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Anterior tarsectomy reoperation for upper eyelid blepharoptosis or contour abnormalities.

In five cases, a simplified anterior tarsal resection corrected complicated upper eyelid blepharoptosis and contour abnormalities. One case of residual blepharoptosis after levator muscle resection was corrected by resecting an amount of tarsus equal to the desired amount of correction. Two cases of upper eyelid blepharoptosis resulting from overcorrected levator muscle recession were corrected in the same manner. In one case of residual segmental blepharoptosis of the upper eyelid causing a contour abnormality, we resected a segment of tarsus corresponding to the amount of blepharoptosis in the affected segment of the eyelid. In one patient who developed a contour abnormality after a Fasanella procedure with segmental blepharoptosis nasally and overcorrection temporally, a segment of tarsus resected nasally and inserted temporally created an even contour. Anterior tarsal resection is a simple method of revising the upper eyelid level of contour in situations where the upper eyelid anatomy has been distorted by previous surgery.

Adult↗

Ectropion of the lower eyelid secondary to Müller's muscle-capsulopalpebral fascia detachment.

A patient developed severe lower eyelid ectropion after a bilateral levator aponeurosis and Müller's muscle advancement-and-truck blepharoptosis procedure and bilateral attachment of the lateral canthi to the lateral canthal tendons. The cause of this ectropion was detachment of Müller's muscle and capsulopalpebral fascia from the inferior tarsus and recession of these tissues into the orbit. This left the inferior tarsal border with only redundant conjunctiva attached to it, which could not maintain it in a downward direction; thus, an ectropion occurred. Müller's muscle and capsulopalpebral fascia were detached from the inferior tarsus and recessed 15 mm into the orbit. Reattaching Müller's muscle and capsulopalpebral fascia to the inferior tarsus relieved the ectropion.

Aged↗

Tarsal-conjunctival disease associated with Wegener's granulomatosis.

OBJECTIVE: To describe the clinical characteristics of tarsal-conjunctival disease in a cohort of patients with Wegener's granulomatosis (WG). DESIGN: Retrospective, case-controlled study. PARTICIPANTS: The medical records of 82 consecutive WG patients who underwent an eye examination between January 1996 and June 2002 at the National Institutes of Health were reviewed. METHODS: Details of the ophthalmic examination, results of medical therapy, and histopathologic analysis results were recorded. Tarsal-conjunctival disease was defined by (1). conjunctival hyperemia and granuloma formation, areas of necrosis, or active fibrovascular changes in the tarsus or conjunctiva, or (2). evidence of inactive fibrovascular scar. The association of tarsal-conjunctival disease with major organ system involvement was assessed using Bayesian methods. MAIN OUTCOME MEASURES: The occurrence and clinical characteristics of tarsal-conjunctival disease in a cohort of patients with WG and associations with major organ system involvement. RESULTS: Tarsal-conjunctival disease occurred in 13 of 82 patients (16%) with WG examined over a 6.5-year period. The palpebral surface of the upper lid was involved most commonly, showing conjunctival hyperemia in seven patients, granulomatous lesions in three patients, tarsal-conjunctival necrosis in four patients, active fibrovascular proliferation in six patients, and inactive fibrous scar tissue in seven patients. Histopathologic analysis of eyelid biopsy specimens showed granulomatous inflammation, focal necrosis, and areas of occlusive vasculitis in the tarsus and conjunctiva. In reviewing the patterns of organ involvement in patients with and without tarsal-conjunctival disease, the association of subglottic stenosis and nasolacrimal duct obstruction with tarsal-conjunctival disease showed a high probability of clinical significance. CONCLUSIONS: Tarsal-conjunctival disease, a previously uncommon finding in patients with WG, was characterized by inflammation of the palpebral conjunctiva and tarsus followed by a fibrovascular proliferation and scar formation. Because of the important association of tarsal-conjunctival disease with subglottic stenosis, which can progress and lead to laryngeal obstruction and respiratory failure, patients with tarsal-conjunctival disease should be referred to an otolaryngologist for evaluation.

Adult↗

Histopathologic features of the floppy eyelid syndrome. Involvement of tarsal elastin.

PURPOSE: Patients with the floppy eyelid syndrome have chronic papillary conjunctivitis with easily everted upper eyelids and a soft, pliant upper tarsus. The purpose of this study is to describe the clinical features and the histopathologic correlate in a group of patients with floppy eyelid syndrome. METHODS: The authors examined eight patients with floppy eyelid syndrome, four of whom underwent surgical management with horizontal eyelid shortening. Eyelid tissue from these patients was examined using light microscopy, electron microscopy, and immunohistochemistry and compared with controls with unrelated eyelid or orbital disorders. RESULTS: Clinical findings included obesity or eye rubbing, lash ptosis, and, less commonly, blepharoptosis. Two patients had documented sleep apnea with abnormal sleep electroencephalogram. Light microscopy of the surgical specimens showed chronic conjunctival inflammation, papillary conjunctivitis, and meibomian gland abnormalities, including granuloma formation. Verhoeff's modified elastin stain demonstrated a marked decrease in the amount of elastin fibers in tarsus from patients with floppy eyelid syndrome compared with controls. Immunohistochemical staining for elastin also showed a marked decrease of tarsal elastin in floppy eyelid patients compared with controls. In contrast, immunohistochemical stains showed that the distribution of collagen types I and III was similar between patients with floppy eyelid syndrome and controls. Electron microscopy demonstrated that tarsal collagen was comparable in patients and controls, and that there was a reduced amount of tarsal elastin in floppy eyelid syndrome compared with controls. CONCLUSIONS: These findings demonstrate that tarsal elastin is decreased in the floppy eyelid syndrome, which may contribute to the laxity of the tarsus in this disorder.

Adult↗

Morphological observations on Brevipalpus phoenicis (Acari: Tenuipalpidae) including comparisons with B. californicus and B. obovatus.

The genus Brevipalpus has over 300 species worldwide. The three most important agricultural pest species in the genus, Brevipalpus californicus (Banks), B. obovatus Donnadieu, and B. phoenicis (Geijskes), have been consistently confused and misidentified for more than 50 years. The present study provides a discussion of the characters and character states used to separate these mites. Low-temperature scanning electron microscopy and traditional light microscopy techniques were used to illustrate the subtle morphological differences between these three species. Morphology of the dorsal propodosoma, opisthosoma, and leg chaetotaxy of all three species was examined and compared. The number of dorsal setae, the number of solenidia (omega) on tarsus II, and dorsal cuticular patterns were the most important characters in the identification of Brevipalpus species. B. phoenicis is similar to B. californicus in having two omega on tarsus leg II and different from B. obovatus which has only one omega on tarsus leg II and similar to B. obovatus in having only one pair of F setae (f3), but differing from B. californicus which has two pairs of F setae (f2-3). The dorsal opisthosomal and propodisomal cuticular patterns frequently used to distinguish between these three species are useful but one must be aware that age, feeding, and mounting techniques can affect the appearance of these characters.

Animals↗

[Ultrasound of the upper eyelid to evaluate tarsal curvature in facial palsy].

BACKGROUND: Treatment of paralytic lagophthalmos involves surgical repair, requiring exact knowledge of eyelid anatomy. While there are extensive studies on anatomical eyelid measurements in healthy eyes, no data exist on the changes in the functional anatomy of the upper eyelid in paralytic lagophthalmos. The aim of this study, was to examine by ultrasound the upper lid tarsus during changes in the patient's line of vision, and to answer the question of whether there are changes in the curvature radius of the tarsus, caused by facial paralysis with resultant lagophthalmos. MATERIAL AND METHODS: Two groups were formed. The first group consisted of 50 subjects with healthy eyes, and the second contained 47 patients with paralytic lagophthalmos. The upper lid tarsal radius, when looking straight ahead and in the abducted position, was determined by ultrasound with a 7.5 MHz scanner in the non-contact mode, and then compared statistically. RESULTS: Both groups showed a highly significant difference in the tarsus curvature, when looking straight ahead and in the abduction position. While there was no significant difference between both groups in the abduction position, they differed significantly when looking straight ahead. Also, a significant difference was noted, between the eyes of healthy subjects and the healthy eye in patients with facial palsy. CONCLUSION: The changes in curvature of the tarsal plate, when looking straight ahead, can be explained by the loss of tone in the paralyzed Orbicularis Occuli muscle. This means, that in addition to the lagophthalmos resulting from facial paralysis, changes occur in the functional anatomy of the upper eyelid, which must be considered during surgical correction. Additionally, the physiological loss of tone of the upper eyelid tarsal plate, which comes with age, has a certain influence.

Eyelid Diseases↗

Heritability of nestling growth in cross-fostered European Starlings Sturnus vulgaris.

In altricial birds, growth rates and nestling morphology vary between broods. For natural selection to produce evolutionary change in these variables, ther must exist heritable variation. Since nestling traits are not any longer presents in parents, traditional offspring-parent regressions cannot estimate heritabilities of these. In this study, a partial cross-fostering experiment was performed, where nestlings of the European Starling (Sturnus vulgaris) were reciprocally exchanged between nests. The experiment demonstrated a significant heritability of nestling tarsus length and body mass, but not of the growth trajectories followed by individual nestlings. the heritability estimate for tarsus length obtained in the cross-fostering experiment using full-sib analysis was lower than those obtained by offspring-parent regressions. This is likely due to a genotype-by-environment effect on tarsus length, with nestlings destined to become large but in poor condition having a low probability of appearing as parents. The main reason for the low heritability of growth was probably the large within-brood variation in growth pattern due to the initial size hierarchy of nestlings. Nestlings demonstrated targeted growth, where small-sized nestlings that initially grew slower than their siblings, managed to catch up.

Aging↗

Redescription of Alcedinectes alcyon (Acari:Hypoderatidae) from the belted kingfisher (Aves:Coraciiformes; Alcedinidae).

Alcedinectes alcyon (Boyd) is redescribed based on specimens collected from its belted kingfisher, Megaceryle alcyon (L.), type host in Florida. This species differs from A. cerylei Fain by the chaetotaxy of tarsus III. A. alcyon has a long stout apical seta that tapers to a curved tip resembling that seen on tarsus III of the genus Tytodectes (Ispidectes) Fain. The equivalent seta in A. cerylei is a stout spine. There are other minor differences between these species in the pattern of idiosomal sclerotization and leg chaetotaxy. The chaetotaxy and solenidiotaxy of legs I and II in Alcedinectes closely resemble that of Amazonectes psittaci Fain & Vercammen-Grandjean from parrots (Psittaciformes), whereas the morphology and chaetotaxy of the idiosoma resemble that of Tytonectes (Ispidectes) spp. which also occurs in kingfishers (Coraciiformes). The long stout seta that tapers to a curved tip on tarsus III in A. alcyon also links the genus Alcedinectes with Tytodectes (Ispidectes).

Animals↗

Etiology and pathogenesis of aponeurotic blepharoptosis.

How and why aponeurotic blepharoptosis develops was investigated in terms of the relationship between the levator aponeurosis and Mueller's muscle functioning as the muscle spindle of the levator muscle. A total of 200 consecutive patients with moderate to severe acquired blepharoptosis completed questionnaires regarding their history of physical irritations to the eyelids, and intraoperative conditions of the levator aponeurosis and Mueller's muscle were evaluated. Several kinds of physical irritations to the eyelids were reported, such as habitual rubbing of the eyelids, contact lens usage, cataract surgery, and continuous rubbing of the eyelids while crying all night. The two main findings for aponeurosis were that it was disinserted from the tarsus, resulting in a large amount of play between the aponeurosis and the tarsus, and that the aponeurosis and Mueller's muscle were attenuated and elongated. The authors believe that rubbing may have caused disinsertion as well as attenuation and elongation of the aponeurosis, which result in transmission failures between the levator muscle and the tarsus as well as between the levator muscle and the mechanoreceptor of Mueller's muscle, leading to clinical blepharoptosis.

Adult↗

Anatomic study of the insertions of the levator aponeurosis and Müller's muscle in Oriental eyelids.

To clarify the detailed anatomy of the insertions of the levator aponeurosis and Müller's muscle, 10 upper eyelids of 5 fixed Japanese cadavers were examined. The eyelids were dissected in a manner that the authors devised to disclose the delicate pretarsal structures in close proximity. After removing the orbital roof and fat, they divided the levator aponeurosis at the origin and dissected along its posterior aspect up to the upper tarsal area. The dissected eyelids were evaluated grossly and histologically with a special staining technique. Gross and histological examinations revealed that the dense collagenous levator aponeurosis was transformed distally into fine elastic fibers, which inserted into the pretarsal orbicularis layer. They also found a distinct fascia covering the anterior aspect of the tarsus that continued proximally to Müller's muscle. Conclusively, the levator aponeurosis has no direct collagenous insertion into the tarsus, but is connected mainly to the pretarsal tissue via fine elastic fibers. A fibrous tissue covering the anterior aspect of the tarsus is not the levator aponeurosis, but an extension of Müller's muscle.

Aged↗

Dominant familial congenital entropion with tarsal hypoplasia and atrichosis.

BACKGROUND: Congenital entropion and atrichosis of the lower eyelids associated with tarsal hypoplasia is a rare condition, with isolated reports in the literature and without previous pathologic examination. METHODS: Case report. A father and son with mild entropion, lower eyelash atrichosis, and tarsal hypoplasia are described. A family pedigree demonstrates autosomal dominant inheritance. RESULTS: Histopathology from an entropion repair shows rudimentary tarsus and Meibomian glands consistent with hypoplasia of the tarsus. CONCLUSIONS: Isolated congenital entropion may occur in association with atrichosis of the lower eyelashes and hypoplasia of the tarsus as an isolated anomaly. The condition may be inherited as an autosomal dominant trait and appears to be well tolerated.

Adult↗

The use of conchal cartilage graft in involutional entropion.

A simple and stable technique for repairing involutional entropion is described. Through a transconjunctival incision between the lower border of tarsus and the lower lid retractor, the eyelid is divided between the tarsus and the orbicularis oculi muscle into external and internal layers. The internal layer is moved upward until the eyelashes turn outward, and then through-and-through sutures are placed to fix it in this corrected state. The resultant defect between the lower end of the tarsus and the retractor is filled with a conchal cartilage graft. The raw surface of the cartilage is epithelialized from the surrounding mucosa within 1 to 2 weeks without shrinkage. This technique is more stable than any other technique that we have performed.

Aged↗

An eyelid mass caused by a migrated hard contact lens.

PURPOSE: To describe a mass caused by a hard contact lens in the upper eyelid. METHODS: We present a case of a 77-year-old man who complained of a mass in his right upper eyelid. He had previously undergone cataract surgery in the right eye at age 60 and then became a hard contact lens wearer. He underwent horizontal wedge-shaped excision of the tarsus at age 73. RESULTS: The mass in the right upper eyelid was excised. During the surgery, a hard contact lens was found embedded in the mass near the excision site of the tarsus. CONCLUSIONS: Hard contact lens migration through the wedge-shaped excision site of the tarsus into the upper eyelid, as seen in our patient, may be rare.

Aged↗

Microscopic anatomy of Asian lower eyelids.

PURPOSE: To elucidate the microscopic anatomy of the Asian lower eyelid. METHODS: Specimens (full-thickness sections of lower eyelids from 19 postmortem lower eyelids) from 11 Asians aged 73 to 96 years at death were fixed in 10% buffered formalin and microscopically examined. After pretreatment, sagittal sliced sections of the central part were stained with Masson trichrome. RESULTS: The distinct junction of the orbital septum to the capsulopalpebral fascia (CPF) was confirmed in 7 eyelids in which orbital septum was clearly stained, with an average distance from the tarsus to the junction of 2.38 mm. The other 12 eyelids did not show a distinct junction, and the orbital septum was poorly defined anteriorly and indistinct posteriorly. There was a distinct layer between the orbicularis oculi muscle and the orbital septum. The inferior and the posterior attachments of the CPF to the tarsus were seen in all eyelids. Seventeen of the 19 eyelids had attachment of the CPF on the anterior aspect of the tarsus, from which an extension of the CPF through the pretarsal orbicularis oculi muscle was observed. All eyelids had anterior extension of the CPF through the preseptal orbicularis oculi muscle, which was overridden on the pretarsal orbicularis oculi muscle. CONCLUSIONS: The microscopic findings of Asian lower eyelids, especially fascial components, were mostly similar to those of non-Asian eyelids, but differences existed in higher or indistinct septum fusion, anterior and superior orbital fat projection, and the overriding of the preseptal orbicularis oculi muscle.

Aged↗

Sex-specific development of cell-mediated immunity under experimentally altered rearing conditions in blue tit nestlings.

In birds, poor rearing conditions usually have negative effects on T-cell-mediated immune response. However, earlier studies demonstrate that fitness-related traits such as body mass may show sex-specific patterns when subject to alteration of rearing conditions. Therefore, to investigate whether deterioration of rearing conditions influences the development of immune function differently in male and female nestlings, we performed brood size manipulation experiments on blue tit (Parus caeruleus) nestlings. To alter rearing conditions, some broods were increased by three nestlings soon after hatching, while other broods were left non-manipulated. Immune response was assessed as a hypersensitivity reaction to phytohaemagglutinin in 11-day-old nestlings. Additionally, we studied the consequences of brood size manipulation for fledgling body mass and tarsus length. The enlargement of brood size had different effects on the cellular immune responses of male and female nestlings, with males being more negatively affected than their female nest-mates. Sex-specific effects of poor rearing conditions were also recorded for tarsus length, such that tarsus growth was more retarded in female than in male nestlings. We discuss the effects of deterioration of rearing conditions on sex-specific development of cell-mediated immunity with respect to sexual dimorphism of size and developmental strategies in male and female nestlings.

Animals↗

Quantitative genetics of sexually dimorphic traits and capture of genetic variance by a sexually-selected condition-dependent ornament in red junglefowl (Gallus gallus).

We studied the quantitative genetics of sexually selected traits in a captive population of red junglefowl (Gallus gallus L.) using a multi-generational 'animal model' approach. We found significant heritability of mass, tarsus length (both strongly sexually dimorphic), residual mass, and male comb (a fleshy head ornament) length. Residual mass has a genetic correlation between the sexes smaller than unity and so could show partially independent responses to selection in the two sexes. In males, tarsus length and mass were not genetically correlated, and this produced a negative genetic correlation between tarsus length and residual mass. The male red junglefowl's comb, an ornament influencing female choice, is highly condition dependent. We show that expression of this ornament is heritable, however, and shows strong genetic correlation with a condition index, residual mass. Because residual mass is partly influenced by various aspects of condition, it appears that comb size has 'captured' genetic variability in condition.

Analysis of Variance↗

Intersegmental and local interneurons in the metathorax of the stick insect Carausius morosus that monitor middle leg position.

1. In the stick insect, proprioceptive information from the middle leg is used to define the target for the swing movement of the adjacent rear leg ("targeting behavior"). To investigate the underlying neural circuits, intracellular recordings were made in the ganglion controlling the rear leg, the metathoracic ganglion, while systematically moving the tarsus of the middle leg. 2. Several intersegmental interneurons and one local interneuron were identified as possible contributors to the targeting behavior. The intersegmental interneurons code the position of the middle leg tarsus in a highly simplified manner: test movements of the middle leg in the dorsal, lateral, and caudal directions from the standard starting position at right angles to the thorax elicit phasic-tonic responses in three different intersegmental neurons. The response in each interneuron actually reflects the movement and position at only one joint of the middle leg: for the neurons responding primarily to movement in the caudal, dorsal, and lateral test directions, the adequate stimulus is movement at the subcoxal joint, the coxa-trochanter joint, and the femur-tibia joint, respectively. 3. The metathoracic local interneuron integrates information from ipsilateral middle and rear legs in such a way as to provide an approximate measure of the distance between the two tarsi in the longitudinal direction. It is depolarized in a phasic-tonic manner both by caudal movements of the ipsilateral middle leg and by rostral movements of the ipsilateral rear leg. The adequate stimulus in each case is the change in the angle at the subcoxal joint of the leg moved. Depolarization of this neuron activates retractor motoneurons, which is consistent with a role in terminating the swing movement. 4. Altogether the results indicate first, that the targeting behavior could be controlled by very few intersegmental channels and, second, that the nervous system encodes the position of the middle leg tarsus in terms of joint angles rather than in abstract, body-centered coordinates.

Animals↗

Bowl is required downstream of Notch for elaboration of distal limb patterning.

In the Drosophila leg, activation of Notch leads to the establishment of the joints that subdivide the appendage into segments. We find that mutations in bowl result in similar phenotypes to Notch, causing fusion and truncations of tarsal segments (tarsomeres) and, like its close relative Odd-skipped, Bowl is produced in response to Notch signalling at a subset of segment boundaries. However, despite the fact that bowl mutant clones result in fusion of tarsomeres, Bowl protein is only found at the t1/tibial and t5/pretarsal boundaries, not at tarsomere joints. One hypothesis to reconcile these data is that bowl has a role at an earlier stage in tarsal development. We therefore investigated the effects of bowl mutations on the expression of leg 'gap' genes that confer regional identity on the developing leg. Several of these genes have altered expression in bowl mutant cells. For example, bric-a-brac2 is normally expressed in the central part of the tarsus domain but expands into distal and proximal regions in bowl clones. Conversely, ectopic bowl leads to a reduction in bric-a-brac2, with a concomitant expansion of proximal (t1) and distal (t5) tarsomere fates. The bowl gene is therefore required for the elaboration of pattern in the tarsus and its effects suggest a progressive model for the determination of P/D identities. This mechanism might be important in the diversification of arthropod limbs, because it explains how segmented tarsomeres could have arisen from an ancestral limb with an unsegmented tarsus.

Animals↗