay; Garreis, Fabian; Schlötzer-Schrehardt, Ursula; Schicht, Martin; Hampel, Ulrike; Bräuer, Lars; Paulsen, Friedrich

2012-09-01

To investigate the morphology of the human eyelid margin and the presence of different cytokeratins, mucins and stem cell markers within the skin epithelium, mucocutaneous junction (MCJ) and palpebral conjunctiva. Eyelids of body donors were investigated histologically and ultrastructurally as well as by immunohistochemical methods using antibodies to cytokeratins 1, 4, 7, 8, 10, 13, 14, 15, and 19; mucins MUC1, MUC4, and MUC5AC and potential stem cell markers K15, BCRP/ABCG2, integrin β1, and N-cadherin. The expression pattern of cytokeratins, mucins and stem cell markers varied across the different epithelia of the human eyelid. Within the MCJ, CK7, 15 and 19 were absent, whereas the epithelium reacted positive to antibodies to CK1, 4, 8, 10, 13 and 14. Reactivity was also observed for MUC1 and MUC4, but not for MUC5AC. No reactivity was determined for K15, BCRP/ABCG2 and integrin β1 in the area of the MCJ epithelium but a strong reactivity was present for N-cadherin. The present immunohistochemical findings lead to a better characterization of the MCJ. Additionally, the knowledge of distribution of biomarkers like cytokeratins, mucins and stem cells can be useful in the investigation of MCJ disturbances which occur in several disorders of the meibomian glands and the lid epithelium in the course of dry eye syndrome and especially meibomian gland dysfunction. Copyright © 2012 Elsevier GmbH. All rights reserved.

Hickam's dictum: Myasthenia Gravis presenting concurrently with Graves' disease.

PubMed

Sehgal, Shekhar; Rebello, Roshan; Wolmarans, Louise; Elston, Marianne

2017-09-07

We present two patients with Graves' disease and concurrent myasthenia gravis. The impact of the dual diagnosis on the clinical course and the potential for a delayed diagnosis of myasthenia gravis is discussed. Patient 1, a 28-year-old man was diagnosed with Graves' disease following his second respiratory arrest. His history was strongly suggestive of a second pathology. Patient 2, a 66-year-old Cantonese woman with established Graves' disease presented with thionamide-related neutropaenia. Examination revealed bilateral ptosis and right lateral rectus palsy. Both patients had thyrotoxicosis secondary to Graves' disease with concurrent myasthenia gravis. Although neuromuscular weakness is common in Graves' disease, coexisting myasthenia gravis (MG) is rare and can cause profound morbidity. Ocular signs in both diseases may cause diagnostic confusion although ptosis suggests coexisting MG. In both cases, the thyrotoxicosis delayed the diagnosis of MG. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Steinert myotonic dystrophy and blepharoptosis surgery: 9 case reports].

PubMed

Karim, A; Schapiro, D; Morax, S

2003-01-01

Steinert myopathic dystrophy is a generalized, hereditary disease with bone, muscular, heart and ocular involvement. This is a retrospective study of nine patients with significant blepharoptosis due to Steinert disease, who were treated at the Adolphe de Rothschild Ophthalmology Foundation over a period of 5 years. Ptosis was symmetric and major in all cases with poor levator excursion. Severity criteria were an absence of the Bell phenomenon and diminished orbicularis tone. A frontalis suspension was performed in eight cases with intentional undercorrection. The outcome was favorable in all cases, 2 with a slight overcorrection underwent a second operation conclusion: Surgical treatment of ptosis in Steinert disease is difficult because of a risk of lagophthalmic, keratopathy due to the severity of the disease, an absence of the Bell phenomenon and ophthalmoplegia. This surgery must be undertaken with caution, most often using a frontalis suspension. Undercorrection must be systematic, with the single goal of freeing the pupil in the primary position.

Coexistence of primary biliary cirrhosis and myasthenia gravis: a case study.

PubMed

Horigome, H; Nomura, T; Saso, K; Joh, T; Ohara, H; Akita, S; Sobue, S; Mizuno, Y; Kato, Y; Itoh, M

2000-01-01

We present a case that suggests a relationship between primary biliary cirrhosis and myasthenia gravis. A 43-year-old Japanese woman was admitted to the Nagoya City University Medical School, First Department of Internal Medicine with abnormal liver function in August 1991. She had had ptosis of the right eye since 1990. She had not been treated for liver disease. Ptosis of the right eye and hepatomegaly were present. Serum laboratory examinations revealed elevated biliary enzymes and IgM levels; tests were positive for antimitochondrial antibody and antiacetylcholine antibody. Liver histology revealed chronic non-suppurative destructive cholangitis and led to a diagnosis of primary biliary cirrhosis. The tensilon test was positive. Electromyography with repetitive motor nerve stimulation revealed a neuromuscular junction defect; i.e., the primary characteristic of myasthenia gravis. The patient was diagnosed with myasthenia gravis. Although the development of myasthenia gravis has previously been reported in patients with primary biliary cirrhosis during D-penicillamine administration, this is a very rare case of the coexistence of both diseases before such treatment.

Human eyelid meibomian glands and tarsal muscle are recognized by autoantibodies from patients affected by a new variant of endemic pemphigus foliaceus in El-Bagre, Colombia, South America.

PubMed

Abreu-Velez, Ana Maria; Howard, Michael S; Hashimoto, Takashi; Grossniklaus, Hans E

2010-03-01

Previously, we described a new variant of endemic pemphigus foliaceus (EPF) in Colombia, South America (El Bagre-EPF). Continuing our characterization of this variant of EPF, we now focus on one of our previously reported clinical findings: the presence of ocular lesions. These ocular lesions are seen in patients having extensive skin involvement, as measured by the Lund and Browder scale, which is generally used for patients with skin burns. We specifically searched for evidence of autoreactivity to various eyelid structures in these patients and correlated our immunologic data with the clinical findings. We performed indirect immunofluorescence studies using normal-appearing human eyelid skin from routine blepharoplasties as substrate tissue. We tested sera from 12 patients with El Bagre-EPF and ocular lesions, 5 patients with sporadic (nonendemic) pemphigus foliaceus, and 20 healthy control subjects (10 from the El Bagre-EPF endemic area and 10 from nonendemic areas). We used fluorescein isothiocyanate conjugated goat antiserum to human total IgG/IgA/IgM as a secondary antibody. In addition, we used fluorescein isothiocyanate conjugated antibodies to human fibrinogen, albumin, IgG, IgE, C1q, and C3, Texas Red (Rockland Immunochemicals, Inc, Gilbertsville, PA), Alexa Fluor 555, or Alexa Fluor 594 (Invitrogen, Carlsbad, CA). Ki-67 (a cell proliferation marker) was used to determine the cell proliferation rate, and nuclear counterstaining was performed with either 4', 6-diamidino-2-phenylindole or Topro III (Invitrogen, Carlsbad, CA). We observed autoreactivity to multiple eyelid structures, including meibomian glands and tarsal muscle bundles at different levels, and some areas of the epidermis and the dermis close to the isthmus of the eyelids. Tarsal plate autoreactivity was seen in 10 of 12 of the El Bagre-EPF sera and in one control with pemphigus erythematosus. Furthermore, immunoprecipitation using an eyelid sample as a substrate with 1 mmol/L of sodium orthovanodate showed autoreactivity to several antigens, including some of possible lipid origin. The main limitation of this study is the fact that the antigen or antigens remain unknown. We identified for the first time to our knowledge autoantibodies to meibomian glands and tarsal muscle in El Bagre-EPF. Our findings suggest that the autoantibodies to the ocular structures cause the clinical and histopathological findings in the ocular lesions in El Bagre-EPF. Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Human eyelid meibomian glands and tarsal muscle are recognized by autoantibodies from patients affected by a new variant of endemic pemphigus foliaceus in El-Bagre, Colombia, South America

PubMed Central

Abreu-Velez, Ana Maria; Howard, Michael S.; Hashimoto, Takashi; Grossniklaus, Hans E.

2010-01-01

Background Previously, we described a new variant of endemic pemphigus foliaceus (EPF) in Colombia, South America (El Bagre-EPF). Objective Continuing our characterization of this variant of EPF, we now focus on one of our previously reported clinical findings: the presence of ocular lesions. These ocular lesions are seen in patients having extensive skin involvement, as measured by the Lund and Browder scale, which is generally used for patients with skin burns. Methods We specifically searched for evidence of autoreactivity to various eyelid structures in these patients and correlated our immunologic data with the clinical findings. We performed indirect immunofluorescence studies using normal-appearing human eyelid skin from routine blepharoplasties as substrate tissue. We tested sera from 12 patients with El Bagre-EPF and ocular lesions, 5 patients with sporadic (nonendemic) pemphigus foliaceus, and 20 healthy control subjects (10 from the El Bagre-EPF endemic area and 10 from nonendemic areas). We used fluorescein isothiocyanate conjugated goat antiserum to human total IgG/IgA/IgM as a secondary antibody. In addition, we used fluorescein isothiocyanate conjugated antibodies to human fibrinogen, albumin, IgG, IgE, C1q, and C3, Texas Red (Rockland Immunochemicals, Inc, Gilbertsville, PA), Alexa Fluor 555, or Alexa Fluor 594 (Invitrogen, Carlsbad, CA). Ki-67 (a cell proliferation marker) was used to determine the cell proliferation rate, and nuclear counterstaining was performed with either 4′, 6-diamidino-2-phenylindole or Topro III (Invitrogen, Carlsbad, CA). Results We observed autoreactivity to multiple eyelid structures, including meibomian glands and tarsal muscle bundles at different levels, and some areas of the epidermis and the dermis close to the isthmus of the eyelids. Tarsal plate autoreactivity was seen in 10 of 12 of the El Bagre-EPF sera and in one control with pemphigus erythematosus. Furthermore, immunoprecipitation using an eyelid sample as a substrate with 1 mmol/L of sodium orthovanodate showed autoreactivity to several antigens, including some of possible lipid origin. Limitations The main limitation of this study is the fact that the antigen or antigens remain unknown. Conclusion We identified for the first time to our knowledge autoantibodies to meibomian glands and tarsal muscle in El Bagre-EPF. Our findings suggest that the autoantibodies to the ocular structures cause the clinical and histopathological findings in the ocular lesions in El Bagre-EPF. PMID:20061054

Objective assessment of quality of life in female patients after esthetic, non-oncologic or oncologic surgery of their mammary glands--reality and perspectives.

PubMed

Molov, Veselin V; Tepavicharova, Penka P; Deenichin, George P; Mitov, Franz S

2005-01-01

The World Health Organisation defines health as a state of complete physical, mental and social well-being, and not merely the absence of a disease or infirmity. The female breast, surgically considered as a "troubled organ", can be affected by disorders of various types. Its normal morphology can be changed by deformities which may have a serious impact on the mental state of female patients. Assessment of these deformities is essential when doctors should define the inclusion and exclusion criteria for each breast operation that has elements of esthetic surgery in it, the breast being indisputably a symbol of female beauty. When we consider the parameters of normal breast morphology, it is only proper to take into account their dependence on race, national culture, folk psychology, etc. For Bulgarian women, P. Tepavicharova has found that the distance from fossa jugularis to the nipple-areolar complex can have the following characteristic proportions: 15.5-17 cm for a woman 155-160 cm in height and with breast circumference of 75-80 cm; 17-18.5 cm for woman 160-165 cm in height and with breast circumference of 89-95 cm; and 18-20 cm for a woman 165-170 cm in height and with breast circumference of 95-100 cm. J. Lalardie points out that breast stability is determined by three principal factors: skin and its elasticity, the condition of the underlying collagenous structure of the breast, and the firm bond between the skin and fibrous elements. RB Brinks defines the four forms of ptosis of the breast: glandular ptosis, true ptosis, parenchymal maldistribution, and pseudoptosis. According to P. Tepavicharova, the violation of breast symmetry is the major factor triggering a sequence of psychosomatic reactions. The basic parameters of female breast morphology are the mammary base, mammary perimeter, the forward projection of the breast, symmetry, breast volume, and the state of the axillary extension. The major deviations from normal breast morphology that can have an impact on the quality of life are mammary ptosis, hypertrophy, asymmetry, and deformations of the breast shape as well as the operation cicatrices on the breast. An assessment of the association of the deviations from normal morphology with the correction to normal morphology (with or without dealing with a pathological process) and with the impact on the quality of life is a possible base for objective assessment of the latter parameter.

Comparison of Efficacy and Complications Among Various Spacer Grafts in the Treatment of Lower Eyelid Retraction: A Systematic Review.

PubMed

Park, Eugene; Lewis, Kevin; Alghoul, Mohammed S

2017-07-01

Lower eyelid retraction is a difficult problem to treat, but it is a prevalent condition and a common complication of blepharoplasty. The use of spacer grafts to increase eyelid height and improve symptoms has been described for a long time, but the optimal choice of spacer graft material is unknown. The authors reviewed the currently available evidence to determine the best available spacer graft material in terms of efficacy and complications. A systematic review of all available literature published between 1985 and the present was performed using the Pubmed, Ovid MEDLINE, and Cochrane library databases. Inclusion criteria were that the studies contain original content assessing the treatment of lower eyelid retraction in humans using a spacer graft and provide quantitative outcomes data. One hundred and twelve articles were reviewed following an initial screen using titles, and 19 articles were chosen for inclusion in this systematic review. Analysis of these articles revealed no spacer graft material that is clearly superior to others. Due to a lack of high quality evidence, this review did not reveal one spacer graft material that is clearly superior to others. However, a narrative summary of the available evidence reveals unique sets of advantages and disadvantages associated with the various materials currently available. Further research in the form of well-designed studies will be necessary to further clarify advantages of certain spacer graft materials over others. 5. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Relationships Between Meibomian Gland Loss and Age, Sex, and Dry Eye.

PubMed

Pult, Heiko

2018-02-12

This study evaluated relationships between meibomian gland loss (MGL) and age, sex, and dry eye. Dry eye and MGL of the lower eyelid was evaluated from 112 randomly selected subjects (66 women; mean age 62.8; SD ±15.7; and age range: 19-89 years) from Horst Riede GmbH, Weinheim, Germany. In addition, subjects were grouped into dry eye and non-dry eye by the Ocular Surface Disease Index (OSDI) score, lid-parallel conjunctival folds and non-invasive break-up time. Symptoms were evaluated by the OSDI. Meibography of the lower eyelid was performed using a Cobra camera (bon Optic, Lübeck, Germany), and images were analyzed by its digital grading tool. Data were analyzed by backward, multiple regression analyses and Pearson correlation. Analyzing all subjects, multiple regression analyses detected that age and dry eye status (dry eye diagnosis or OSDI) but not sex were significantly related to MGL. In both, non-dry eye (n=66) and dry eye subjects (n=46), dry eye status (OSDI) but not age or sex was significantly related to MGL. Ocular Surface Disease Index scores were significantly correlated with MGL, but this correlation was stronger among all subjects (Pearson correlation; r=0.536, P<0.001) and dry eye group subjects (r=0.520, P<0.001) than in non-dry eye group subjects (r=0.275, P=0.014). Dry eye group subjects showed significantly increased MGL of the lower eyelid. Age and dry eye status were related to MGL of the lower eyelid, but sex was not; dry eye status was the dominant factor.

'En face' ex vivo reflectance confocal microscopy to help the surgery of basal cell carcinoma of the eyelid.

PubMed

Espinasse, Marine; Cinotti, Elisa; Grivet, Damien; Labeille, Bruno; Prade, Virginie; Douchet, Catherine; Cambazard, Frédéric; Thuret, Gilles; Gain, Philippe; Perrot, Jean Luc

2017-07-01

Ex vivo confocal microscopy is a recent imaging technique for the perioperative control of skin tumour margins. Up to date, it has been used in the fluorescence mode and with vertical sections of the specimen margins. The aim of this study was to evaluate its use in the reflectance mode and with a horizontal ('en face') scanning of the surgical specimen in a series of basal cell carcinoma of the eyelid. Prospective consecutive cohort study was performed at the University Hospital of Saint-Etienne, France. Forty-one patients with 42 basal cell carcinoma of the eyelid participated in this study. Basal cell carcinomas were excised with a 2-mm-wide clinically safe margin. The surgical specimens were analysed under ex vivo confocal microscopy in the reflectance mode and with an en face scanning in order to control at a microscopic level if the margins were free from tumour invasion. Histopathogical examination was later performed in order to compare the results. Sensitivity and specificity of ex vivo confocal microscopy for the presence of tumour-free margins. Ex vivo confocal microscopy results were consistent with histopathology in all cases (tumour-free margins in 40 out of 42 samples; sensitivity and specificity of 100%). Ex vivo confocal microscopy in the reflectance mode with an 'en face' scanning can control tumour margins of eyelid basal cell carcinomas and optimize their surgical management. This procedure has the advantage on the fluorescent mode of not needing any contrast agent to examine the samples. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

Electrostatic artificial eyelid actuator as an analog micromirror device

NASA Astrophysics Data System (ADS)

Goodwin, Scott H.; Dausch, David E.; Solomon, Steven L.; Lamvik, Michael K.

2005-05-01

An electrostatic MEMS actuator is described for use as an analog micromirror device (AMD) for high performance, broadband, hardware-in-the-loop (HWIL) scene generation. Current state-of-the-art technology is based on resistively heated pixel arrays. As these arrays drive to the higher scene temperatures required by missile defense scenarios, the power required to drive the large format resistive arrays will ultimately become prohibitive. Existing digital micromirrors (DMD) are, in principle, capable of generating the required scene irradiances, but suffer from limited dynamic range, resolution and flicker effects. An AMD would be free of these limitations, and so represents a viable alternative for high performance UV/VIS/IR scene generation. An electrostatic flexible film actuator technology, developed for use as "artificial eyelid" shutters for focal plane sensors to protect against damaging radiation, is suitable as an AMD for analog control of projection irradiance. In shutter applications, the artificial eyelid actuator contained radius of curvature as low as 25um and operated at high voltage (>200V). Recent testing suggests that these devices are capable of analog operation as reflective microcantilever mirrors appropriate for scene projector systems. In this case, the device would possess larger radius and operate at lower voltages (20-50V). Additionally, frame rates have been measured at greater than 5kHz for continuous operation. The paper will describe the artificial eyelid technology, preliminary measurements of analog test pixels, and design aspects related to application for scene projection systems. We believe this technology will enable AMD projectors with at least 5122 spatial resolution, non-temporally-modulated output, and pixel response times of <1.25ms.

[Efficacy of physiotherapy and hygienic procedures in treatment of adults and children with chronic blepharitis and dry eye syndrome].

PubMed

Prozornaia, L P; Brzhevskiĭ, V V

2013-01-01

110 patients aged from 3 to 42 years old were examined to estimate the efficacy of chronic blepharitis treatment: 50 patients with chronic blepharitis and dry eye syndrome (DES), 28 with DES due to computer vision syndrome and 32 with isolated chronic blepharitis. All patients received eyelid massage. If the secretion was too thick and difficult to evacuate from meibomian glands then duct probing was performed. In addition a complex of hygienic procedures was performed using phytoproducts ("Geltec-Medika", Russia): blepharoshampoo, blepharolotion, blepharogel 1 and 2. Moist warm pads (with blepharolotion and calendula extraction) were applied on the eyelids in 25 patients. Massage and probing of meibomian gland ducts and hygienic procedures were showed to be effective in management of clinical signs of chronic blepharitis including coexisting DES. Moist warm pads improve efficacy of background therapy in patients with meibomian gland hypofunction and have no effect in blepharitis with excessive meibomian gland secretion. Eyelid hygiene was showed to be effective in adults and children as well including infants.

Prevalence and phenomenology of eye tics in Gilles de la Tourette syndrome.

PubMed

Martino, Davide; Cavanna, Andrea E; Robertson, Mary M; Orth, Michael

2012-10-01

Eye tics seem to be common in Gilles de la Tourette syndrome (GTS). We analyzed the frequency and clinical characteristics of eye tics in 212 GTS patients. Of the 212 patients, 201 (94.8 %) reported eye tics in their life-time; 166 (78.3 %) reported eye movement tics (rolling eyes up/down, eyes looking sideways, staring), and 194 (91.5 %) eyelid/eyebrow movement tics (frowning, raising eyebrows, blinking or winking). Patients with eye movement tics were younger at age of GTS onset (7.1 ± 4 years) than those without (8.9 ± 6.8; p = 0.024). Tic severity positively correlated to lifetime history of eye and/or eyelid/eyebrow movement tics. Our data confirm that eye and eyelid/eyebrow movement tics are very common in GTS, and most patients have several types of eye tics over time. Eye tic phenomenology was similar in patients with or without co-morbidity. Eye tics are therefore likely to be a core feature of GTS and should be routinely evaluated in order to strengthen the clinician's confidence in diagnosing GTS.

Combined excision and intralesional bevacizumab for sebaceous carcinoma of the eyelid in an Amur tiger (Panthera tigris altaica).

PubMed

Edelmann, Michele L; Utter, Mary L; Klein, Lin V; Wotman, Kathryn L

2013-05-01

An 18-year-old zoo-kept female Amur tiger presented with an approximately 5 mm diameter lateral canthal eyelid mass in the left eye which grossly appeared red and irregular. The mass was completely excised via lateral canthoplasty. Histopathologic evaluation was consistent with a diagnosis of sebaceous cell carcinoma, which is a potentially aggressive cutaneous neoplasm. The sebaceous carcinoma recurred within 3 months and slowly increased in size until a second surgical excision was performed 9 months following the first surgery. The second surgical excision was combined with intralesional injection of 10 mg of the antiangiogenic drug bevacizumab. Histology confirmed the diagnosis. The tiger was euthanized 16 months postoperatively for reasons unrelated to, and without recurrence of, the eyelid neoplasm. At postmortem, no gross periocular or metastatic lesions were noted, and histopathology of the lateral canthus provided no evidence of recurrence. Surgical excision combined with intralesional bevacizumab treatment induced life-long resolution of the sebaceous carcinoma. Bevacizumab treatment may be associated with the regression of periocular angiogenic proliferative conditions, including neoplasia, by inhibiting angiogenesis. © 2012 American College of Veterinary Ophthalmologists.

Live Speech Driven Head-and-Eye Motion Generators.

PubMed

Le, Binh H; Ma, Xiaohan; Deng, Zhigang

2012-11-01

This paper describes a fully automated framework to generate realistic head motion, eye gaze, and eyelid motion simultaneously based on live (or recorded) speech input. Its central idea is to learn separate yet interrelated statistical models for each component (head motion, gaze, or eyelid motion) from a prerecorded facial motion data set: 1) Gaussian Mixture Models and gradient descent optimization algorithm are employed to generate head motion from speech features; 2) Nonlinear Dynamic Canonical Correlation Analysis model is used to synthesize eye gaze from head motion and speech features, and 3) nonnegative linear regression is used to model voluntary eye lid motion and log-normal distribution is used to describe involuntary eye blinks. Several user studies are conducted to evaluate the effectiveness of the proposed speech-driven head and eye motion generator using the well-established paired comparison methodology. Our evaluation results clearly show that this approach can significantly outperform the state-of-the-art head and eye motion generation algorithms. In addition, a novel mocap+video hybrid data acquisition technique is introduced to record high-fidelity head movement, eye gaze, and eyelid motion simultaneously.

Congenital oculomotor nerve synkinesis associated with fetal retinoid syndrome.

PubMed

Morrison, David G; Elsas, Frederick J; Descartes, Maria

2005-04-01

Isotretinoin (RA), used for the treatment of cystic acne, is a powerful teratogen, causing craniofacial dysmorphisms and neural tube defects. We present two patients with RA embryopathy and oculomotor nerve synkinesis. Retrospective review of patient records. Two patients presented with third nerve synkinesis and fetal RA exposure. Both had marked elevation of the upper eyelids on adduction such that the lid fissures alternately opened and closed on gaze from side to side. Both patients showed typical dysmorphisms of RA embryopathy. The first patient had complete agenesis of the cerebellar vermix and died at 2 years. The second patient had restricted extraocular muscles in one eye and was exotropic and hypotropic. Both patients demonstrated simultaneous innervation of the medial rectus and levator palpebrae muscles causing coincident lid elevation in adduction. This evidence of oculomotor nerve synkinesis is consistent with animal studies showing abnormalities in the formation of cranial nerve ganglia following fetal RA exposure. RA is a powerful teratogen. These patients provide additional clinical evidence of its influence on neural migration during early development.

Extranodal marginal zone B cell lymphoma of the orbit in a patient with sarcoidosis: a case report.

PubMed

Richards, Nikisha Q; Kidwell, Earl D R; Ramadan, Ali M; Naab, Tammey J

2014-10-20

To describe a case of extranodal marginal zone B-cell lymphoma (EMZL) "mucosa associated lymphoid tissue (MALT)" of the orbit that presented with stage IV disease in a patient with sarcoidosis. Clinicopathologic case report. Biopsies of the lesion were performed in the operating room and the samples were submitted for pathology processing. Pathology analysis identified the lesion as an extranodal marginal zone B-cell lymphoma "mucosa associated lymphoid tissue (MALT)" via flow cytometry, histopathology, cytogenetics, and immunohistochemical staining and fluorescent in situ hybridization (FISH). The institutional review board of Howard University Hospital waived the need for IRB approval for this intraoperative finding. A 70-year-old Black woman with biopsy-proven sarcoidosis presented complaining of foreign body sensation, redness, swelling of her left upper eyelid and tearing. The patient was found to have an orbital lymphoproliferative malignancy. It is still unclear if the presence of immunosuppression or an autoimmune disease increases the risk of lymphoproliferative malignancies {6}. Malignancy should always be suspected and investigated.

Trains of large Kelvin-Helmholtz billows observed in the Kuroshio above a seamount

NASA Astrophysics Data System (ADS)

Chang, Ming-Huei; Jheng, Sin-Ya; Lien, Ren-Chieh

2016-08-01

Trains of large Kelvin-Helmholtz (KH) billows within the Kuroshio current at ~230 m depth off southeastern Taiwan and above a seamount were observed by shipboard instruments. The trains of large KH billows were present in a strong shear band along the 0.55 m s-1 isotach within the Kuroshio core; they are presumably produced by flow interactions with the rapidly changing topography. Each individual billow, resembling a cat's eye, had a horizontal length scale of 200 m, a vertical scale of 100 m, and a timescale of 7 min, near the local buoyancy frequency. Overturns were observed frequently in the billow cores and the upper eyelids. The turbulent kinetic energy dissipation rates estimated using the Thorpe scale had an average value of O(10-4) W kg-1 and a maximum value of O(10-3) W kg-1. The turbulence mixing induced by the KH billows may exchange Kuroshio water with the surrounding water masses.

[Possibilities in the surgical management of eyelid trauma].

PubMed

Lipke, K J

2011-08-01

The face plays a central role in interpersonal communication and aesthetic perception. Moreover, due to the heavy dependence of ocular function on lid anatomy, the treatment of periocular injuries, particularly those involving soft tissue loss, requires profound knowledge of both anatomy and reconstructive plastic surgery. Numerous surgical procedures are described in the literature. The aim of these procedures is to achieve an optimal functional and aesthetic result according to injury localization and extent. Against this background, treating eyelid injuries presents certain challenges. Close collaboration between all areas of head surgery is required particularly in the case of large defects.

Quality Assurance in Trichiasis Surgery: a methodology

PubMed Central

Buchan, John C; Limburg, Hans; Burton, Matthew J

2013-01-01

SUMMARY Trachoma remains a significant cause of blindness in many parts of the world. The major route to blindness involves upper lid entropion leading to trachomatous trichiasis (TT) which promotes progressive corneal opacification. The provision of surgery to correct TT in the populations most severely affected is a major challenge for the global effort to eliminate Trachoma blindness by the year 2020. Most attention has been paid to increasing the quantity of TT surgery performed, and large numbers of non-doctor operators have been trained to this end. Surgical audit by those performing TT surgery is not a routine part of any national trachoma control programme, and no effective mechanism exists for identifying surgeons experiencing poor outcomes. We propose a methodology for surgical audit at the level of the individual surgeon based on Lot Quality Assurance. A set number of patients operated on previously for upper eyelid TT are examined to detect the recurrence of TT. The number of recurrent cases found will lead to categorisation of the TT surgeon to either “high recurrence” or “low recurrence” with reasonable confidence. The threshold of unacceptability can be set by individual programmes according to previous local studies of recurrence rates or those from similar settings. Identification of surgeons delivering unacceptably high levels of recurrent TT will guide managers on the need for remedial intervention such as re-training. PMID:20881027

Novel autosomal dominant mandibulofacial dysostosis with ptosis: clinical description and exclusion of TCOF1

PubMed Central

Hedera, P; Toriello, H; Petty, E

2002-01-01

Methods: Six affected family members underwent a complete medical genetics physical examination and two affected subjects had skeletal survey. All available medical records were reviewed. Linkage analysis using the markers spanning the TCOF1 locus was performed. One typically affected family member had a high resolution karyotype. Results: Affected subjects had significant craniofacial abnormalities without any significant acral changes and thus had a phenotype consistent with a MFD variant. Distinctive features included hypoplasia of the zygomatic complex, micrognathia with malocclusion, auricular abnormalities with conductive hearing loss, and ptosis. Significantly negative two point lod scores were obtained for markers spanning the TCOF1 locus, excluding the possibility that the disease in our kindred is allelic with TCS. High resolution karyotype was normal. Conclusions: We report a kindred with a novel type of MFD that is not linked to the TCOF1 locus and is also clinically distinct from other types of AD MFD. Identification of additional families will facilitate identification of the gene causing this type of AD MFD and further characterisation of the clinical phenotype. PMID:12114479

Trends in the Surgical Correction of Gynecomastia.

PubMed

Brown, Rodger H; Chang, Daniel K; Siy, Richard; Friedman, Jeffrey

2015-05-01

Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using arthroscopic morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results.

Presumed Isotretinoin-Induced, Concomitant Autoimmune Thyroid Disease and Ocular Myasthenia Gravis: A Case Report

PubMed Central

Gursoy, Huseyin; Cakmak, Idil; Yildirim, Nilgun; Basmak, Hikmet

2012-01-01

Introduction There are many adverse effects that have been described for isotretinoin. To the best of our knowledge, this is the first report of a possible association of oral isotretinoin intake with autoimmune thyroiditis and ocular myasthenia gravis (OMG). Case Presentation A 19-year-old Caucasian male, who had used oral isotretinoin for severe acne disease for the previous six months, was referred to our clinic. He had a three-week history of diplopia and variable bilateral ptosis. Physical examination showed moderate periorbital edema and limitations of up- and down-gaze in the left eye. Laboratory findings and thyroid ultrasound were consistent with autoimmune thyroiditis. Antithyroid therapy did not relieve the clinical symptoms. Concomitant OMG was suspected. Variable ptosis and a positive response to oral prednisolone of 40 mg/day and pyridostigmine of 360 mg/day supported the diagnosis of concomitant autoimmune thyroiditis and OMG. Conclusion Autoimmune disorders may be triggered by oral isotretinoin treatment. Clinicians prescribing isotretinoin should be aware of the possible association between isotretinoin intake and concomitant autoimmune thyroiditis and OMG. PMID:23275770

A Case of Brown-Vialetto-Van Laere Syndrome Due To a Novel Mutation in SLC52A3 Gene

PubMed Central

Thulasi, Venkatraman; Veerapandiyan, Aravindhan; Pletcher, Beth A.; Tong, Chun M.

2017-01-01

Brown-Vialetto-Van Laere syndrome is a rare disorder characterized by motor, sensory, and cranial neuronopathies, associated with mutations in SLC52A2 and SLC52A3 genes that code for human riboflavin transporters RFVT2 and RFVT3, respectively. The authors describe the clinical course of a 6-year-old girl with Brown-Vialetto-Van Laere syndrome and a novel homozygous mutation c.1156T>C in the SLC52A3 gene, who presented at the age of 2.5 years with progressive brain stem dysfunction including ptosis, facial weakness, hearing loss, dysphagia, anarthria with bilateral vocal cord paralysis, and ataxic gait. She subsequently developed respiratory failure requiring tracheostomy and worsening dysphagia necessitating a gastrostomy. Following riboflavin supplementation, resolution of facial diplegia and ataxia, improvements in ptosis, and bulbar function including vocalization and respiration were noted. However, her sensorineural hearing loss remained unchanged. Similar to other cases of Brown-Vialetto-Van Laere syndrome, our patient responded favorably to early riboflavin supplementation with significant but not complete neurologic recovery. PMID:28856173

A Case of Brown-Vialetto-Van Laere Syndrome Due To a Novel Mutation in SLC52A3 Gene: Clinical Course and Response to Riboflavin.

PubMed

Thulasi, Venkatraman; Veerapandiyan, Aravindhan; Pletcher, Beth A; Tong, Chun M; Ming, Xue

2017-01-01

Brown-Vialetto-Van Laere syndrome is a rare disorder characterized by motor, sensory, and cranial neuronopathies, associated with mutations in SLC52A2 and SLC52A3 genes that code for human riboflavin transporters RFVT2 and RFVT3, respectively. The authors describe the clinical course of a 6-year-old girl with Brown-Vialetto-Van Laere syndrome and a novel homozygous mutation c.1156T>C in the SLC52A3 gene, who presented at the age of 2.5 years with progressive brain stem dysfunction including ptosis, facial weakness, hearing loss, dysphagia, anarthria with bilateral vocal cord paralysis, and ataxic gait. She subsequently developed respiratory failure requiring tracheostomy and worsening dysphagia necessitating a gastrostomy. Following riboflavin supplementation, resolution of facial diplegia and ataxia, improvements in ptosis, and bulbar function including vocalization and respiration were noted. However, her sensorineural hearing loss remained unchanged. Similar to other cases of Brown-Vialetto-Van Laere syndrome, our patient responded favorably to early riboflavin supplementation with significant but not complete neurologic recovery.

Minimally invasive brow suspension for facial paralysis.

PubMed

Costantino, Peter D; Hiltzik, David H; Moche, Jason; Preminger, Aviva

2003-01-01

To report a new technique for unilateral brow suspension for facial paralysis that is minimally invasive, limits supraciliary scar formation, does not require specialized endoscopic equipment or expertise, and has proved to be equal to direct brow suspension in durability and symmetry. Retrospective survey of a case series of 23 patients between January 1997 and December 2000. Metropolitan tertiary care center. Patients with head and neck tumors and brow ptosis caused by facial nerve paralysis. The results of the procedure were determined using the following 3-tier rating system: outstanding (excellent elevation and symmetry); acceptable (good elevation and fair symmetry); and unacceptable (loss of elevation). The results were considered outstanding in 12 patients, acceptable in 9 patients, and unacceptable in only 1 patient. One patient developed a hematoma, and 1 patient required a secondary adjustment. The technique has proved to be superior to standard brow suspension procedures with regard to scar formation and equal with respect to facial symmetry and suspension. These results have caused us to abandon direct brow suspension and to use this minimally invasive method in all cases of brow ptosis due to facial paralysis.

Trends in the Surgical Correction of Gynecomastia

PubMed Central

Brown, Rodger H.; Chang, Daniel K.; Siy, Richard; Friedman, Jeffrey

2015-01-01

Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using arthroscopic morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results. PMID:26528088

Temperature profiles of patient-applied eyelid warming therapies.

PubMed

Wang, Michael T M; Gokul, Akilesh; Craig, Jennifer P

2015-12-01

To compare temperature profile characteristics (on and off eye) of two patient-applied heat therapies for meibomian gland dysfunction (MGD): an eye mask containing disposable warming units (EyeGiene(®)) and a microwave-heated flaxseed eye bag(®) (MGDRx EyeBag(®)). In vitro evaluation: surface temperature profiles of activated eye masks and heated eye bags(®) (both n=10), were tracked every 10s until return to ambient temperature. Heat-transfer assessment: outer and inner eyelid temperature profiles throughout the eye mask and eye bag(®) treatment application period (10min) were investigated in triplicate. The devices were applied for 12 different time intervals in a randomised order, with a cool-down period in between to ensure ocular temperatures returned to baseline. Temperature measurements were taken before and immediately after each application. In vitro evaluation: on profile, the eye bag(®) surface temperature peaked earlier (0±0 s vs. 100±20 s, p<0.001), cooled more slowly and displayed less variability than the eye mask (all p<0.05). Heat-transfer assessment: the eye bag(®) effected higher peak inner eyelid temperatures (38.1±0.4°C vs. 37.4±0.2°C, p=0.04), as well as larger inner eyelid temperature increases over the first 2 min, and between 9 and 10 min (all p<0.05). The eye bag(®) surface temperature profile displayed greater uniformity and slower cooling than the eye mask, and was demonstrated to be significantly more effective in raising ocular temperatures than the eye mask, both statistically and clinically. This has implications for MGD treatment, where the melting points of meibomian secretions are likely to be higher with increasing disease severity. Copyright © 2015 Elsevier Ltd. All rights reserved.

Eyelid reconstruction using the "Hughes" tarsoconjunctival advancement flap: Long-term outcomes in 122 consecutive cases over a 13-year period.

PubMed

McKelvie, James; Ferguson, Reid; Ng, Stephen G J

2017-08-01

This article evaluates the complications and long term functional and cosmetic outcomes of tarsoconjunctival advancement flaps for repairing a range of lower eyelid defects in a large cohort of consecutive cases. A retrospective series of 122 consecutive cases of eyelid reconstruction using tarsoconjunctival-advancement flaps was conducted at Waikato Hospital, or Hamilton Eye Clinic, New Zealand. All cases of lid reconstruction using tarsoconjunctival-advancement flaps between January 1, 2001 until April 3, 2014 were included for analysis. All patients provided written consent for surgery and the study complied with New Zealand Health and Disability Ethics Committee guidelines and the Declaration of Helsinki. Data were collected on patient demographics, lesion histology, defect size, adjuvant surgical procedures required for reconstruction, surgical and postoperative complications, cosmesis and patient satisfaction. Patients requiring lower eyelid reconstruction were predominantly male (56%) and basal cell carcinoma was the most common pathology (>80%). Male gender was associated with larger tarsoconjunctival-advancement-flap width (P-value = 0.0432), larger maximum flap width (20 vs 15 mm), and required on average more adjuvant procedures for reconstruction (1.80 vs 1.48, P-value = 0.02). Mean duration to flap division was 37 days and decreased over the duration of the study. Complicated cases were associated with shorter duration to flap division. Mean follow-up was 7 months, complications were observed in 14% with revision required in 4%. Tarsoconjunctival flap reconstruction of the lower lid is suitable for a range of defect sizes and produces excellent functional and cosmetic outcomes. Complications are relatively infrequent and may be associated in some cases with decreased duration to flap division.

Satisfaction and convenience of using terpenoid-impregnated eyelid wipes and teaching method in people without blepharitis.

PubMed

Qiu, Tian Yu; Yeo, Sharon; Tong, Louis

2018-01-01

Demodex infestations cause blepharitis and are difficult to treat. Recently, a new type of eyelid wipes with terpenoids has been found effective. We aim to evaluate patient satisfaction after short-term use and compare two teaching modalities on the techniques of use. Eligible participants were taught to use eyelid wipes (Cliradex ® ) by either live or online video demonstration based on random allocation. Participants used the wipes twice daily for a week. All participants had prior evaluation of socioeconomic status, dry eye symptoms, and meibomian gland features. After 1 week, competence of use was assessed by participants showing their technique to the investigator, and a questionnaire on comfort, ease, and convenience of use was administered. Higher scores indicate greater satisfaction, and these levels are compared among the two teaching modalities using chi square. A total of 50 participants were recruited, with a mean age of 42±16 years, and 88% of the participants were females. Overall, median comfort level was 4.0 (range: 1-6), ease level was 5.0 (3-6), and convenience level was 5.0 (2-6). Median stinging was 2.0 (1-4), which corresponded to some but mild stinging. The median competence level was 4.0 (2-4), which corresponded to excellent competence. These satisfactory levels (ease, comfort, and convenience) experienced were not significantly associated with different socioeconomic indicators, that is, housing type, income, highest education level, and were not different between teaching methods ( p >0.05). Short-term use of Cliradex eyelid wipes seems to be acceptable to most people. The teaching instructions before using these wipes were equally effective - whether live or online video demonstration was used.

Satisfaction and convenience of using terpenoid-impregnated eyelid wipes and teaching method in people without blepharitis

PubMed Central

Qiu, Tian Yu; Yeo, Sharon; Tong, Louis

2018-01-01

Purpose Demodex infestations cause blepharitis and are difficult to treat. Recently, a new type of eyelid wipes with terpenoids has been found effective. We aim to evaluate patient satisfaction after short-term use and compare two teaching modalities on the techniques of use. Patients and methods Eligible participants were taught to use eyelid wipes (Cliradex®) by either live or online video demonstration based on random allocation. Participants used the wipes twice daily for a week. All participants had prior evaluation of socioeconomic status, dry eye symptoms, and meibomian gland features. After 1 week, competence of use was assessed by participants showing their technique to the investigator, and a questionnaire on comfort, ease, and convenience of use was administered. Higher scores indicate greater satisfaction, and these levels are compared among the two teaching modalities using chi square. Results A total of 50 participants were recruited, with a mean age of 42±16 years, and 88% of the participants were females. Overall, median comfort level was 4.0 (range: 1–6), ease level was 5.0 (3–6), and convenience level was 5.0 (2–6). Median stinging was 2.0 (1–4), which corresponded to some but mild stinging. The median competence level was 4.0 (2–4), which corresponded to excellent competence. These satisfactory levels (ease, comfort, and convenience) experienced were not significantly associated with different socioeconomic indicators, that is, housing type, income, highest education level, and were not different between teaching methods (p>0.05). Conclusion Short-term use of Cliradex eyelid wipes seems to be acceptable to most people. The teaching instructions before using these wipes were equally effective – whether live or online video demonstration was used. PMID:29379270

Unilateral localized conjunctival amyloidosis in a patient with a history of contralateral orbit/eyelid lymphoma.

PubMed

Byers, Joshua T; Qing, Xin; Lo, Christopher; French, Samuel W; Ji, Ping

2018-04-01

Amyloidosis is a disorder characterized by the deposition of insoluble abnormal proteins in the extracellular space. It may occur as a localized lesion or as a systemic disease involving multiple organs and systems. Localized conjunctival amyloidosis is rare and is less frequently associated with systemic involvement. Although amyloidosis itself is a benign lesion involvement of multiple organs and systems is associated with poor prognosis. Diagnosis of amyloidosis is made on biopsy specimens with Congo red staining for the appearance of apple-green birefringence under polarized light microscopy. Liquid chromatography tandem-mass spectrometry (LC-MS/MS) is much more sensitive in diagnosing amyloidosis and can determine the type of amyloid deposit. Here we reported a case of conjunctival amyloidosis in a 52 year-old male patient who was presented with left lower eyelid swelling to our medical center. He has a complicated past medical history of anti-phospholipid antibody syndrome, Buerger's disease (thromboangitis obliterans), and small cell lymphoma (SLL) of the right orbit/eyelid. The patient received radiation to the right orbit to treat SLL with therapy completed one and a half years prior to presentation. Physical examination revealed a firm, raised yellowish colored lesion in the left lower conjunctiva. The conjunctival lesion was biopsied, and tissue sections were examined with Congo red stains and LC-MS/MS analysis. The biopsy showed amyloid deposits without evidence of malignancy, and the type of proteins in the deposit was immunoglobulin light chain (AL) of kappa type. A complete work up was taken for possible systemic involvement of amyloidosis and results were all negative. To our knowledge, this is the first case of localized conjunctival amyloidosis with a history of contralateral orbit/eyelid SLL. Copyright © 2018 Elsevier Inc. All rights reserved.

Meibomian gland dropout in patients with dry eye disease in China.

PubMed

Feng, Yun; Gao, Ziqing; Feng, Kang; Qu, Hongqiang; Hong, Jing

2014-10-01

To examine the morphological changes in the meibomian glands of eyes of patients with dry eye disease using the non-contact infrared meibography system and to assess their relationship with meibomian dropout, signs, and tear-film function. Subjects included 264 randomly selected patients (528 eyes) suffering from dry eye disease (95 males, 169 females; age range, 7-85 years; mean male age, 39.83 ± 19.17 years; mean female age, 46.16 ± 17.38 years). Tear-film break-up time (BUT) was measured and tear-film production was evaluated by the Schirmer test I (SIT). Subjective symptoms were also scored. The upper and lower eyelids were turned over, and the meibomian glands were observed using the non-contact meibography system. Partial or complete loss of the meibomian glands (meibomian dropout) was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area was >2/3 of the total meibomian gland area). The average SIT result was 6.71 ± 6.13 mm (range 0-30 mm) and that for BUT was 3.13 ± 2.39 s (range 0-10 s). The average fluorescein staining score was 4.25 ± 4.05 (range 0-12). In addition, the mean meibomian gland photographic score was 4.35 ± 1.39. The correlation between the meibomian gland photographic scores and various ocular surface examinations were evaluated using Kendall's correlation. SIT and BUT were significantly negatively correlated with the meibomian gland photographic score, whereas corneal fluorescein staining was positively correlated. The results suggest a large proportion of meibomian dropout cases among patients with dry eye disease, indicating that treatment targeted at the meibomian gland will become an important direction for treating dry eye disease. Meibography is recommended as a routine test for dry eye disease.

Survival analysis for respiratory failure in patients with food-borne botulism.

PubMed

Witoonpanich, Rawiphan; Vichayanrat, Ekawat; Tantisiriwit, Kanit; Wongtanate, Manas; Sucharitchan, Niwatchai; Oranrigsupak, Petchdee; Chuesuwan, Aphinya; Nakarawat, Weeraworn; Tima, Ariya; Suwatcharangkoon, Sureerat; Ingsathit, Atiporn; Rattanasiri, Sasivimol; Wananukul, Winai

2010-03-01

Botulism is a rare presynaptic neuromuscular junction disorder caused by potent toxins produced by the anaerobic, spore-forming, Gram-positive bacterium Clostridium botulinum. Food-borne botulism is caused by the ingestion of foods contaminated with botulinum toxin. In March 2006, there was a large outbreak of food-borne botulism associated with the ingestion of home-canned bamboo shoots in Thailand. The survival analyses for respiratory failure in these patients were studied and are reported here. A prospective observational cohort study was conducted on this outbreak. The primary outcome of interest was the time to respiratory failure. The secondary outcome was the time to weaning off ventilator. The prognostic factors associated with respiratory failure and weaning off ventilator are presented. A total of 91 in-patients with baseline clinical characteristics were included. Most cases first presented with gastrointestinal symptoms followed by neurological symptoms, the most striking of which being difficulty in swallowing. Common clinical features included ptosis, ophthalmoplegia, proximal muscle weakness, pupillary abnormality, and respiratory failure. Forty-two patients developed respiratory failure requiring mechanical ventilation and the median duration on ventilator was 14 days. The median length of hospital stay for all patients was 13.5 days. Difficulty in breathing, moderate to severe ptosis, and dilated and fixed pupils were associated with respiratory failure. Among patients who were on ventilators, a short incubation period and pupillary abnormality were associated with a longer period of mechanical ventilation. All patients had antitoxin injection and there was no mortality in this outbreak. The history of difficult breathing and the findings of moderate to severe ptosis and pupillary abnormality were associated with severe illness and respiratory failure. A long incubation time was associated with a better prognosis. Although botulism is a potentially fatal disease, there was no mortality in this outbreak. All patients had antitoxin injection and good intensive care that resulted in good clinical outcomes.

[Reduction mammaplasty with a superior pedicle - a retrospective 10-year follow-up analysis of 33 patients].

PubMed

Schratt, J; Binter, A; Rab, M

2014-12-01

Long-term results after reduction mammaplasty with a superior pedicle evaluating the postoperative sensibility, degree of breast ptosis and the patients' satisfaction are rarely found in the literature. This retrospective analysis answers the question whether the resection weight has an influence on the postoperative sensibility of the nipple-areola complex after reduction mammaplasty with a superior pedicle. 33 patients were enrolled in this retrospective study. Depending on the resection weight, the patients were divided into 3 groups: Group A (<500 g), Group B (500-1,000 g), Group C (>1,000 g). The following parameters were evaluated: age, comorbidities, sensibility of the breast (Semmes-Weinstein monofilament test), jugular notch-to-nipple distance, histological results, degree of ptosis, BMI (body mass index), preoperative physical complaints (visual analogue scale 1-10), postoperative patients' satisfaction based on a questionnaire created by the authors. Furthermore, the complications, corrective revisions and pregnancies were evaluated. The median age of the patients at the moment of examination was 51 years (range: 29-71). None of the patients had any relevant comorbidities. 97% of the patients complained about preoperative physical problems (visual analogue scale 3-10). Postoperative complications arose in 21% of the patients. Corrective revisions were necessary in 18% of the cases. 97% of the patients were very satisfied or satisfied with the result. With regard to the sensibility we found a reduction of sensibility especially in the inferior and lateral part of the areola. In the group B we recorded a ptosis of degree I in 3 patients. A pseudoptosis was found in 6 patients in particular in group B. Reduction mammaplasty with a superior pedicle turns out to be a reliable method with a high satisfaction of the patients after a follow-up of 10 years. These findings were independent from the resection weight. A reduced sensibility occurred especially in the inferior and lateral part of the areola. © Georg Thieme Verlag KG Stuttgart · New York.

V-Y and rotation flap for reconstruction of the epicanthal fold.

PubMed

Shin, Yong Ho; Hwang, Pil Joong; Hwang, Kun

2012-07-01

Epicanthoplasty is commonly performed on Asian eyelids. Consequently, overcorrection may appear. The aim of this study was to introduce a method of reconstructing the epicanthal fold and to apply this method to the patients. A V flap with an extension (eagle beak shaped) was designed on the medial canthal area. The upper incision line started near the medial end of the double-fold line, and it followed its curvature inferomedially. For the lower incision, starting at the tip (medial end) of the flap, a curvilinear incision was designed first diagonally and then horizontally along the lower blepharoplasty line. The V flap was elevated as thin as possible. Then, the upper flap was deeply undermined to make it thick. The lower flap was made a little thinner than the upper flap. Then, the upper and lower flaps were approximated to form the anteromedial surface of the epicanthal fold in a fashion sufficient to cover the red caruncle. The V flap was rotated inferolaterally over the caruncle. The tip of the V flap was sutured to the medial one-third point of the lower margin. The inferior border of the V flap and the residual lower margin were approximated. Thereafter, the posterolateral surface of the epicanthal fold was made. From 1999 to 2011, 246 patients were operated on using this method. Among them, 62 patients were followed up. The mean intercanthal distance was increased from 31.7 to 33.8 mm postoperatively. Among the 246 patients operated on, reoperation was performed for 6 patients. Among the 6 patients reoperated on, 3 cases were due to epicanthus inversus, 1 case was due to insufficient reconstruction, 1 case was due to making an infold, and 1 case was due to reopening the epicanthal fold.This V-Y and rotation flap can be a useful method for reconstruction of the epicanthal fold.

Effect of face washing with soap and water and cleaning with antiseptics on upper-lid bacteria of surgical eye patients.

PubMed

Bekibele, Charles O; Kehinde, Aderemi O; Ajayi, Benedictus G K

2010-12-01

To determine the effect of face washing with soap and water and cleaning with povidone iodine and cetrimide/chlorhexidine gluconate (Savlon) on upper-lid bacteria. Prospective, nonrandomized clinical trial. Eighty patients attending the Eye Clinic, University College Hospital, Ibadan, Nigeria. Eighty patients assigned to 4 groups had swabs of the upper eyelid skin taken before and after face wash with soap and water, and cleansing with Savlon and 5% povidone iodine. Specimens were cultured and Gram stained. Bacterial counts were carried out using standard techniques. Face washing with soap and water increased the proportion of patients with bacterial isolates from 80.0% to 87.5%. The average colony count increased from 187.1 to 318.5 colony units per mL (p = 0.02). Application of 5% povidone iodine without face washing with soap and water reduced the proportion of patients with bacterial isolates from 82.6% (mean count 196.5) to 28.6% (mean count 34.1)(p = 0.001); in comparison, the application of 5% povidone iodine after face washing with soap and water reduced the proportion from 71.4% (mean count 133.9) to 40.0% (mean count 69.0)(p = 0.01). Application of Savlon without face washing with soap and water reduced the proportion of patients with bacterial isolates from 100% (mean count 310.9) to 41.2% (mean count 19.8)(p = 0.004) compared with the application after face washing, which reduced the proportion from 89.5% (mean count 240.3) to 41.2% (mean count 82.9)(p = 0.02). Both povidone and Savlon are effective in reducing periocular bacteria in an African setting. Prior face washing with soap and water had no added benefit in reducing bacterial colony count.

Minimally invasive eyelid care in dermatology: medical, laser, and cosmetic therapies.

PubMed

Fathi, Ramin; Pfeiffer, Margaret L; Tsoukas, Maria

2015-01-01

There is a high demand for facial aesthetic enhancement, and the periorbital region is one of the first areas to show signs of aging. Many nonsurgical therapies exist to tackle these problems. These therapies are becoming more efficacious while reducing postprocedural recovery time. The goal is to restore the natural youthful appearance rather than to create an effect that differs from the patient's appearance earlier in life. Eyelid care, and cosmetic dermatology in general, intends to restore balance and symmetry. We discuss the initial consultation, relevant anatomy for the dermatologist, and medical, laser and cosmetic therapies. Copyright © 2015 Elsevier Inc. All rights reserved.

Comparison of two methods for composite score generation in dry eye syndrome.

PubMed

See, Craig; Bilonick, Richard A; Feuer, William; Galor, Anat

2013-09-19

To compare two methods of composite score generation in dry eye syndrome (DES). Male patients seen in the Miami Veterans Affairs eye clinic with normal eyelid, corneal, and conjunctival anatomy were recruited to participate in the study. Patients filled out the Dry Eye Questionnaire 5 (DEQ5) and underwent measurement of tear film parameters. DES severity scores were generated by independent component analysis (ICA) and latent class analysis (LCA). A total of 247 men were included in the study. Mean age was 69 years (SD 9). Using ICA analysis, osmolarity was found to carry the largest weight, followed by eyelid vascularity and meibomian orifice plugging. Conjunctival injection and tear breakup time (TBUT) carried the lowest weights. Using LCA analysis, TBUT was found to be best at discriminating healthy from diseased eyes, followed closely by Schirmer's test. DEQ5, eyelid vascularity, and conjunctival injection were the poorest at discrimination. The adjusted correlation coefficient between the two generated composite scores was 0.63, indicating that the shared variance was less than 40%. Both ICA and LCA produced composite scores for dry eye severity, with weak to moderate agreement; however, agreement for the relative importance of single diagnostic tests was poor between the two methods.

Management of epiblepharon: state of the art.

PubMed

Woo, Kyung In; Kim, Yoon-Duck

2016-09-01

Epiblepharon is prevalent in East-Asian children. As the population in Asia is increasing, so is the demand for epiblepharon surgery. Surgeons should be familiar with the standards of beauty and needs of Asian people for epiblepharon management. This review provides a comprehensive summary of the published studies on the clinical manifestations, pathophysiology, and management of epiblepharon. Astigmatism is prevalent in epiblepharon patients, which can contribute to amblyopia. Early surgery and visual rehabilitation is important for epiblepharon patients with a high degree of astigmatism and amblyopia. Various etiologic factors play a role in the pathophysiology of epiblepharon. Surgical procedures focusing on creation of a lower eyelid crease have been popular for treating epiblepharon in Western textbooks; however, this is not appropriate for Asian patients in whom, a crease may be undesirable. In selecting surgical methods, it is important to resect a minimal amount of skin-muscle to avoid the adverse effects of ectropion and eyelid retraction. Although epiblepharon may resolve with facial growth, surgical correction is needed for cases in which there is significant corneal injury from the lash touch. Surgical management should focus on techniques that are effective, with little chance of complication, and do not create a lower eyelid crease.

Non-surgical treatment for eyelid retraction in thyroid eye disease (TED).

PubMed

Grisolia, Ana Beatriz Diniz; Couso, Ricardo Christopher; Matayoshi, Suzana; Douglas, Raymond S; Briceño, César Augusto

2017-08-09

Thyroid eye disease (TED) is an autoimmune condition with an unpredictable course that may lead to permanent facial disfigurement. Eyelid retraction is one of the most common findings, and frequently demands attention due to ocular exposure and impaired cosmesis. Surgical treatment remains the most effective option, but there is a role for temporary corrections during the active phase of the disease, as well as in patients who are poor surgical candidates. The aim of this review is to describe the non-surgical modalities currently available for treatment of eyelid malposition in TED. The authors have focused on the use of hyaluronic acid, triamcinolone injections and botulinum toxin type A as non-surgical treatment alternatives, paying special attention to dosing, technique, efficacy and duration of effect. Non-surgical treatment modalities may represent viable in cases where surgical correction is not an option. Although temporary, these modalities appear to be beneficial for ocular exposure remediation, improving quality of life and broadening our therapeutic arsenal. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Carbon dioxide (CO2) laser third eyelid excision: surgical description and report of 7 cases.

PubMed

Dees, Dustin D; Knollinger, Amy M; MacLaren, Nicole E

2015-09-01

To describe a novel technique for third eyelid (TEL) excision using a carbon dioxide (CO2) laser. Prospective. The procedure was performed on six canine patients and one feline patient. The laser was set to 6 Watts (W) of power and a linear continuous setting. Forceps were used to elevate the TEL and, with a protective shield covering the cornea, the base was cut and cauterized simultaneously. Minimal to no hemorrhage was observed, and the conjunctiva was left to heal by second intention. Seven patients underwent unilateral surgical TEL excision. All patients had suspected neoplasms affecting either the glandular tissues or conjunctival surfaces of the TEL. Clean surgical margins were achieved in all but one patient. All surgical sites were considered healed by 14 days showing mild-to-moderate conjunctival hyperemia and accumulation of mucoid discharge at the ventronasal fornix. One patient experienced postoperative keratoconjunctivitis sicca. Prolapse of orbital fat was not observed in any patient. Use of CO2 laser appears to be an efficient and effective means for surgical third eyelid removal with excellent postoperative comfort and minimal complications. © 2014 American College of Veterinary Ophthalmologists.

Group size of a permanent large group of agile mangabeys (Cercocebus agilis) at Bai Hokou, Central African Republic.

PubMed

Devreese, Lieven; Huynen, Marie-Claude; Stevens, Jeroen M G; Todd, Angelique

2013-01-01

White-eyelid mangabeys (genus Cercocebus) live in groups of highly variable size. Because of their semi-terrestrial behaviour and preference for dense forest habitats, re-liable data on group size are scarce. During a 5-month study, we collected 17 group counts on a habituated group of agile mangabeys (C. agilis) at Bai Hokou in the Central African Republic. We found a stable group size of approximately 135 individuals. This permanent large grouping pattern is known to occur among several populations of white-eyelid mangabeys and is congruent with extreme group sizes reported in mandrills at Lopé in Gabon. Copyright © 2013 S. Karger AG, Basel.

Fine mapping suggests that the goat Polled Intersex Syndrome and the human Blepharophimosis Ptosis Epicanthus Syndrome map to a 100-kb homologous region.

PubMed

Schibler, L; Cribiu, E P; Oustry-Vaiman, A; Furet, J P; Vaiman, D

2000-03-01

To clone the goat Polled Intersex Syndrome (PIS) gene(s), a chromosome walk was performed from six entry points at 1q43. This enabled 91 BACs to be recovered from a recently constructed goat BAC library. Six BAC contigs of goat chromosome 1q43 (ICC1-ICC6) were thus constructed covering altogether 4.5 Mb. A total of 37 microsatellite sequences were isolated from this 4.5-Mb region (16 in this study), of which 33 were genotyped and mapped. ICC3 (1500 kb) was shown by genetic analysis to encompass the PIS locus in a approximately 400-kb interval without recombinants detected in the resource families (293 informative meioses). A strong linkage disequilibrium was detected among unrelated animals with the two central markers of the region, suggesting a probable location for PIS in approximately 100 kb. High-resolution comparative mapping with human data shows that this DNA segment is the homolog of the human region associated with Blepharophimosis Ptosis Epicanthus inversus Syndrome (BPES) gene located in 3q23. This finding suggests that homologous gene(s) could be responsible for the pathologies observed in humans and goats.

Entropion

MedlinePlus

... Names Eyelid - entropion; Eye pain - entropion; Tearing - entropion Images Eye References Gigantelli JW. Entropion. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; ...