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PubMed1982

Histopathology of meibomian gland dysfunction.

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.

Aged↗
PubMed2004

Pivot point and secondary defect problems with rotation flaps.

PURPOSE: Our goal was to evaluate 2 design properties, pivot point and secondary defect, that affect the results of rotation flaps used to treat skin cancer defects of the head and neck. MATERIALS AND METHODS: We conducted a retrospective review of the last 50 patients who underwent rotation flaps for closure of skin cancer defects on the head and neck with regard to postoperative complications. RESULTS: Four patients experienced complications, all of which were managed to an acceptable conclusion. These complications included tip necrosis and ectropion. CONCLUSION: Rotation flaps, although simple in design, are often modified during their execution. Understanding the basic design and possible modifications of pivot point and secondary defect will yield a successful outcome.

Adult↗
PubMed2003

Acquired external punctal stenosis: etiology and associated findings.

UNLABELLED: PURPOSE; To investigate the underlying causes of acquired external punctal stenosis (AEPS) and assess the associated tear drainage problems. DESIGN: Prospective, noncomparative observational case series. METHODS: Seventy-eight eyes of 52 patients with symptomatic AEPS were prospectively assessed by or under supervision of a consultant oculoplastic surgeon from June 1999 to October 2002. The severity of the stenosis was graded on clinical examination. Associated findings from ophthalmic examination, diagnostic probing, and irrigation were recorded. The chi(2) test with 95% confidence interval (CI) and the Fisher exact test were used for statistical analysis. RESULTS: The age range was 39 to 90 years (mean, 69.4 years). Acquired external punctal stenosis was due to chronic blepharitis in 35 eyes (45%), unknown etiology in 21 eyes (27%), ectropion in 18 eyes (23%), and related to drugs in 4 eyes (5%). Associated canalicular stenosis and common canalicular stenosis with obstruction (at the level of the internal punctum) was found in 36 eyes (46%) with AEPS. Nasolacrimal duct stenosis (5 eyes) or obstruction (2 eyes) was found in 8.5%. The number of patients with associated canalicular and common canalicular stenosis increased with increasing age (95% Confidence Interval [CI] = 0.03-0.04, P =.03) and duration of symptoms (95% CI = 0.02-0.03, P =.02). The number of patients with associated nasolacrimal duct stenosis and obstruction increased with increasing age (95% CI = 0.000- 0.001, P =.001) and in AEPS with unknown etiology (95% CI = 0.004-0.006, P =.003). CONCLUSIONS: Chronic blepharitis is a common cause of AEPS even after treating the blepharitis, but in a significant number of patients there is no apparent etiology. Associated upper and lower tear drainage stenosis should be considered in the preoperative evaluation and surgical plan for AEPS.

Adult↗
PubMedDate not supplied

Poland-Moebius syndrome: a case report.

BACKGROUND: The primary site of pathology in Moebius syndrome is still unknown, although several studies have variably localized the lesion in the extraocular muscles, cranial nerves, or central nervous system. CASE: A 24-year-old man with Poland-Moebius syndrome and acquired progressive bilateral paralytic lower eyelid ectropion is described. OBSERVATIONS: In this patient, magnetic resonance imaging studies revealed a barely detectable pontine hypoplasia and normal recti muscles. Nerve conduction studies of the facial nerves showed a severe demyelinating or dysmyelinating type of neuropathy. Bilateral lower eyelid ectropium of the patient was successfully corrected by canthal tightening procedures. CONCLUSION: Contrary to many reported cases, this patient serves as a rare example of a progressive type of Poland-Moebius syndrome presumably resulting from a combination of a brainstem abnormality and a peripheral neural degenerative process.

Adult↗
PubMed1988

Anoplasty.

Because of the anatomic variations of stricture or ectropion, the surgeon should master several of the techniques quoted here. These methods may have to be modified in selected patients, but all changes should be based on sound anorectal plastic principles.

Anal Canal↗
PubMed1982

Surgical treatment of the denervated or sagging lower lid.

Paralytic ectropion of the lower eyelid and increased curvature of the lower eyelid associated with anophthalmos both cn be optimally treated by use of an autogenous fascia lata sling. Some patients also have problems with prosthesis retention due to lower eyelid deformity with a shortened inferior fornix. In some instances, it is also necessary to perform a horizontal shortening operation on the lower eyelid. In anophthalmic patients, the relationship between prosthesis size and weight and a sagging lower lid is discussed. In some patients when the lower eyelid is elevated, the patient then has an upper lid ptosis for which it is necessary to perform an appropriate levator shortening operation. Surgical technique and illustrative pre- and post-operative photographs are shown.

Blepharoptosis↗
PubMed1983

Avoidance of complications in lower lid blepharoplasty.

The most common complication of lower lid blepharoplasty is lower lid malposition either lower lid retraction or frank ectropion. This is caused by the vertical pull of skin shortage or shrinkage on a lax tarso-ligamentous sling. A method of tightening the tarso-ligamentous sling combined with a lower lid blepharoplasty is presented. An alternate method of lower lid fat removal through the fornix without skin incision is presented to be used in patients with taut lower lid skin.

Adipose Tissue↗
PubMed2002

Treatment of bilateral severe eyelid burns with skin grafts: an odyssey.

Eyelid burns occur in about 10% of thermal injuries and pose a considerable challenge for the reconstructive surgeon. A consensus on a treatment regime has not been reached and plastic surgeons are divided on the subject. A case of severe bilateral eyelid burns was treated with full- and split-thickness skin grafts. The patient was first operated at 2 years post-injury, and a total of 5 operations in 5 years were necessary to address recurrent ectropion of both upper and lower eyelids.

Adult↗
PubMed1991

Eyelid surgery in facial palsy.

Paralysis of the orbicularis oculi muscle is by far the most serious consequences of loss of function of the facial nerve. The severity of the resultant ocular problems is related to the degree and duration of this paralysis. The primary goal of the ophthalmologist in managing the patient with orbicularis oculi paralysis is to protect the cornea. The alleviation of epiphora, correction of paralytic ectropion, and amelioration of the resultant cosmetic deformities are secondary goals. The major factor in determining the most appropriate therapeutic approach in the management of the patient with a facial paralysis is whether the paralysis is temporary or permanent. In temporary paralysis, conservative methods of treatment are usually adequate and are well documented. In permanent orbicularis paralysis, the development of lid abnormalities is inevitable, and corrective lid procedures are required. The procedures required depend on the resultant dysfunction and degree of deformity. This study reviews 65 patients who underwent surgical treatment for the ophthalmic consequences of established and permanent facial palsy in order to evaluate the efficacy of their treatment.

Adult↗
PubMed2002

A previously unreported syndrome of multiple scalp whorls and associated anomalies.

A 13-month-old male infant with 14 hair whorls in the scalp, sparse frontal hair, wide forehead, ectropion, abnormal implantation of eyelashes, peculiar face and depigmented nipples is reported. Other aspects of his physical and mental development were within normal limits. The constellation of clinical features in this patient appear to represent a previously undescribed syndrome.

Abnormalities, Multiple↗
PubMed2001

Transcaruncular medial orbitotomy for stabilization of the posterior limb of the medial canthal tendon.

PURPOSE: A method to stabilize the posterior limb of the medial canthal tendon (MCT), using a transcaruncular medial orbitotomy (TMO) approach, is described in a stepwise fashion. The technique described is a modified version of procedures published by Ritleng, Crawford and Collin, and Fante and Elner METHODS: A prospective clinical evaluation of MCT stabilization via the TMO approach was undertaken in I I consecutive patients who presented with MCT laxity as one of the features of their ectropion. These cases are initially described in detail in two representative case reports, and summarized in 11 cases. The stepwise surgical approach is outlined. RESULTS: All patients had improved symptomatology in terms of epiphora and comfort. Furthermore, in all cases the lid position was improved or normalized. In four of the I cases (36%) the lower punctum did not ultimately reside in the lacrimal ake, but the punctal position was nevertheless improved and the MCT was stabilized. CONCLUSION: The TMO procedure provides both excellent MCT stabilization and adequate placement of the lower lacrimal punctum onto the globe. It does not require canalicular resection, and avoids continued anterior displacement of the medial lower lid which may occur when only the anterior limb of the MCT is addressed surgically.

Aged↗
PubMed2000

Restoration of lower eyelid support in facial paralysis.

Lower eyelid dysfunction in the patient with facial paralysis is frequently the result of several deleterious factors, including the loss of orbicularis tone, involutional changes in the canthal ligaments, the effect of aging on the midfacial soft tissue structures, and malposition of the lower eyelid punctum. This dysfunction is manifested as lagophthalmos, ectropion, and epiphora. Fortunately, there are several surgical methods by which the various abnormalities can be corrected or compensated for. This article addresses the management of the lower eyelid and several of the current methods available to the surgeon for management of the lower eyelid in facial paralysis.

Ear Cartilage↗
PubMed1985

Common eyelid and orbital problems.

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.

Aged↗
PubMed2000

Supratrochlear artery flap for the repair of lower eyelid defects.

An island pattern flap in the treatment of lower eyelid cicatricial ectropion is described. The flap is based on the supratrochlear artery and its associated veins. The donor site can be closed easily primarily. The very thin thickness of the pedicle increases the rotational arc of the flap. However, this procedure requires two stages and there is a slight bulkiness of the flap, both of which are major drawbacks of this method. This flap was used to restore missing supporting soft tissue of the lower eyelid in the clinical cases described herein.

Blepharoplasty↗
PubMed1992

Soft-tissue alterations associated with acute, extended open reduction and internal fixation or orbital fractures.

Soft-tissue alterations associated with radical degloving of the overlying soft tissues during extended open reduction and rigid internal fixation of facial fractures involving 51 orbits in 36 patients were studied. In all patients, the blepharoplasty skin muscle flap incision was employed in conjunction with, as necessary, a gingivobuccal sulcus and coronary incisions. Patients were evaluated between 6 and 20 months after surgery. Physical examination and standardized photographs were used for assessment. Ectropion developed in 2 lids (4%), and 10 lids (20%) had increased scleral show. Thirteen of the 51 lids (25%) revealed lateral canthal displacement; all 13 lids underwent canthal stripping. Cheek pad displacement developed in 8 patients (22%), all of whom had complete maxillary degloving without soft-tissue resuspension. No patient had frontal nerve palsy. Depression in the temporal area was noted in all patients in whom the temporalis was mobilized. Remote incisions and soft-tissue degloving used for extended open reduction and internal fixation are associated with morbidity that can be minimized by meticulous technique and soft-tissue repositioning at closure.

Adolescent↗
PubMed1989

Ophthalmic manifestation of metastatic basal cell carcinoma.

A case of metastatic basal cell carcinoma is reported that presented as a tearing problem caused by a paralytic ectropion from a metastasis to the parotid gland affecting the seventh cranial nerve. Features of metastatic basal cell carcinoma are discussed.

Aged↗
PubMed1991

Reanimation of the paretic eyelid using gold weight implantation. A new approach and prospective evaluation.

Sixty-one lid-loading procedure, performed by the author, were evaluated prospectively. Simple, gold weight implantation, combined with lower lid retractor recession, placement of fascia lata, and lateral tarsal strip tightening is effective for promoting voluntary closure and correction of lower lid paralytic ectropion. Placement of a heavier gold weight, in combination with mullerectomy, is a reliable new approach for mimicking involuntary blink without ptosis.

Blinking↗