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At least 235 records · Page 13Linked to original sources
PubMed2001

Autogenous hard palate mucosa: the ideal lower eyelid spacer?

BACKGROUND/AIMS: Raising a displaced lower eyelid frequently involves recession of the lower eyelid retractors with interposition of a "spacer," and several materials for this purpose have been described. This study reviewed the results of autogenous palatal mucosa in the treatment of lower eyelid displacement, including assessment of any donor site morbidity. METHODS: A retrospective case note review of consecutive patients treated at Moorfields Eye Hospital between 1993 and 1998. All patients underwent insertion of hard palate mucosa between the inferior border of the tarsus and the recessed conjunctiva and lower eyelid retractors. Parameters studied included the underlying diagnosis, measurements of lower lid displacement or retraction, related previous surgery, the experience of the operating surgeon, intraoperative and postoperative complications, surgical outcome, and length of follow up. The main outcome measure was the position of the lower eyelid relative to the globe in primary position of gaze. RESULTS: 102 lower eyelids of 68 patients were included and a satisfactory lid position was achieved in 87/102 (85%), with inadequate lengthening or significant recurrence of displacement occurring in 15 cases. Donor site haemorrhage requiring treatment in the early postoperative period occurred in seven patients (10%). CONCLUSION: Autogenous hard palate mucosa is an effective eyelid spacer and provides good long term support for the lower eyelid. Donor site complications are the main disadvantage, but may be minimised by attention to meticulous surgical technique and appropriate postoperative management.

Adult↗
PubMed2005

[Combination of multiple procedures to repair of severe lower eyelid ectropion].

OBJECTIVE: Lower eyelid ectropion is one of the most severe complications following lower eyelid blepharoplasty. Combination of multiple procedures was used to repair this deformity and the results were observed. METHODS: Severe lower eyelid ectropion following blepharoplasty was repaired with the combination method of multiple procedures, including transferring the island forehead flap, buried guiding suture of the lower eyelid skin to orbital periosteum and horizontal lid-shortening. 10 patients (15 eyelids) with lower eyelid ectropion after blepharoplasty were treated with the above method from Mar 2001 to Mar 2004. RESULTS: The lower eyelid ectropion was repaired effectively. All the patients were satisfied with the results. CONCLUSIONS: The combination method of multiple procedures was an effective method for severe lower eyelid ectropion.

Adult↗
PubMed1983

Tarsal-conjunctival advancement flaps for upper eyelid reconstruction.

For subtotal or total upper eyelid reconstruction, a technique combining tarsal-conjunctival advancement flaps from the upper and lower eyelids was used. A tarsal-conjunctival flap was begun just inside the lower lid margin, and was brought into the upper eyelid so that the tarsus formed the new upper eyelid margin. The remaining tarsus and conjunctiva from the upper eyelid were brought forward to join the lower lid flap. On this conjoined tarsal-conjunctival flap, a full-thickness skin graft was placed. Four weeks later, the conjunctival flap from the lower eyelid was separated. The main advantage of this technique is that it provides stability and support for the new upper eyelid margin while keeping the skin and hair from turning in against the globe.

Aged↗
PubMed2004

Eyelid position measurement in Graves' ophthalmopathy: reliability of a photographic technique and comparison with a clinical technique.

PURPOSE: To evaluate intraobserver reliability and interobserver reliability of a computer-based digital image measurement of eyelid position in Graves' ophthalmopathy and to compare digital image measurement with clinical measurement. DESIGN: Cross-sectional study. PARTICIPANTS: Eighty-four eyes of 42 patients with mild to moderate bilateral Graves' ophthalmopathy. METHODS: Digital images were created from 35-mm color slides of both eyes of participants and projected onto a 15-inch flat-screen computer monitor. Three observers (2 oculoplastic surgeons and 1 ophthalmology resident) independently recorded eyelid fissure height, margin-reflex distance, and inferior scleral show for each eye. MAIN OUTCOME MEASURES: Intraobserver reliability and interobserver reliability of eyelid parameter measurements, as described by the intraclass correlation coefficient (ICC) and Bland-Altman plots. Agreement between digital image measurements of the investigators and clinical measurements taken on the same day as the photographs also was assessed. RESULTS: Excellent intraobserver agreement was found for the measurement of all eyelid parameters for all 3 investigators (ICC range, 0.93-0.99). Interobserver agreement for all eyelid parameters was also excellent for all investigators (ICC, 0.86-0.97). Agreement between the photographic and clinical measurements for eyelid parameters was fair to moderate (ICC range, 0.38-0.62). CONCLUSION: Measurement of several eyelid parameters in Graves' ophthalmopathy patients from computer-based digital images is reliable. Associations between photographic and clinical measurements for all parameters are weaker. Relative to clinical measurements, the photographic technique offers the advantages of potential for masking and ease of transmission that might be useful in clinical trials.

Cross-Sectional Studies↗
PubMed2005

The Pathogenesis of floppy eyelid syndrome: involvement of matrix metalloproteinases in elastic fiber degradation.

OBJECTIVE: To investigate histopathologic alterations of eyelid biopsy specimens from patients with floppy eyelid syndrome (FES) with special regard to elastic fiber content and ultrastructure as well as to the expression of elastin-degrading enzymes to elucidate the pathogenesis of this disorder. DESIGN: Retrospective, interventional case series. PARTICIPANTS AND CONTROLS: Eleven consecutive patients with FES and 10 age-matched control patients with basal cell carcinoma of the eyelid. METHODS: Horizontal pentagonal eyelid resections of 16 upper lids were performed in 11 patients with FES. Full-thickness eyelid biopsy specimens from study and control patients were examined by light and transmission electron microscopy, semiquantitative morphometry, and immunohistochemistry using antibodies against matrix metalloproteinase (MMP)-2, MMP-7, MMP-9, and MMP-12 and neutrophil elastase. RESULTS: All patients treated with surgical horizontal eyelid shortening were asymptomatic at follow-up. Histopathologic analysis of the surgical specimens showed, apart from unspecific signs of chronic inflammation, a significant decrease in the amount of elastin within the tarsal plate and eyelid skin as compared with controls. Residual elastic fibers revealed an abnormal ultrastructure with a diminished elastin core. Immunohistochemistry demonstrated an increased immunoreactivity for elastolytic proteases, particularly MMP-7 and MMP-9, in areas of elastin depletion in FES specimens as compared with controls. CONCLUSIONS: The findings indicate that upregulation of elastolytic enzymes, most probably induced by repeated mechanical stress, participates in elastic fiber degradation and subsequent tarsal laxity and eyelash ptosis in FES.

Aged↗
PubMed1993

Composite grafting for eyelid reconstruction.

Viable composite grafting is a technique used in eyelid reconstruction in which the graft is obtained from the contralateral eyelid. We reviewed the charts of 51 patients who underwent composite grafting of the eyelid since 1983. The average horizontal length of the defect repaired with this technique was 17.3 mm, and the most common indication for its use was basal cell carcinoma. Postoperatively, 39 (91%) of the 43 patients with available measurements had within 2.0 mm of palpebral fissure symmetry. Furthermore, this method of reconstruction allows survival of the eyelid margin and eyelid margin cilia. Composite grafting of the eyelid is a valuable method for eyelid reconstruction that provides acceptable cosmetic results.

Adolescent↗
PubMed1995

Electromyographic studies of the reconstructed lower eyelid after a modified Hughes procedure.

PURPOSE: We evaluated quantitatively, with electromyography, the function of orbicularis oculi muscle flaps in modified Hughes reconstructions of the lower eyelids. METHODS: A modified Hughes procedure with a bipedicle orbicularis oculi flap was used to reconstruct large left lower eyelid defects after tumor excision in six consecutive patients. Standard needle electromyography and facial nerve conduction studies were performed on each reconstructed lower eyelid, and results were compared with those of the unoperated-on right lower eyelid. Electromyographic studies were performed between 143 and 517 days after division of the tarsoconjunctival flap. RESULTS: Blink reflexes and results of facial nerve studies were normal and similar on both sides. All operated-on eyelids demonstrated electromyographic activity during voluntary orbicularis contraction. The functional and cosmetic results were satisfactory in all patients. No complications of reconstruction, such as eyelid retraction, ectropion, tissue necrosis, or abnormal contour or thickness, occurred. CONCLUSIONS: A modified Hughes procedure using a bipedicle orbicularis oculi flap provides viable, electrically active muscle to the reconstructed lower eyelid and may enhance the functional results.

Blinking↗
PubMed1987

Lumbosacral chordoma metastatic to the eyelid.

The authors report a patient treated with radiation therapy for a lumbosacral chordoma. The first and only evidence of metastatic disease was an eyelid cyst. This case is unusual for several reasons. First, eyelid metastases are rare; they are much more uncommon than metastases to the uvea or orbit. Second, metastatic tumors to the eyelid are usually manifestations of widespread disease and seldom occur as a solitary focus of dissemination. Third, the clinical presentation of our patient's lesion as an eyelid cyst is uncommon for a metastasis to the eyelid. Finally, to the best of our knowledge, all previously reported tumors metastatic to the eyelid have been carcinomas; this is the first report of a metastatic soft-tissue tumor to the eyelid.

Aged↗
PubMed1997

Accuracy of clinical diagnosis of cutaneous eyelid lesions.

PURPOSE: Previous studies of cutaneous eyelid lesions have been retrospective using multiple contributing surgeons. The purpose of this study was to determine prospectively the accuracy of the clinical diagnosis of benign, premalignant, and malignant cutaneous eyelid lesions and to determine if all clinical diagnoses require histopathologic confirmation, or if an experienced clinician can reliably distinguish benign from malignant lesions on the basis of history and clinical examination alone. METHODS: This prospective study was conducted between January 1988 and January 1995. All patients presenting during this time with periocular cutaneous eyelid lesions were evaluated and a specific clinical diagnosis made in each case before biopsy and histopathologic evaluation. The lesions were categorized prospectively as benign, premalignant, or malignant, and histopathologic evaluation then correlated to determine the accuracy of the clinical diagnosis. Only patients who presented without previous biopsy were eligible for inclusion in the study. RESULTS: A biopsy was done on a total of 864 eyelid lesions during the 85 month study period. One hundred fifty-three lesions clinically were thought to represent malignancies. Of these, 140 (91.5%) were found to have malignant histopathologies. Nineteen lesions clinically were thought to represent premalignant processes. Histopathologic evaluation of these 19 lesions showed 16 to be actually premalignant, 1 to be a malignancy, and 2 to be benign. Six hundred ninety-two lesions clinically were thought to be benign. Of these, 13 (1.9%) proved on histopathologic evaluation to be malignant. These included 10 basal cell carcinomas, 1 squamous cell carcinoma, 1 non-Hodgkin lymphoma, and 1 adenoid cystic carcinoma. Three (0.4%) of the 692 clinically benign lesions were found to be premalignant. The 13 missed malignancies were distributed among a number of different clinical diagnoses, including papilloma, epidermal inclusion cyst, melanocytic nevus, hydrocystoma, and trichoepithelioma. Of the 153 clinically malignant lesions, 6 lesions that clinically were highly suspicious for malignancy had initial benign histopathologic diagnoses. Rebiopsy results in all of these six subsequently confirmed the suspected malignant diagnosis. CONCLUSIONS: Malignant eyelid lesions may masquerade as a number of different clinically benign conditions. The authors conclude that all excised eyelid lesions should be submitted for histopathologic confirmation because it is not possible to obtain 100% accuracy in diagnosing eyelid lesions on clinical grounds alone. However, strong clinical suspicion of a malignancy is highly significant, and if initial histopathologic evaluation does not agree with the malignant clinical diagnosis, repeat biopsy should be performed.

Adult↗
PubMed1995

Evaluation of the Hall-effect sensor for determination of eyelid closure in vivo.

A small device to detect eyelid closure was designed on the basis of a Hall-effect sensor. Accurate sensing of normal eyelid closure is required to develop a prosthetic eyelid closure device for patients with paralyzed orbicularis oculi muscles. In this study, six rabbits had the sensors surgically implanted. A Hall-effect sensor, a small device that measures magnetic fields, was implanted in the inferior eyelid near the ciliary margin. An opposing magnet was implanted in the upper eyelid. Thus, as the eyelid closes, the output of the Hall-effect sensor will increase. This output voltage was monitored weekly. During the first 5 weeks the output of the Hall-effect sensor decreased slightly but then reached a steady state for the duration of the experiment. This study suggests that the Hall-effect sensor could be used to detect normal eyelid closure in an implantable facial reanimation device.

Animals↗
PubMed1999

Advances in the management of lower eyelid retraction.

The purpose of this article is to describe the newer surgical techniques and materials available for repair of lower eyelid retraction. The anatomic basis, classification, and prevention of lower eyelid retraction are explored, as well as traditional methods of surgical management. Two case reports involving the successful use of acellular human dermis (AHD) for lower eyelid retraction are presented. Lower eyelid retraction is associated with a variety of etiologies, which mandate that the surgical repair be directed toward correction of the anatomic abnormality in each patient. Each surgical procedure and material used in the repair of eyelid retraction is associated with unique advantages and disadvantages. AHD has found multiple uses in oculoplastics, including reconstruction of the middle and posterior lamellae in eyelid retraction. An understanding of the mechanistic basis of lower eyelid retraction and familiarity with newer techniques and materials enable the oculoplastic surgeon to modify and individualize the operative repair, resulting in better surgical outcomes.

Blepharoplasty↗
PubMed2002

Medial tarsal suspension: a method of elevating the medial lower eyelid.

PURPOSE: When attempting to elevate the lower eyelid for any reason, medial elevation is the most difficult to attain. Medial canthal tendon tightening creates mostly horizontal tension and contributes little vertical vector. We present a technique for applying a lifting force to the medial end of the eyelid: medial tarsal suspension. METHODS: The technique to suspend the medial lower eyelid tarsal plate to the superior orbital rim periosteum is described. The procedure, medial tarsal suspension (MTS), was performed on 38 lower lids of 24 patients. Adjunctive procedures, most commonly lateral canthal sling, were performed on 66% of the lids at the time of the initial medial tarsal suspension. The patients ranged in age from 29 years to 84 years. All had medial lower eyelid retraction, with facial nerve palsy, Graves eye disease, involutional lower eyelid retraction, and forms of muscular dystrophy the commonest etiologies. RESULTS: Thirty-one (82%) of the 38 MTS procedures were successful. There was no unifying factor among the seven failed procedures in five lids of five patients. Three of the five patients, including two who were operated on twice, ultimately had a successful MTS. This procedure was not repeated on the other two failed patients. Range of follow-up was 9 months to 5.6 years, with a mean of 3.7 years. The mean elevation of the central lower eyelid was 1.6 mm in the successful cases. CONCLUSIONS: Medial tarsal suspension is an effective way to elevate the medial end of the lower eyelid.

Adult↗
PubMed1995

Diseases of the eyelid-conjunctival complex and corneal complications of lid disease.

The vascular anatomy of the eyelids has been studied in more detail with regard to possible applications in eyelid surgery. The recognition of different subtypes of eyelid laxity, eg, floppy eyelid, lax eyelid, and eyelid imbrication syndromes, as underlying causes of conjunctival and corneal irritation will contribute to their successful management. Involvement of eyelid, conjunctiva, or cornea has been reported in association with systemic diseases such as Wegener's granulomatosis, xeroderma pigmentosum, scleromyxedema, sarcoidosis, and abnormalities of mitochondrial DNA. The ocular manifestations may be the presenting feature of the underlying disease. Results in two series of patients with ocular surface diseases such as chemical and thermal eye burns suggest that the use of autologous nasal mucosa transplantation is promising for the management of this disorder. Clinical features and results of cryotherapy are reviewed in two series of patients with congenital distichiasis and trichiasis due to ocular cicatricial pemphigoid.

Conjunctiva↗
PubMed1998

Eyelid disorders: diagnosis and management.

Eyelid problems range from benign, self-resolving processes to malignant, possibly metastatic, tumors. Inflammation, infection, benign and malignant tumors, and structural problems such as ectropion, entropion and blepharoptosis may occur. Fortunately, most eyelid disorders are not vision-threatening or life-threatening; however, many cause irritative symptoms such as burning, foreign-body sensation or pain. Blepharitis, or eyelid inflammation, one of the most common problems, is characterized by erythematous eyelids with accumulation of debris along the eyelid margin. Malignant eyelid tumors may be associated with lash loss and erosion of normal eyelid structures. Recognition and diagnosis of these problems are crucial to their proper management. Warm compresses and antibiotics suffice for many conditions, while excision, cryotherapy or laser treatment are required for some.

Eyelid Diseases↗
PubMedDate not supplied

Effects of endoscopic forehead/midface-lift on lower eyelid tension.

OBJECTIVE: To evaluate and quantify the increase in lower eyelid tension (stress) after endoscopic forehead/midface-lift in a cohort of patients with normal lower eyelid function preoperatively. METHODS: A prospective nonrandomized study was conducted at a private facial plastic surgery practice and ambulatory surgical center on 22 patients who underwent subperiosteal endoscopic forehead/midface-lift from October 2000 to June 2002. Patients were evaluated preoperatively, 4 to 6 months postoperatively, and approximately 12 months postoperatively. RESULTS: Compared with preoperative lower eyelid tension, there was a 4- to 5-fold increase in lower eyelid tension at 3 and 5 mm of distraction immediately after the operation. Four to 6 months after the operation, lower eyelid tension decreased but was still 2 to 3 times that of preoperative values. Twelve-month measurements for the 15 patients who remained in the study (the other 7 patients were lost to follow-up or refused to have measurements taken) showed that lower eyelid tension was 1.7 to 1.9 times preoperative values. CONCLUSIONS: Our results show that lower eyelid tension increases following endoscopic forehead/midface-lift and that this increased tension is long lasting and quantifiable 12 months after surgery.

Adult↗
PubMed1990

The tight retracted lower eyelid.

Grave's ophthalmopathy, anophthalmia, trauma, surgery, burns, and skin disorders can result in lower eyelid retraction. The retracted lower eyelid is tight in contrast to the lax lower eyelid of the common involutional ectropion. Cicatrization of the skin and muscle produces the prototype cicatricial ectropion. Downward traction on all layers of the lid rather than cicatrization causes lower eyelid retraction. Sixty-one retracted lower eyelids were surgically repaired without a skin graft in 40 patients. In the new technique, the retracted lower lid is repaired by releasing the lower eyelid retractors from their tarsal attachment. A lateral canthoplasty and lower lid prezygomatic flap anchored to the orbital periosteum support the released lower eyelid.

Adolescent↗
PubMed2001

Fibroblast growth factor receptor 2 (Fgfr2) plays an important role in eyelid and skin formation and patterning.

Initiating as protruding ridges above and below the optic vesicle, the eyelids of mice grow across the eye and temporarily fuse in fetal life. Mutations of a number of genes disrupt this developmental process and result in a birth defect, "open-eyelids at birth." Here we show that a critical event for eyelid induction occurs at embryonic day 11.5 (E11.5) when the single cell-layered ectoderm in the presumptive eyelid territory increases proliferation and undergoes morphologic transition to form cube-shaped epithelial cells. Using embryos lacking the Fgfr2 Ig domain III (Fgfr2(DeltaIII/DeltaIII)) generated by tetraploid rescue and chimeric embryo formation approaches, we demonstrate that this event is controlled by Fgfr2 signals as the Fgfr2(DeltaIII/DeltaIII) mutation blocks these changes and results in embryos without eyelids. Fgfr2 and its ligands are differentially expressed in the ectoderm and underlying mesenchyme and function in a reciprocal interacting loop that specifies eyelid development. We also demonstrate that similar defects account for failure of skin formation at early stages. Interestingly, Fgfr2-independent skin formation occurs at E14.5 mutant embryos, resulting in much thinner, yet well-differentiated epidermis. Notably, mutant skin remains thin with decreased hair density after transplantation to wild-type recipients. These data demonstrate an essential role of Fgfr2 in eyelid and skin formation and patterning.

Animals↗
PubMed2006

Monopolar radiofrequency treatment of human eyelids: a prospective, multicenter, efficacy trial.

BACKGROUND/OBJECTIVE: To evaluate the efficacy of a novel 0.25 cm(2) monopolar radiofrequency (RF) treatment tip for aesthetic rejuvenation of the eyelids. STUDY DESIGN/MATERIALS AND METHODS: This was a prospective, multicenter trial in which the eyelids of 72 patients were treated. Patients underwent a single treatment session and were then followed on a serial basis for 6 months. Cutaneous anesthesia was not required to perform the treatments. Assessments were made by the treating physician, the subjects, and by masked physician observers evaluating photographs taken at each data point. RESULTS: Upper eyelid tightening and reduction of hooding was noted in 88 and 86% of subjects, respectively. Lower eyelid tightening was noted in 71-74% of subjects. The majority of patients treated achieved at least up to 25% improvement while a smaller percentage achieved more dramatic results. There was no correlation between the amount of energy applied to the eyelids and the clinical outcome. There were no serious adverse sequelae. CONCLUSION: Human eyelids can be safely treated with monopolar RF energy delivered via a novel 0.25 cm(2) treatment tip. Using this technology non-invasive eyelid rejuvenation was achieved in the majority of subjects treated. The factors differentiating those patients who achieve the most impressive changes from others remain unclear. Further development and testing of this technology is warranted.

Adult↗