SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A 3-week-old male infant had an extreme form of entropion caused by a congenital horizontal tarsal kink, which led to corneal ulceration and visual impairment. The combination of absence of the upper eyelid fold, irritability, and blepharospasm in the absence of congenital blepharoptosis is a sign that may facilitate early recognition of this problem.
We conducted a histopathologic study of he meibomian glands of seven patients (all men, ranging in age from 58 to 83 years) who had severe or moderately severe meibomian dysfunction and who were undergoing ectropion or entropion repair. Abnormal features included signs of obstruction and dilatation of ducts, enlargement of acini with cystic degeneration and squamous metaplasia, foreign-body reaction and granuloma formation, a mild increase in inflammatory cells, and abnormal keratinization. Demodex organisms were found in both acini and ducts of one patient. These findings were similar to those reported in other entities involving meibomian duct obstruction, probably related to abnormalities of keratinization, plays an important role in the pathogenesis of meibomian gland dysfunction.
A graft of hard palate mucosa is a satisfactory substitute for the posterior lamella of tarsus and conjunctiva in eyelid reconstruction. The graft may be harvested after administration of local anesthesia in adults, provides structural support as well as a mucosal surface, and contracts minimally. The palatal donor site heals with a minimum of postoperative care. Results in four eyelids with severe cicatricial entropion were satisfactory. The only observed complication was apparent partial keratinization of one graft in a patient with Stevens-Johnson syndrome.
PURPOSE: To evaluate the rate of recurrence of horizontal laxity or lid malposition and suture-related complications associated with the use of an absorbable suture in the lateral tarsal strip procedure. DESIGN: Prospective, interventional, consecutive case series. METHODS: A prospective study. SETTING: Institutional. PATIENT POPULATION: One hundred patients with horizontal lid laxity associated with ectropion or entropion. Patients with paralytic ectropion or ocular prostheses were excluded. INTERVENTION: One hundred and five lateral tarsal strip procedures were performed using a 6-0 polyglactin suture. These were combined with full-thickness skin grafts (34), internal (55) or external (23) retractor plications, and inverting sutures (4) as required to correct the lid malposition. MAIN OUTCOME MEASURES: Recurrence of horizontal laxity or lid malposition and suture related complications were the main outcome measures. Suture related wound infection was diagnosed clinically by the presence of pus associated with wound breakdown. RESULTS: One patient failed to reach 3-month follow-up and was excluded. There was one recurrence of horizontal laxity after a mean follow-up period of 9.1 months. Four patients developed lateral canthal wound infections, compared with none at the other operative sites. The 95% confidence intervals for infections in the tarsal strip procedure were 1.1% to 9.6%, which were significantly greater than zero (P < .0001), the infection rate for the other procedures. CONCLUSION: A 6-0 absorbable suture may be used for the lateral tarsal strip and does not lead to a recurrence of horizontal laxity. It does not appear to reduce the wound infection rate associated with this procedure.
PURPOSE: To evaluate amniotic membrane transplantation (AMT) for ocular surface reconstruction in Stevens-Johnson syndrome (SJS). DESIGN: Prospective interventional case series. PARTICIPANTS: Ten consecutive patients (10 eyes) with SJS that underwent AMT as the first step in staged ocular surface reconstruction were included. METHODS: Amniotic membrane was processed under sterile conditions from a fresh placenta obtained from cesarean section in a seronegative pregnant woman and stored at -700 degrees C. Symblepharon release, excision of epibulbar fibrous tissue, and clearing of the fibrovascular membrane over the cornea was performed in all cases. Amniotic membrane covered the entire bulbar surface up to the fornices in five eyes; cornea and the perilimbal area in two eyes; cornea, the inferior bulbar surface, and the lower fornix in two eyes; and cornea and the superior bulbar surface in one eye. Obliterated fornices were deepened by use of fornix-formation sutures in all eyes. Symblepharon ring was placed postoperatively for 3 weeks to 2 months. Mean postoperative follow-up was 13.5 months (SD, +3.8 months; range, 9-30 months). MAIN OUTCOME MEASURES: Restoration of adequate bulbar surface free of symblepharon and good fornix depth were the main outcome measures. RESULTS: Complete corneal reepithelization occurred in all eyes between 1 and 6 weeks. Adequate bulbar surface and fornix depth were achieved in nine eyes, all of which were free of symblepharon at the final follow-up visit. Cicatricial entropion resolved in four of five lower eyelids and one of two upper eyelids after AMT. One patient had a central corneal melt that required or necessitated a penetrating keratoplasty. CONCLUSIONS: AMT restores adequate bulbar surface and fornix depth and prevents recurrence of symblepharon in severe cases of SJS.
OBJECTIVE: To describe a simple grading system for medial canthal tendon (MCT) laxity and measure its reproducibility. STUDY DESIGN: Observational case series and interobserver variability study. PARTICIPANTS: Fifty subjects (100 lower eyelids) without eyelid disease. The age range was 19 to 98 years. METHODS: Subjects without eyelid pathology or previous surgery were selected. Two ophthalmologists assessed the position of the inferior punctum in relation to the cornea with the patient in primary gaze. Two measurements were made, the first with the lower eyelid at rest and then with the lateral distraction test. Both observers were masked to the other observer's measurements. MAIN OUTCOME MEASURES: Kappa statistics to show the strength of agreement between the two observers for the resting and lateral distraction eyelid positions. RESULTS: High kappa values were found for resting position (agreement in 92 of 100 eyelids) and for lateral distraction testing (agreement in 85 of 100 eyelids). The range of resting positions was from position -1 to position 1. The range of laterally distracted positions was from position 0 to position 5. Overall, a very high level of agreement was achieved between observers. CONCLUSIONS: This grading system for MCT laxity is simple, easy to learn and reproducible, easier than measuring in millimeters, and has an advantage over merely saying the tendon is "lax" or "not lax." We propose this standardized grading system in the evaluation of patients with entropion and ectropion to identify those patients who may benefit from MCT stabilization/plication.
The transconjunctival inferior fornix incision provides access to the floor, rim, lateral, and inferior medial walls of the orbit. Complications of this surgical approach to the orbit are known to be rare but heretofore have not been clearly defined. Over an 8-year period, in an estimated 1200 cases, the authors have encountered cicatricial entropion, lower eyelid retraction, canthal dehiscence, lower eyelid avulsion, canalicular laceration, buttonhole laceration of the lower eyelid, conjunctival chemosis, and lacrimal sac laceration. Attention to anatomic landmarks and sound surgical execution will prevent these complications in most patients.
We describe a 46-year-old woman with multiple symmetrical papulocystic lesions on the face, neck, chest, back, and upper arms since childhood. Vermiculate atrophoderma, entropion, and progressive loss of eyelashes was also noted. Since the age of 30, 12 basal cell carcinomas have developed on the face. Histopathologic examination revealed multiple anastomosing nests and strands that arose from the lower part of a hair follicle in early lesions. In more advanced lesions, multiple keratinizing microcysts within a moderately sclerotic stroma were noted in the upper and mid dermis. In some biopsy specimens, focal areas showing sweat gland (ductal) and sebaceous differentiation were also observed. Basal cell carcinomas developed from the basaloid component of the hamartomatous proliferation.
PURPOSE: The surgical procedures used until now to rebuild the conjunctiva in patients affected by ocular cicatricial pemphigoid (OCP) have not demonstrated appreciable anatomical and functional success. This study reports the postoperative clinical and cytological outcomes of a human amniotic membrane transplantation (AMT) to rebuild the conjunctiva in a case of late stage OCP. METHODS: We present a 75-year-old woman with a severe form of pemphigoid with entropion, trichiasis, symblepharon and blunting of the fornices, who underwent excision of the scarred and inflamed tissue covering the ocular surface and AMT. RESULTS: Our data show an improvement of the ocular surface condition, with reacquired fornix depth, reduced inflammation and presence of goblet cells at each follow-up. CONCLUSION: Amniotic membrane transplantation was successful as a first step procedure to reduce inflammation and to rebuild a physiological conjunctival epithelium in late stage OCP.
The typical signs of the postenucleation socket syndrome consist of enopthalmos, shallow lower fornix, lower lid laxity and entropion, and ptosis. It causes discomfort and can render the bearing of a prosthesis uncomfortable or impossible. The signs must be corrected in single or combined procedures. The lower fornix and the lids can be corrected with good success, enophthalmos is difficult to correct, however.
Results of surgical correction of senile entropion employing the method described by Fox are analysed and discussed, using both subjective and objective assessment criteria. Out of 64 lower eyelids that were operated on 16 to 58 months before follow-up, the functional or cosmetic result was fully satisfactory in about 70%.
Several pathologic processes can disturb the complex structures of the eyelids and orbital tissues and the muscles that enable their proper function. Some disorders, such as entropion and ectropion, are usually acquired in later years from laxity of supporting structures. Blepharoptosis has a range of causes, from aging to an intracranial aneurysm, and its severity varies, from mild to almost complete closure of the lid fissures. Graves' orbitopathy can produce lid retraction, lid lag, and proptosis and can cause vision-threatening conditions. Orbital cellulitis produces pain, swelling, proptosis, and redness of the lids and conjunctivae and, if severe, can compromise ocular motility and visual acuity. Early recognition of the specific disorder and prompt and adequate treatment are essential to spare the patient discomfort and ensure preservation of vision.
Hard palate mucosa grafts are an excellent replacement for tarsus and conjunctiva in eyelid reconstruction. Twenty-five eyelids from 18 patients underwent eyelid reconstruction using hard palate mucosa grafts. Patients were treated for a variety of disorders including postblepharoplasty lower eyelid retraction, cicatricial entropion, eyelid retraction secondary to thyroid eye disease, and lagophthalmos following surgery for paralytic ptosis. Surgical results were evaluated, grafts were measured for postoperative shrinkage, and donor site healing was recorded. Several patients had hard palate biopsy specimens evaluated. One of these patients also had a graft biopsied after it had been in place for 3 months. A review of hard palate anatomy and histology and a discussion of surgical technique are presented.
Ophthalmic manifestations are a common component of the ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome; however, few ophthalmic publications have specifically addressed these features. The authors describe a 38-year-old patient with EEC syndrome who demonstrated several associated ocular signs and symptoms. The ophthalmic findings in this patient included bilateral entropion with secondary trichiasis, and shallow inferior fornices with symblepharon. Interestingly, the patient also had vertically deficient tarsi and absence of the meibomian glands. Ophthalmologists should be aware of the ocular signs and symptoms associated with EEC because some manifestations can potentially be sight threatening.
PURPOSE: Trauma and infection sometimes produce lower lid malpositions that are difficult to repair cosmetically with standard canthoplasty techniques. A new variation is described. METHODS: Surgical techniques of the tarsal strip canthoplasty and of lateral tarsorrhaphy are combined into the tarsal sandwich. RESULTS: Representative cases with preoperative and postoperative photos are presented. CONCLUSION: The sandwich technique allows the surgeon more flexibility in achieving the necessary vertical lift of the lateral canthus in difficult cases of entropion, ectropion, and lagophthalmos.
PURPOSE: To report the clinical and histopathologic findings of a patient with sarcoidosis causing bilateral destruction of the lower eyelids. METHODS: Case report. RESULTS: Bilateral destructive lower eyelid lesions and cicatricial entropion developed in a 43-year-old man with systemic sarcoidosis. Histopathology was consistent with sarcoid granulomas. Disease progression was arrested with systemic prednisone and methotrexate before eyelid reconstruction was performed. CONCLUSIONS: Sarcoidosis very rarely can cause destruction of full-thickness eyelid architecture. Active inflammation should be controlled before reconstruction.
An instrument is designed to measure the distractibility or horizontal laxity of the lower eyelid. It gives precise measurement of laxity independent of the examiner. It enables the surgeon to determine when and how much tightening of the lower eyelid is necessary to achieve the desired result in repair of entropion or ectropion and in cosmetic blepharoplasty.
Lateral canthoplasty is a useful method to restore eyelid function and to protect the ocular surfaces. The success of the procedure depends on the proper analysis of periorbital anatomy as it relates to the specific indication for lateral canthoplasty. We report the experience with 1565 lateral canthoplasties with emphasis on the evaluation of newer techniques that better address anatomic and functional requirements. Between 1981 and 1994, 1565 lateral canthoplasties were performed in 684 patients. Of these, 1369 "reconstructive" lateral canthoplasties were performed in 586 patients and 196 "cosmetic" lateral canthoplasties were performed in 98 patients. All operations were performed by a single surgeon (Jelks), and follow-up ranged from 1 to 14 years. The evolution of the operative technique for lateral canthoplasty has been toward an operation that corresponds with the anatomy of the individual. Indications for the procedure include lateral canthal dystopia, horizontal lid laxity, ectropion, entropion, lid margin eversion, lid retraction with or without soft-tissue deficiency, and aesthetic improvement. The types of procedures performed will be reviewed in detail. The evaluation of the newer forms of lateral canthoplasty as unique reconstructive tools and as adjuncts to aesthetic surgery will be discussed.