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At least 343 records · Page 19Linked to original sources
PubMed2001

Attempted eyelid closure affects intraocular pressure measurement.

PURPOSE: To evaluate the effect of attempted eyelid closure on intraocular pressure measurement. METHODS: Normal subjects underwent intraocular pressure measurement in both eyes using Goldmann applanation tonometry and Tono-pen XL (Mentor, Inc, Norwell, Massachusetts) by the same examiner holding the eyelids open, both with and without the subject simultaneously attempting forced eyelid closure. Subjects were seated during all measurements and waited 5 minutes between measurements with each instrument; the order of measurement was randomized. RESULTS: Thirty eyes of 15 subjects (six men, nine women) were enrolled. Mean age was 30.5 +/- 5.2 years (range, 24 to 40 years). With Goldmann applanation tonometry, intraocular pressure increased in both eyes with attempted eyelid closure by a mean of 1.5 +/- 2.0 mm Hg (P =.0002, paired t test; range, -2 to 8 mm Hg). With the Tono-pen XL, intraocular pressure also increased in both eyes with attempted eyelid closure by a mean of 1.9 +/- 2.7 mm Hg (P =.0002, paired t test; range, -2 to 9 mm Hg). Tono-pen XL mean intraocular pressure values in both eyes (14.4 +/- 2.3 mm Hg) consistently overestimated those of Goldmann applanation tonometry (13.0 +/- 2.2 mm Hg) by a mean of 1.4 +/- 2.3 mm Hg. CONCLUSIONS: Attempted forced eyelid closure is a common and statistically significant source of error in routine outpatient measurement of intraocular pressure and could influence clinical management of glaucoma.

Adult↗
PubMed2002

Attempted eyelid closure affects intraocular pressure measurement in open-angle glaucoma patients.

PURPOSE: To evaluate the effect of attempted eyelid closure on intraocular pressure (IOP) measurements in normal-tension (NTG) and high-tension (HTG) open-angle glaucoma patients. DESIGN: Prospective clinical trial. METHODS: Forty randomly selected eyes of 40 patients underwent corneal pachymetry and IOP measurements using both Goldmann applanation tonometry and Tono-pen XL (Mentor, Inc., Norwell, Massachusetts, USA). Intraocular pressure was measured by the same examiner holding the eyelids open, both with and without the subject simultaneously attempting forced eyelid closure. Subjects were seated during all measurements and waited 5 minutes between measurements with each instrument; the order of measurement was randomized. RESULTS: Twenty NTG and 20 HTG eyes were enrolled. The mean age was 63.0 +/- 13.0 years (range, 31-80 years). The average corneal thickness was 540 +/- 32 microm (range, 480-608 microm) in NTG patients and 552 +/- 40 microm (range, 449-610 microm) in HTG patients (P =.07, analysis of variance [ANOVA]). Using Goldmann applanation tonometry, IOP measurement in eyes with NTG increased by 3.9 +/- 2.0 mm Hg with attempted eyelid closure (P <.0001, paired t test; range, 2-11 mm Hg). With the Tono-pen XL, IOP measurements increased 4.2 +/- 2.7 mm Hg (P <.0001, paired t test; range, 1-14 mm Hg). With attempted forced eyelid closure, the Goldmann applanation measurement in eyes with HTG increased 4.1 +/- 2.1 mm Hg (P <.0001, paired t test; range, 1-9 mm Hg). Using the Tono-pen XL, measurements increased 4.5 +/- 2.0 mm Hg (P <.0001, paired t test; range, 2-11 mm Hg). CONCLUSION: Attempted eyelid closure during tonometry is a significant and common source of error in eyes with glaucoma and may influence the clinical management and decision-making in the treatment of NTG and HTG.

Adult↗
PubMed2002

Isolated unilateral neurogenic blepharoptosis secondary to eyelid trauma.

PURPOSE: To describe eyelid trauma as a cause of isolated neurogenic blepharoptosis. DESIGN: Observational case series. METHODS: Three previously healthy patients (two male and one female; aged 29 to 39 years) were evaluated for unilateral blepharoptosis following forceful anterior displacement of the upper eyelid. Two injuries occurred during domestic altercations and one while the patient was playing basketball. RESULTS: All three patients had complete unilateral upper eyelid ptosis with no levator palpebrae superioris function, consistent with loss of innervation. Additional findings included minimal eyelid ecchymosis, eyelid edema, and subconjunctival hemorrhage in two cases. The remainder of the examinations was unremarkable with full ocular motility and no anisocoria. Without treatment, within 2 weeks, all three patients recovered completely with normal symmetric lid height and levator function. CONCLUSIONS: Isolated neurogenic blepharoptosis may result from traumatic anterior upper eyelid displacement. Resolution is likely within 2 weeks.

Blepharoptosis↗
PubMed1996

Acquired lower eyelid epiblepharon.

PURPOSE: Although congenital epiblepharon is a relatively common condition, particularly in Asians, acquired lower eyelid epiblepharon is rare. METHOD: We examined an 8-year-old boy who developed unilateral lower eyelid epiblepharon after a subciliary incisional approach for repair of a zygomatico-orbital fracture. RESULTS: The patient demonstrated an overriding fold of right lower eyelid skin and loss of the lower eyelid crease. At the time of surgical repair, disruption and scarring of the lower eyelid retractors, suborbicularis fascia, and orbital septum were noted. The epiblepharon was successfully corrected by plication of the retractors and skin to the tarsus. CONCLUSION: Disruption of the anterior subcutaneous fibers of the lower eyelid retractors (that is, capsulopalpebral fascia) contributes to epiblepharon.

Child↗
PubMed1994

Measurements of upper eyelid and eyebrow dimensions in healthy white individuals.

Facial appearance is influenced by the anatomic relationship of the eyebrow and eyelid, and surgical procedures on these structures attempt to restore or preserve not only symmetry but also normal appearance. To provide useful benchmarks for such interventions, we measured the eyebrow height, upper eyelid crease height, and amount of visible pretarsal skin of 143 white subjects who had no facial abnormalities. An age effect was observed for all measures, indicating a direct relationship with age until the middle age range (41 to 60 years), when mean estimates leveled off or decreased somewhat relative to younger age groups. Within the 41- to 60-year age group, for example, the average (S.D.) values for pretarsal skin height, eyelid crease height, and eyebrow height were 1.4 mm (1.1 mm), 6.4 mm (1.2 mm), and 6.4 mm (1.8 mm), respectively. Eyebrow and pretarsal skin heights were greater in females than males, and eyelid crease height showed similar gender-related trends. With increasing age, variation around the mean estimates for eyelid and eyebrow measurement increased, which may be indicative of variability across individuals in the physiologic response to the aging process. As expected, a high degree of intereye correlation was observed (correlation coefficients of 0.87 to 0.96). These results emphasize the importance of providing a normal anatomic relationship that relates to the patient's age and gender, as well as an outcome that is symmetric, in corrective or cosmetic procedures on the eyelid and eyebrow.

Adolescent↗
PubMed1993

The effect of reduced eyedrop size and eyelid closure on the therapeutic index of phenylephrine.

In this study we examined the relative effects of reducing eyedrop size (from 30 microliters to 10 microliters) and eyelid closure on the ocular efficacy and systemic absorption of 10% phenylephrine. Thirteen subjects participated in a quadruple crossover study that involved dilation with a 10-microliters and a 30-microliters drop of phenylephrine with and without eyelid closure. The 10-microliters drop was just as effective for pupillary dilation as the 30-microliters drop. Eyelid closure improved dilation for both drop sizes. Both eyelid closure and reducing the drug volume decreased systemic absorption of phenylephrine as measured by plasma concentration. When used together, eyelid closure and the smaller drop size reduced plasma concentration by 45%. The therapeutic index for 10% phenylephrine appears to be improved by using a 10-microliters drop followed by eyelid closure.

Absorption↗
PubMed1998

Argon laser therapy of benign tumors of the eyelid.

PURPOSE: To report the therapy of benign eyelid tumors with an argon laser as an alternative to surgery. METHODS: Forty-one patients with 47 benign tumors of the eyelid were included in this study. In all patients, the eyelid tumor was eliminated by argon laser. In 24 cases the lower eyelid and in 23 cases the upper eyelid was involved, including the lid margin in 17 cases. Laser spot size ranged from 150 to 500 microm. Argon laser power density varied between 4.1 and 61.1 W/mm2. Spots were counted between 40 and 1204. Twenty-seven of 41 patients treated were followed up; the mean follow-up period was 5.8 months (range, 3 to 24 months). Postoperatively, histologic confirmation was obtained in 42 cases of the 47 treated tumors. RESULTS: All patients were satisfied regarding the laser therapy and the cosmetic result. Remarkably, the wounds were dry after argon laser therapy. No infections of the wounds occurred; wounds were epithelialized after 2 to 3 weeks by a normal-appearing epithelium. The area of argon laser treatment was less pigmented than the surrounding skin and showed no obvious remarkable notches. As a complication, one patient developed a viral conjunctivitis. No relapses occurred during follow-up. CONCLUSIONS: Argon laser therapy of benign eyelid tumors may result in very satisfactory wound healing. Taking the short follow-up and the limited number of cases into account, it seems to be a useful alternative to traditional surgery, especially for tumors positioned close to the lacrimal papillae.

Adolescent↗
PubMed2000

Effective small-incision surgery for involutional lower eyelid entropion.

OBJECTIVE: The aim of this study was to develop an effective and minimally invasive operation to correct lower eyelid entropion that would address both the horizontal and vertical laxity. DESIGN: A prospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-five consecutive patients with involutional entropion, aged 62 to 92 years (mean, 77.1 years), had surgery on 45 lower eyelids. Of the 45 procedures, 33 (73%) had a primary procedure and 12 (27%) were reoperations. INTERVENTION: A lateral tarsal strip with diagonal tightening of the orbital septum and lower lid retractors to the lateral orbital rim was performed via a 1-cm lateral canthal incision. MAIN OUTCOME MEASURES: Complications and surgical outcome were monitored clinically for between 12 and 24 months after surgery. RESULTS: The results were analyzed from 42 eyelids (33 patients) with a mean follow-up of 17.1 months (range 12-24 months). Two patients died and one dropped out of the study 3 months after the second eyelid operation. In 36 cases (86%), the entropion was cured. Transient lateral orbital rim tenderness was noted in six cases (14%), and one patient had a wound infection. Anatomic recurrences were detected in six eyelids of six patients, and five of these (83%) were asymptomatic. CONCLUSIONS: This surgical approach has been found effective in 86% of eyelids. Adequate clinical followup has proven essential for accurate evaluation of entropion surgery.

Aged↗
PubMed2001

Treatment options and future prospects for the management of eyelid malignancies: an evidence-based update.

PURPOSE: To provide evidence-based clinical recommendations for treatment options and future prospects for the management of common malignant eyelid tumors, including global ratings for the strength of published evidence supporting them. CLINICAL RELEVANCE: Approximately 5% to 10% of all skin cancers occur in the eyelid. Incidence studies indicate that basal cell carcinoma is the most frequent malignant eyelid tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma, and malignant melanoma. Many therapeutic methods have been suggested to combat the morbidity and mortality associated with these lesions. LITERATURE REVIEWED: A MEDLINE and PubMed literature search (1966-1999) was conducted for English language abstracts and appropriate (selected) full-text references retrieved regarding treatment of malignant eyelid tumors. These sources then were used to prepare recommendations for patient care. Each recommendation was rated according to: (1) its importance in the care process and (2) the strength of evidence supporting the given recommendation. RESULTS: All recommendations were rated as level A (very important to patient-care outcome). For basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma, the published evidence supporting two recommendations (Mohs' micrographic surgery or excision with frozen-section control) were graded as I (providing strong evidence in support of a recommendation). For sebaceous gland carcinoma, the recommendations also included conjunctival map biopsies. The published evidence supporting all other recommendations for these three eyelid tumors were graded II (substantial evidence in support of a recommendation), primarily because of the small numbers of patients in each clinical study. For malignant melanoma, the recommendation for therapy (i.e., excision with variable margins depending on tumor thickness) was based on published papers individually variably rated as I, II, and III, reflecting ongoing debate as to the best method of therapy. CONCLUSIONS: Published reports regarding the treatment of malignant eyelid tumors include a myriad of treatment options. The strongest evidence favors complete surgical removal using histologic controls for verifying tumor-free margins of excision.

Adenocarcinoma, Sebaceous↗
PubMed2002

Conservative management of necrotizing fasciitis of the eyelids.

OBJECTIVE: To describe the management of patients with necrotizing fasciitis of the eyelids. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Seven patients with necrotizing fasciitis limited to the eyelids. METHODS: Retrospective review of the charts and photographs of seven patients with necrotizing fasciitis limited to the eyelids. MAIN OUTCOME MEASURES: Eyelid function and appearance, mortality, and morbidity. RESULTS: Seven of seven patients had good eyelid function and adequate appearance without reconstruction after healing. No deaths occurred. CONCLUSIONS: Eyelid necrosis due to necrotizing fasciitis can be a devastating condition. The morbidity and mortality of selected cases are reduced with prompt and appropriate antimicrobial therapy and nonaggressive debridement of necrotic tissue after autodemarcation of the necrotic zone.

Adult↗
PubMed2002

Transconjunctival lower eyelid involutional entropion repair: long-term follow-up and efficacy.

OBJECTIVE: To evaluate the safety and long-term efficacy of a modified transconjunctival involutional lower eyelid entropion repair. DESIGN: Retrospective, noncomparative case series and survey. PARTICIPANTS: Eighty-nine consecutive patients with involutional entropion (114 eyelids). METHODS: Modified transconjunctival involutional lower eyelid entropion repair technique was performed on 114 eyelids of 89 consecutive patients over a 7-year period. All cases had a minimum of 3 months of initial office follow-up, with extended follow-up obtained via standardized telephone interviews. MAIN OUTCOME MEASURES: Surgical success and entropion recurrence. RESULTS: Surgery was completed successfully with no complications in all 114 cases. All cases demonstrated correction of entropion at the 3-month office follow-up. Long-term follow-up (mean, 38.3 months; range, 4-85 months) was obtained in 75% of cases. Recurrence was noted in only one patient (two eyelids [2%]). CONCLUSIONS: Modified transconjunctival lower eyelid entropion repair is a time-efficient, safe, and efficacious technique. In contrast to a recent report using another transconjunctival technique, we found a relatively low rate of recurrence on extended follow-up.

Aged↗
PubMed1996

The differential diagnosis and classification of eyelid retraction.

BACKGROUND: Classification schemes are useful in the formulation of differential diagnoses. Thoughtful commentary has been devoted to the classification of blepharoptosis, but the causes of eyelid retraction have received less attention in published reports. Although eyelid retraction most frequently is associated with Graves ophthalmopathy, numerous other entities may cause the sign. This study was undertaken to provide a more comprehensive differential diagnosis and classification of eyelid retraction. METHODS: A series of patients with eyelid retraction was studied, and pertinent published reports were reviewed. RESULTS: Forty-four patients with different causes for eyelid retraction are described. Normal thyroid function and regulation were confirmed in all patients in whom Graves ophthalmopathy could not be excluded by clinical, biochemical, or historical criteria. CONCLUSION: Based on a series of patients and reported cases, a differential diagnosis for eyelid retraction is proposed using a classification system compromising three categories (neurogenic, myogenic, and mechanistic).

Adolescent↗
PubMed1997

Lower eyelid recession combined with ptosis surgery in patients with poor ocular motility.

BACKGROUND: The authors treated ten patients (13 eyelids) with visually significant blepharoptosis and compromised corneal protective mechanisms resulting from paresis of ocular motility and absent Bell phenomenon. METHODS: Traditional upper eyelid surgery consisting of frontalis suspension (6 eyelids) or levator aponeurosis advancement (7 eyelids) was used. In all patients, the ptosis repair was combined with maximum recession of the lower eyelid, using a posterior lamellar scleral spacer graft. The goal was to maintain a narrow, vertical, interpalpebral fissure to allow for eyelid closure, but to reposition this opening centrally over the pupil. RESULTS: Postoperatively, all patients achieved significant improvement in superior visual field, with no associated keratopathy. Complications were few, minor, and transient. The postoperative cosmetic appearance was acceptable in all patients. CONCLUSIONS: This combined procedure allows repair of fair- to poor-function ptosis in patients in whom ptosis surgery previously has been considered risky. For the authors, this technique has been proven safe and effective and should be considered in any patient population with compromised corneal protective mechanisms.

Adult↗
PubMed1999

Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota.

OBJECTIVE: To determine the epidemiologic and clinical characteristics of patients with malignant eyelid tumors in an incidence cohort. DESIGN: Cohort series. PARTICIPANTS: A computerized retrieval system was used to identify all patients residing in Olmsted County, Minnesota, who had a newly diagnosed malignant eyelid tumor during the 15-year interval from 1976 through 1990. The patients' medical records were reviewed for demographic and clinical data. INTERVENTION: Surgical excision with frozen-section histopathologic analysis, Mohs' micrographic excision, and electrodesiccation and curettage were the primary methods of treatment. MAIN OUTCOME MEASURES: Survivorship free of tumor. RESULTS: The incidence cohort included 174 patients who each had 1 tumor; men and women were equally affected, and all patients were white. Tumors developed most commonly on the lower eyelid (n = 85; 48.9%) and in the medial canthal region (n = 48; 27.6%) but involved the right and left sides with equal frequency. Of the 174 tumors, 158 were basal cell carcinomas (90.8%), 15 were squamous cell carcinomas (8.6%), and 1 (0.6%) was a malignant melanoma. The age- and gender-adjusted incidence rates for basal cell carcinoma, squamous cell carcinoma, and malignant melanoma were 14.35, 1.37, and 0.08 per 100,000 individuals per year, respectively. No cases of sebaceous gland carcinoma were identified. The 5- and 10-year recurrence rates for all tumors on the eyelid were 2% and 3%, respectively. The probability of an unrelated malignancy developing elsewhere in the body was approximately 9% at 5 years and 15% at 10 years. CONCLUSIONS: Basal cell carcinoma is the most common malignant eyelid tumor in whites. The lower eyelid and medial canthus are the most frequent sites of origin. Men and women are equally affected. Recurrence after surgical excision is uncommon.

Adult↗
PubMed1999

Sclerosing sweat duct carcinoma of the eyelid margin: unusual presentation of a rare tumor.

OBJECTIVE: Sclerosing sweat duct carcinoma (SSDC) is a rare, slow-growing, locally invasive skin tumor of eccrine and pilar origin. It is usually located on the face, particularly the upper lip, cheek, and forehead. It has been infrequently reported on the eyelid, secondarily involved from adjacent cheek and brow tumors. Only four previous cases have reported primary eyelid tumors. The authors present four cases of primary eyelid margin involvement, which show the variability in clinical presentations. DESIGN: Retrospective case series. The authors present four case studies of lower eyelid margin tumors diagnosed as SSDC. PARTICIPANTS/METHODS: The history of this recently recognized neoplasm is discussed in relation to the cases presented and the role of the ophthalmologist and pathologist in such cases. RESULTS: Primary SSDC of the eyelid margin is a reportedly rare entity. This particular presentation can occur in all age groups; can mimic benign, acanthotic, or basal cell-like tumors; and is usually misdiagnosed initially. This can lead to a delay in definitive treatment for a tumor that classically presents late in its natural history to health professionals. All eight cases of primary eyelid SSDC now reported in the literature have occurred in the lower lid. CONCLUSION: This rare but aggressive tumor is difficult to diagnose from a simple biopsy and may be more common than previously believed. Initial or early diagnosis is important because of unusually invasive characteristics. Recurrence is common and usually leads to extensive tissue loss via direct invasion or subsequent wide resection. Correct histologic diagnosis at the time of initial tumor removal will likely aid in achieving complete excision with fewer recurrences.

Adult↗
PubMed1989

A review of 79 cases of eyelid dermatitis.

Seventy-nine patients with eyelid dermatitis and 1012 patients with dermatitis at other sites were assessed with patch tests. Eighty-nine percent of the eyelid cases involved women. Only the eyelids were involved in 78.5% of cases. Of the patients with eyelid dermatitis 46% had allergic contact dermatitis, 15% had irritant contact dermatitis, and 23% had atopic dermatitis. Only 13% were work related. Positive reactions to patch tests for cinnamic alcohol, diazolidinyl urea, and neomycin sulfate occurred more frequently, whereas those for cobalt and nickel occurred less frequently, in patients who had eyelid dermatitis when compared to the reactions of patients who did not have eyelid dermatitis.

Adult↗
PubMed2001

Thyroid associated ophthalmopathy: botulinum toxin A in the treatment of upper eyelid retraction--a pilot study.

PURPOSE: Eyelid retraction in patients with thyroid associated ophthalmopathy is a common cause of eye discomfort and a disfigured facial appearance. The aim of this pilot study was to evaluate the effects and safety of inducing a temporary partial ptosis of the eyelid through injection of botulinum toxin A into the levator palpebrae superioris muscle. METHODS: Nine patients were treated. They were followed up with ophthalmologic examinations and self-assessment questionnaires until the point at which they either required renewed treatment or had no residual effect of the first injection. Maximum follow-up time was twenty weeks. RESULTS: In all eyes but one there was a lowering of the eyelid position one week after treatment and all these patients reported an improvement of eye appearance and symptoms. There was variability in the degree of lowering of the eyelid with the same dose of injected botulinum toxin A. It was also difficult to predict the time interval needed for re-treatment. Ptosis impairing visual acuity was not a consequence of the treatment in any of the patients. One week after treatment two patients experienced increased diplopia but only one showed transient change in Lees screen measurement of eye motility. CONCLUSION: Botulinum toxin A injection may be used to lower the upper eyelid position in patients awaiting eyelid surgery. The treatment safely relieved symptoms and improved eye appearance. However, treatment was short term and difficult to predict. There is also an inherent risk of transient diplopia.

Adult↗
PubMed1988

Bilateral cerebellar lesions disrupt conditioned eyelid responses in unrestrained rats.

Electromyographic eyelid responses in unrestrained rats were classically conditioned in a Pavlovian delay paradigm by using a tone conditioned stimulus (CS) and periorbital shock unconditioned stimulus (US). After eyelid conditioning was complete, bilateral electrolytic lesions were made in the dentate-interpositus region of the cerebellar nuclei. Initial eyelid conditioning was reliable and very similar to that previously observed in the rabbit, although the asymptotic eyelid responses contained a short-latency startle response in addition to the usual conditioned and unconditioned responses (CR and UR). Substantial decrements in CRs were observed in 13 of the 14 rats with accurately placed lesions. In contrast, startle responses and URs were unaffected. The results replicate the effects of cerebellar lesions on eyelid CRs in the rabbit and suggest that the anatomical basis of eyelid conditioning in both species is similar.

Acoustic Stimulation↗