Brow-supported spectacle frames for nasal bridge reconstruction and other deformities.
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Equipment Design↗
Biomedical subjects
J R Collin
Publications and source records attributed to J R Collin.
Epiphora in facial paralysis.
Current management concepts of epiphora in established facial palsy are reviewed and compared with those advocated by McLaughlin and criticized by Stallard in 1949.
Facial Paralysis↗
Retractor plication for lower lid entropion in ocular cicatricial pemphigoid.
The surgical treatment of lower lid entropion in ocular cicatricial pemphigoid has previously met with limited success and conventional techniques have in some cases caused disease progression. We have treated lower lid entropion in this condition with retractor plication, avoiding surgery to the conjunctiva in five patients (seven eyelids) over the past five years with successful correction of the condition and symptomatic improvement in all patients. It has not led to an acute exacerbation of the condition in any patient and we recommend it as the procedure of choice in the surgical management of entropion in this disorder.
Aged↗
Distichiasis: management with cryotherapy to the posterior lamella.
Distichiasis is the congenital condition of partial or complete accessory rows of eyelashes which exit from the posterior lid margin at or near the meibomian gland orifices. A series of 24 patients with distichiasis is presented with clinical features and results of treatment. The treatment modes of epilation, lid margin cryotherapy, or eyelid splitting cryotherapy to the posterior lamella are evaluated. The latter was found to effectively relieve symptoms without retreatment in 87% patients. Keratinisation of the lid margin was found at long term follow up in a few cases and retinoic acid has been used successfully in the treatment of this. Two previously unreported associations of distichiasis are Pierre Robin syndrome and idiopathic eyelid oedema. A family history of distichiasis was found in 50% patients, and of distichiasis with lymphoedema in 30%.
Adolescent↗
Centurion syndrome. Idiopathic anterior displacement of the medial canthus.
PURPOSE: To describe a series of patients with epiphora due to a medial canthal anomaly. This anomaly consists of an anterior displacement of the anterior limb of the medial canthal tendon and a prominent nasal bridge, with lid malposition away from the globe and displacement of the lacrimal puncta out of the tear lake. The authors use the term Centurion syndrome to describe this anomaly. METHODS: The history, results of examination, investigations, and surgical management and outcome of 13 patients with Centurion syndrome were reviewed. Seven patients were recalled for examination to complete patient details. RESULTS: All patients had epiphora since childhood, which worsened at puberty, and all were patent to syringing. Lacrimal scintillography (ten cases) showed a functional block at the inner canthus, with hold up of activity before entry into the sac. Surgery to restore lid globe apposition medially by release of the anterior limb of the medial canthal tendon (eight patients), sometimes combined with dacryocystorhinostomy (four patients), relieved the epiphora. CONCLUSION: There is a group of patients with unexplained epiphora due to a medial canthal anomaly, which the authors have termed Centurion syndrome. It is important to recognize this anomaly, as it can be corrected surgically by medial canthal tendon release or by medial canthal tendon release combined with dacryocystorhinostomy if there is concomitant lacrimal outflow obstruction.
Adolescent↗
The use of Q-switched Nd:Yag laser for removal of permanent eyeliner tattoo.
We present the results of a pilot study of the use of Nd:Yag laser in the removal of permanent eyeliner tattoos. Fourteen eyelids were treated, and in all cases a reduction in pigmentation was achieved although responses were variable. The advantages of such therapy over existing techniques are described. The technique offers a useful reduction of permanent eyeliner pigmentation and is particularly suited to treatment of localized areas of imperfect application or pigment migration.
Cosmetics↗
Micrographically controlled excision (Mohs' surgery) of basal cell carcinoma around the eye. Combined dermatological surgical clearance and oculoplastic surgical repair.
Periorbital infiltrative basal cell carcinomas are notoriously difficult to treat, particularly those around the medial canthus. Micrographically controlled excision with horizontal frozen sections (Mohs' surgery) allows for clearance of the tumour with minimal loss of normal tissue. Once the tumour has been completely removed, the defect can be repaired by the oculoplastic surgeon for the best functional and cosmetic result. This is the ideal treatment for tumours with a contiguous growth pattern that are liable to be seriously over or under treated by other modalities. The technique requires special training for both the operator and the Medical Laboratory Scientific Officer (MLSO). It is costly in time and manpower but in selected cases, where recurrent tumour is most dangerous and where tissue conservation is paramount, it may be invaluable. Close collaboration between dermatological and oculoplastic surgeons in such cases probably offers the patient the best treatment and outcome.
Basal Cell Carcinoma↗
Eyelid surgery in facial palsy.
Paralysis of the orbicularis oculi muscle is by far the most serious consequences of loss of function of the facial nerve. The severity of the resultant ocular problems is related to the degree and duration of this paralysis. The primary goal of the ophthalmologist in managing the patient with orbicularis oculi paralysis is to protect the cornea. The alleviation of epiphora, correction of paralytic ectropion, and amelioration of the resultant cosmetic deformities are secondary goals. The major factor in determining the most appropriate therapeutic approach in the management of the patient with a facial paralysis is whether the paralysis is temporary or permanent. In temporary paralysis, conservative methods of treatment are usually adequate and are well documented. In permanent orbicularis paralysis, the development of lid abnormalities is inevitable, and corrective lid procedures are required. The procedures required depend on the resultant dysfunction and degree of deformity. This study reviews 65 patients who underwent surgical treatment for the ophthalmic consequences of established and permanent facial palsy in order to evaluate the efficacy of their treatment.
Adult↗
Blepharochalasis. A review of 30 cases.
This paper presents the findings in a series of 30 patients with blepharochalasis, including the age of onset, sex, predisposing factors, symptoms and signs, frequency and duration of attacks, and length of the history. There were 16 bilateral and 14 unilateral cases. The condition can be divided into an active (early) and a quiescent (late) stage. The active stage is further subdivided into intumescent (hypertrophic) and atrophic forms. The sequelae included excess thin skin, fat herniation, lacrimal gland prolapse, ptosis, blepharophimosis, pseudoepicanthic fold, proptosis, conjunctival injection and cysts, entropion, and ectorpion. Surgery primarily involved blepharoplasty, ptosis correction, and lateral canthal reattachment alone or in combination. The pathology showed a variable picture of epithelial atrophy, vasculitis, and loss of elastic fibers, which did not greatly help to differentiate blepharochalasis from angioedema, lymphedema, dermatochalasis, tumors and infiltrations, and floppy lid syndromes. Blepharochalasis is probably a localized angioedema. The diagnosis depends on the clinical features of intermittent attacks of localized swelling affecting one or more eyelids associated with thinning of the skin giving either an intumescent (hypertrophic) or atrophic appearance in the active stage of the condition and progressing to atrophic changes in the quiescent (late) stage.
Adolescent↗
Paper-clip technique for upper eyelid skin crease assessment.
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Anthropometry↗
Visual development in the blepharophimosis syndrome.
One hundred and one cases of the blepharophimosis syndrome presenting over a decade are reviewed with particular attention to the factors influencing their visual development. Three distinct clinical patterns emerge--severe bilateral ptosis, moderate bilateral ptosis, and asymmetric ptosis--and their differing incidence of amblyopia and strabismus is discussed. The risk of amblyopia is much higher than previously believed (56.4% in our series) and preventive management is discussed.
Amblyopia↗
Medical canthal resection: an effective long-term cure for medial ectropion.
The results of 37 medial canthal resection procedures performed for the correction of severe paralytic or involutional medial ectropion are presented with an average follow-up of 5.4 years. Epiphora was improved in 33 out of the 37 cases and all but one patient had an anatomically improved lid-globe apposition, medial canthal angle, and posterofixation of the medial canthus. These results confirmed the long-term value of the operation.
Aged↗
Capillary haemangiomas: an approach to their management.
Twenty-five children with eyelid haemangiomas were reviewed. Fifteen patients with enlarging lesions thought to be at risk of causing amblyopia were treated with intralesional steroids as soon after presentation as possible. This appeared to reduce significantly the incidence of amblyopia. Surgery was reserved for older children in whom no further involution of the lesion was expected.
Amblyopia↗
Surgical management of essential blepharospasm.
We have reviewed the surgical management of essential blepharospasm over the last 15 years, comparing the results from facial nerve avulsion with those from orbicularis muscle stripping. After facial nerve avulsion 50% of patients remained free of troublesome spasm for 15 months after surgery, but only 25% remained so for more than two years. Following orbicularis oculi myectomy 50% of patients were free of troublesome spasms for 30 months after surgery and 55% of patients had relief from spasm for more than two years. Secondary effects of the two procedures are compared and are found to be fewer after orbicularis myectomy. There were no major complications after either form of surgery. Botulinum toxin is the treatment of first choice for this condition. If this becomes ineffective or inconvenient, surgical treatment is warranted and should not be deferred for fear of severe side effects of treatment, since these are rare. Protractor myectomy gives longer relief from blepharospasm than facial nerve avulsion and has fewer complications. However, it is technically difficult, time consuming, and has greater peroperative morbidity. Facial nerve avulsion may therefore still have a role in selected patients.
Adult↗
Micrographic (MOHS') surgery in the management of periocular basal cell epitheliomas.
The use of fresh tissue micrographic surgery offers distinct advantages over other currently available forms of treatment in the management of primary and recurrent periocular basal cell epitheliomas. The technique is described and the results of a prospective study of 22 patients are presented. The advantages in terms of both surgery of tumour excision and tissue preservation are discussed. We conclude that micrographic surgery has a definite role to play in the management of certain periocular basal cell epitheliomas.
Adult↗
The Mersilene mesh ptosis sling.
A variety of materials are currently available for use in brow suspension ptosis surgery when an alternative to autogenous fascia lata is indicated. We describe the use of a Mersilene mesh sling, developed to overcome the problems of failure and extrusion commonly associated with substitute suspensory materials. The results and follow up in 23 cases of blepharoptosis are presented. Our findings suggest that the Mersilene mesh sling has a definite place in ptosis management; we currently use this sling for all cases in which autogenous fascia lata is considered inappropriate.
Adolescent↗
Congenital eyelid retraction.
Twenty two patients with primary congenital lid retraction affecting either the upper or lower eyelids or both are presented. The clinical features and management are discussed in the hope that recognition of this clinical entity will prevent unnecessary investigation.
Adolescent↗
Ophthalmic management of seventh nerve palsy.
The management of acute and established seventh nerve palsy is discussed with reference to corneal exposure, paralytic ectropion and the cosmetic defect. Details are given of how these can all be improved with relatively simple procedures which can be performed under local anaesthesia as an outpatient.
Corneal Diseases↗