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PubMed1999

Eyelid healing after carbon dioxide laser skin resurfacing: histological analysis.

OBJECTIVE: To clarify in vivo healing of eyelid skin after carbon dioxide (CO2) laser resurfacing. DESIGN: Patients requesting upper eyelid blepharoplasty consented to undergo previous CO2 laser skin resurfacing of the upper eyelid skin segments to be excised at various time intervals. After blepharoplasty, the skin specimens were analyzed histopathologically by 2 masked pathologists. PATIENTS: Eight patients with Fitzpatrick skin types I and II. INTERVENTION: Upper eyelid CO2 laser resurfacing 1,2, 4, or 12 weeks before planned upper eyelid blepharoplasty. MAIN OUTCOME MEASURES: Epidermis: thickness, polarity, contour, and constituents. Dermis: repair zone thickness, vascular and inflammatory pattern, collagen deposition, and elastic fiber changes. RESULTS: The epidermis regenerated within 7 to 10 days. By 3 months, the epidermis revealed flattening of the rete peg pattern with restoration of polarity, keratinocytes, and melanocytes. The 3-month dermis demonstrated a fibrotic repair zone (500-700 microm), new elastic fibers, and telangiectatic capillaries. CONCLUSIONS: Eyelids heal similarly to other skin regions treated by CO2 laser resurfacing. This cutaneous healing is analogous to that previously reported with use of chemical peels. Histological changes may explain the skin smoothing and wrinkle reduction seen clinically.

Aged↗
PubMed2000

Correlation of the Schirmer 1 and fluorescein clearance tests with the severity of corneal epithelial and eyelid disease.

OBJECTIVE: To evaluate the correlations of the fluorescein clearance test (FCT) and the Schirmer 1 test with the severity of corneal epithelial and eyelid disease in normal patients and patients with tear film disorders due to meibomian gland disease (MGD) and/or aqueous tear deficiency (ATD). METHODS: Nineteen normal control subjects, 16 patients with MGD associated with rosacea, 21 patients with noninflammatory atrophic MGD, and 43 patients with ATD were enrolled. There was a similar age and sex distribution in each group. Each patient completed a symptom severity questionnaire that consisted of 11 questions and then underwent a panel of diagnostic tests in the following order: assessment of corneal and conjunctiva sensation with the Cochet-Bonnet esthesiometer, FCT, assessment of corneal fluorescein staining, Schirmer 1 test (5 minutes without anesthesia), and biomicroscopic examination of the eyelid margins and meibomian glands. The FCT was performed with a fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus. By studying the best area under the receiver operating characteristic curves, we developed a formula that combined the FCT and Schirmer test results, which we termed the FCT corrected by Schirmer test. RESULTS: The FCT showed stronger correlation with ocular irritation symptoms (r = 0. 35, P <.001), corneal fluorescein staining (r = 0.54, P<.001), and meibomian gland and eyelid pathologic signs than the Schirmer 1 test. A correction factor that was based on the best area under the receiver operating characteristic curves, added to the FCT score, improved its correlation with ocular irritation symptoms, eyelid margin and meibomian gland pathologic signs, and ocular surface sensitivity scores. CONCLUSIONS: Corneal epithelial disease is correlated with decreased aqueous tear production and delayed tear clearance, whereas eyelid and MGD are correlated with delayed tear clearance. The FCT corrected by Schirmer 1 test improves the correlations of the FCT with ocular irritation symptoms, corneal epithelial and eyelid pathologic signs, and corneal and conjunctival sensitivity for patients with MGD and ATD.

Aged↗
PubMed1991

Surgical correction of lower-eyelid tarsal ectropion by reinsertion of the retractors.

Lower-eyelid tarsal ectropion is an unusual form of eyelid malposition in which the entire lid is everted. The cause is most likely the disinsertion of the lower-eyelid retractors. In 12 eyelids of six patients, a transconjunctival approach was used to reunite the retractors with the inferior tarsal border. In eight eyelids, a horizontal tightening procedure was also needed. The looping passage of fornix sutures through the full thickness of the eyelid created a vector force that helped rotate the lid margin inward. The subsequent formation of an inflammatory cicatrix induced by the absorbable sutures also contributed to maintain the lid in an upright posture. During follow-up periods ranging from 8 to 36 months, there were no instances of overinversion, recurrent ectropion, or suture abscess.

Aged↗
PubMed2003

Dynamic and quantitative evaluation of eyelid motion using image analysis.

Evaluation of facial movement, especially eyelid movement, has depended on the subjective judgment of trained clinicians. Recently, a few objective methods have been reported, but they required uncomfortable markers to be attached to the eyelids and a special-purpose, high-speed video camera. This study had two aims: one was to develop a new device for measuring eyelid motion dynamically and quantitatively, without eyelid markers or a high-speed camera; the other was to devise feasible parameters for eyelid motion. The system consisted of a personal computer with a general-purpose multimedia board and a software program that the authors named blepharokymography. A sequence of blinking eyes was recorded with a video camera. After the capturing process of the video, kymograms were produced from the movie file. Kymograms were converted to binary images by threshold filtering. The lower margin of the upper eyelid was traced, and displacement and velocity curves were obtained. Some parameters were devised and verified in preliminary clinical data. The analysis revealed that the displacement (8 mm in normal compared with 5.2 mm in paralysis), average closing velocity (74 mm s(-1) in normal compared with 30.6 mm s(-1) in paralysis) and peak closing velocity (154 mm s(-1) in normal against 63.4 mm s(-1) in paralysis) were useful parameters for differentiating the normal and facial-paralysis states.

Adolescent↗
PubMed2001

Intermediate cerebellum and conditioned eyeblinks. Parallel involvement in eyeblinks and tonic eyelid closure.

The intermediate cerebellum (the intermediate cerebellar cortex and interposed nuclei) and associated brainstem circuits are essential for the acquisition and expression of classically conditioned eyeblinks in the rabbit. The purpose of the present experiment was to determine whether these circuits are also involved in adaptive eyelid closure learned in an instrumental paradigm. For that purpose, rabbits with unrestrained eyelids were trained in two tasks: (1) classical conditioning of the eyeblink; and (2) a new instrumental task in which they avoided delivery of an aversive stimulus by maintaining tonic eyelid closure. To examine the involvement of the intermediate cerebellum in these two types of learned behavior, the cerebellar interposed nuclei were injected with the GABAA agonist muscimol and with the GABAA antagonist picrotoxin. Inactivating the interposed nuclei with muscimol abolished classically conditioned eyeblinks and severely affected the rabbit's capacity to maintain tonic eyelid closure. On the other hand, reducing inhibition with picrotoxin failed to interrupt the learned responses and increased the amplitude of eyelid closure. These data indicate that the cerebellar interposed nuclei control both phasic classically conditioned eyeblinks and tonic instrumental eyelid closure. To account for this new finding, a "hybrid" hypothesis combining the cerebellar learning hypothesis and the performance hypothesis is proposed.

Animals↗
PubMed2005

The concentric malar lift: malar and lower eyelid rejuvenation.

Midface rejuvenation surgery is most challenging. The margin of error for the lower lid is on the order of 0.5 mm, and the cosmetic result can sometimes look unnatural. A minimally invasive technique for malar and lower lid lift is proposed. Two incisions are used: the standard subciliary lower eyelid incision and one on the lateral part of the upper eyelid. Through these incisions a skin flap lower eyelid dissection and a subperiosteal malar dissection are performed. The arcus marginalis itself is not transected as is the case when the malar area is entered from the lower eyelid. Rather, a subperiosteral release of the arcus marginalis is performed through a muscle-splitting incision at the lateral canthus. Eyelid malposition is avoided because the muscles, vessels, and nerves converging toward the medial canthus are not interrupted. The subperiosteal dissection of the arcus marginalis extends to the medial canthus and also releases the insertion of the orbicularis oculi superior malar part. Consequently, all the attachments of the tear trough are released. Two subperiosteal suspensions connect the central part of the nasolabial volume and, more laterally, the central part of the malar area to the inferolateral orbital rim. The elevation of the malar volume resulting from these suspensions is concentric with the orbit. A final third suspension vertically connects the orbicularis oculi muscle with the underlying periosteum to the bone of the lateral orbital rim. Significant skin excess is removed from the lower eyelid. Complete disinsertion of the tear trough attachments combined with the malar elevation treats the entire palpebromalar groove. The lifted fat volume fills the space resulting from the subperiosteal disinsertion. A safer, more natural and more reliable result is achieved because the vectors of traction with this technique are exactly opposite those of the midface aging process, and because a very stable fixation is created between the lifted malar periosteum and the malar and latero-orbital rim bones.

Adult↗
PubMed2005

[Advanced carcinoma of the eyelids. Principles of plastic reconstruction after excision].

BACKGROUND: We present the surgical methods and results of operations in cases with advanced carcinoma of the eyelids over a 5-year period. METHODS: The study included 71 patients with advanced mono- and multifocal carcinoma (n=76) of the eyelids, selected from 324 consecutive cases with tumors of the eyelids. Various reconstruction techniques were performed after frozen section control. RESULTS: Thirty-two defects at the medial canthus were handled by glabellar transposed flap. A "dog-ear" fold occurred in three cases of this group. Twelve defects of the lower eyelid were closed by transposed nasojugal flap and 21 defects at the lateral canthus by advancement flap without any complications. For the reconstruction of three large upper eyelid defects, the Cutler-Beard procedure was applied. The Mustarde cheek rotation flap with and without skin graft was used in eight patients with large defects of the lower lid. A small part of the skin graft became necrotic in two patients of this group. CONCLUSIONS: We recommend the described surgical techniques for the reconstruction of large eyelid defects. These are successful procedures with good therapeutic, functional and esthetic results. The choice of the method depends on the individual assessment of the patients.

Adult↗
PubMed2007

[Subcutaneous leiomyosarcoma metastatic to the eyelid].

BACKGROUND: Metastatic eyelid lesions are rare. Most metastatic lesions to the eyelid are carcinomas. Leiomyosarcomas are soft tissue sarcomas arising most commonly in the uterus and gastrointestinal tract, whereas dermal leiomyosarcomas are less frequent. Dermal leiomyosarcomas metastatic to the eyelid have not been reported so far. CASE REPORT: A 28-year-old female patient presented with a rapidly growing tumor of her right lower eyelid. A subcutaneous leiomyosarcoma of the neck had been excised 21 months before with subsequent radiotherapy. Seven months later metastases to the lung, liver, and left upper arm were detected. The patient received chemotherapy. The eyelid tumor was completely excised. Histologically the lesion consisted of spindle cells arranged in fascicles with perinuclear vacuoles and myofilaments. There was a strong immunoreactivity for smooth muscle actin, and negative staining for cytokeratin and S100. CONCLUSION: Cutaneous and subcutaneous leiomyosarcomas occur at almost any age, but are most common between the 5th and 7th decades. They are more common in men and usually occur at the extremities. The prognosis of cutaneous/subcutaneous leiomyosarcoma correlates with the depth of the tumor. To our knowledge this is the first presentation of a subcutaneous leiomyosarcoma metastatic to the eyelid. Presumably, parenchymatous metastases of this tumor occur before dermal metastases arise.

Adult↗
PubMed2005

Eyelid splitting with follicular extirpation using a monopolar cautery for the treatment of trichiasis and distichiasis.

PURPOSE: To assess the efficacy of eyelid splitting coupled with follicular extirpation via monopolar cautery in the treatment of trichiasis and distichiasis. METHODS: Between March 2000 and October 2003, this surgery was performed on 52 eyelids from 45 patients, with a mean follow-up period of 14.3 months (ranging from 12.3 to 17.6 months) . Under local anesthesia and a surgical microscope, a chalazion clamp is positioned on the eyelid, and a no. 11 scalpel is employed to make an incision located immediately anterior and parallel to the abnormal eyelash line. Each of the abnormal hair follicles is then removed via cautery with a monopolar needle. No sutures are involved in this procedure. RESULTS: Forty-four eyelids of 40 patients (84.6%) were successfully treated without recurrence or any residual symptoms. Repeat surgery was then performed on eight eyelids, with successful results in six cases. The cumulative success rate for this procedure was 96.1%. No complications were noted in the treated area, including lid deformities, granuloma formation, infections, and others. CONCLUSIONS: Eyelid splitting coupled with follicular extirpation via cautery with a monopolar needle, a procedure which requires no sutures, constitutes a simple and effective method for the treatment of both trichiasis and distichiasis and is associated with favorable functional and cosmetic results.

Adolescent↗
PubMedDate not supplied

Glucose metabolism in the visual structures of rat monocularly deprived by eyelid suture after postnatal eye opening.

PURPOSE: To determine the changes in the visual centers of rats following monocular visual deprivation after postnatal eyelid opening (PEO). METHODS: Monocular eyelid suture was performed on rats on days 1, 3, 5, 7, 14, and 28 after PEO, and the glucose metabolism was measured 1, 2, 5, and 7 days after the eyelid suture. Ex vivo autoradiography with (14)C- or (18)F-labeled 2-deoxy-D-glucose was carried out. Effects of monocular enucleation or dark rearing were also determined. RESULTS: Monocular eyelid suture did not decrease the glucose metabolism in any contralateral visual structures on day 1 after visual deprivation in the PEO1 or PEO3 lid-sutured rats. However, there was a decrease on day 1 after the eyelid suture in PEO7 and older rats. Similarly, monocular enucleation on PEO1 did not reduce the glucose metabolism in the visual cortex (VC), but enucleation on PEO7 and thereafter did. Eyelid suture on PEO8 following dark rearing until PEO7 did not reduce the glucose metabolism 1 day after suture, but reduced it at 7 days after suture. CONCLUSIONS: Glucose metabolism was altered by visual deprivation on PEO7 and thereafter. Five days of visual experience after PEO were required for initiation of visual function in the rat visual system.

Animals↗
PubMed1977

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↗
PubMed1986

Correction of upper eyelid retraction using tissue removed in blepharoptosis repair.

Five patients (four women, 41, 51, 66, and 78 years old, and a 5-year-old boy) had blepharoptosis of one upper eyelid and an abnormal retraction of the other eyelid. Both anomalies were corrected at the same operation by using the tissue removed during blepharoptosis repair in one eyelid to correct the retraction in the other eyelid. As a result, both upper eyelids had a more normal, symmetric appearance and eyelid function was maintained.

Adult↗
PubMed1994

Injection of doxorubicin into rabbit eyelid does not result in loss of facial motor neurons.

In both laboratory and clinical studies, injection of doxorubicin directly into the eyelid results in permanent muscle loss of the majority of fibers within treated eyelids. A first clinical trial of this technique in blepharospasm and hemifacial spasm patients has been performed. All patients who completed a full course of doxorubicin treatment showed a permanent decrease in eyelid strength, with over 50% of these patients requiring no further treatment. Doxorubicin is known to be carried by retrograde axonal transport to the brain and is a known neurotoxin. This raises the question of the effect of these treatments on the facial neurons which innervate the orbicularis oculi muscle in the eyelids. The effect on the number of facial neurons present after injection of doxorubicin into the eyelid of rabbits was determined using both HRP and diI retrograde labeling techniques. Despite the extensive and permanent muscle loss caused by the doxorubicin treatments, there was no measurable loss of facial neurons on the doxorubicin treated sides. DiI was shown to be myotoxic at high concentrations and amplified the myotoxic effect of doxorubicin. Lack of neuronal loss may offer assurance of clinical safety to the facial motor neurons of muscle spasm patients who receive doxorubicin injections into their eyelids.

Affinity Labels↗
PubMed1989

The relationship of eyelid movement to the blink reflex.

Although the blink reflex is a standard neurophysiological investigation its relationship with eyelid movement has not been clearly established. We studied normal subjects and patients with unilateral facial paralysis to define the pattern of eyelid movement following glabellar tap, supraorbital nerve stimulation, facial nerve stimulation and direct corneal stimulation. We found that eyelid closure did not necessarily occur in a single movement. Following glabellar tap the first component of a two-stage movement was initiated by levator palpebrae relaxation while with supraorbital nerve stimulation orbicularis oculi contraction produced the first movement. The compound muscle action potential following direct facial nerve stimulation produced only minimal eyelid movement, the major closure being associated with a longer latency orbicularis oculi reflex. Corneal stimulation elicited a single component eyelid movement. Thus, the pattern of eyelid movement differed for each stimulus reflecting variations in orbicularis oculi contraction and levator palpebrae inhibition.

Adult↗
PubMed2006

Eyelid reconstruction with acellular human dermal allograft after chemical and thermal burns.

OBJECTIVE: To evaluate the efficacy of eyelid reconstruction with acellular dermal allograft in patients with eyelid defect after chemical and thermal burns. METHOD: Eyelid reconstruction was performed in 15 eyelids of 13 patients during the period of June 2001-October 2004 by a single senior surgeon (Chen). Among them five patients had thermal burns, and eight patients had chemical burns. The acellular dermal allograft was used as a tarsus substitute that was sutured into the place between the levator aponeurosis in upper lid or retractor in lower eyelid and the remaining tarsus. RESULTS: After a mean follow-up of 9 months, satisfactory function and cosmesis were obtained. No implant rejection or severe complications were observed. CONCLUSION: Acellular dermal allograft may be used safely as a posterior lamellar spacer graft after chemical and thermal burns; the allograft appears to be biocompatible and does not aggravate the inflammation in the injured eyelid.

Adolescent↗
PubMed2006

Evaluation of aneuploidy frequency for chromosomes 6 and 17 in eyelid tumours using the FISH technique.

Although basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are very common skin tumours, the incidence of chromosome aneuploidy with regard to the eyelid has not been investigated. We aimed to find the frequency of chromosome 6 and 17 aneuploidies in eyelid tumours' interphase nuclei with fluorescence in situ hybridization (I-FISH) with chromosome specific DNA probes. I-FISH with chromosome 6 and 17 centromere specific DNA probes was used in the eyelids of 10 patients with BCC or SCC and the peripheral blood cells of 10 healthy donors as controls. The frequency of chromosome 6 and 17 aneuploidies was significantly higher in 7 out of 10 patients and 5 out of 10 patients, respectively, than in controls, indicating a higher frequency of aneuploidy in BCC than in SCC of the eyelid. Distribution of hybridization signals for chromosome 6 and 17 was wide ranging, indicating heterogeneity of cell populations with aneuploidy between patients. These findings indicate that acquisition of chromosome aneuploidies in eyelid tumours may have an important pathogenic role in both BCC and SCC of the eyelid area.

Aged↗
PubMed2004

Brachytherapy with 192Ir as treatment of carcinoma of the tarsal structure of the eyelid.

PURPOSE: Some eyelid tumors present a great challenge for surgical therapy because of the cosmetic and functional impairment. Interstitial radiation with (192)Ir is an optimal alternative treatment modality. The aim of this study was to evaluate the local tumor control and cosmetic results in patients with eyelid tumors treated by interstitial (192)Ir wires. METHODS AND MATERIALS: Twenty-four previously untreated carcinomas involving the eyelid tarsal structure in 23 patients were treated with (192)Ir wire implantation. The tumor location was in the lower eyelid in 22 cases and in the upper eyelid in 2. The mean tumor size was 1.33 cm. Of the 24 tumors, 79.2% were basal cell carcinoma, 16.7% were squamous cell carcinoma, and 4.2% were adenocarcinoma. The total radiation dose was 4000 cGy, delivered to 2-mm depth (mean dose rate, 73 cGy/h). RESULTS: The mean follow-up was 43 months. Local control was obtained in 22 (91.6%) of 24 tumors. Good functional results were achieved in all patients. CONCLUSION: (192)Ir interstitial brachytherapy in a braided silk filament appears to be an excellent method to treat carcinomas involving the eyelid tarsal structure for tumor control and functional and cosmetic results.

Adenocarcinoma↗
PubMed2005

Correlation of corneal complications with eyelid cicatricial pathologies in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis syndrome.

PURPOSE: To look at the correlation between many factors (time of hospitalization, floppy eyelid syndrome, trichiasis, open lacrimal puncta, symblepharon, and aqueous tear deficiency) and corneal complications in Stevens-Johnson syndrome (SJS). DESIGN: Observational cases series. PATIENTS: Clinical data were retrospectively reviewed from 38 patients (32.7+/-20.1 years old) with SJS (n = 11) and with toxic epidermal necrolysis (TENS) (n = 27) from January 2002 to August 2004. One case report with SJS was included to verify the presence of tarsal/lid margin ulceration at the acute stage. METHODS: The medical history was retrieved regarding presumed causative medications used within 15 days and the duration of hospitalization. Data of the latest photographic documentation and eye examination were compared and correlated in a masked fashion. MAIN OUTCOME MEASURES: Floppy eyelid, trichiasis, lid margin keratinization, meibomian gland orifice metaplasia, symblepharon, tarsal scar, and corneal complications. RESULTS: Acute SJS/TENS was characterized by tarsal conjunctival ulceration. Keratinization of the eyelid margin with variable degrees of meibomian gland dysfunction was observed in all cases. Floppy eyelid, trichiasis, partially or totally opened lacrimal punctum, symblepharon, and aqueous tear deficiency were not significantly correlated with corneal complications. In contrast, there was a strong correlation between the severity of eyelid margin and tarsal pathology and the extent of corneal complications (Spearman r, 0.54; P = 0.0005). A multivariable regression analysis also showed that the extent of eyelid and tarsal pathology had a significant effect on corneal complications (coefficient, 0.84; P = 0.006). CONCLUSIONS: Patients with acute SJS/TENS are characterized by severe inflammation and ulceration of the tarsal conjunctiva and lid margins. If left unattended, lid margin keratinization and tarsal scar, together with lipid tear deficiency, contribute to corneal complications because of blink-related microtrauma. Attempts to suppress inflammation and scarring by amniotic membrane transplantation at the acute stage and to prevent microtrauma at the chronic stage are vital to avoid sight-threatening complications.

Adolescent↗