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PubMed1987

Modification of Bick's procedure for treatment of eyelid laxity.

A modification of Bick's procedure is presented that offers a simple, effective treatment of ectropion and entropion secondary to eyelid laxity. A full-thickness lid-shortening procedure performed at the lateral canthus avoids lid notching, with good cosmetic results. The success of the procedure is determined by suture of the tarsus directly to the orbital periosteum. The modification of Bick's procedure improves the outcome of the operation and simplifies its performance.

Aged↗
PubMed1977

Overcorrections of the Wies procedure.

The Wies procedure may be complicated by an overcorrection, which is in effect a cicatricial ectropion. Four cases of such a complication are presented. The mechanism of an overcorrection is related to the level of the incision in the lid and to the suture placement. Correction of this complication primarily involves lysing cicatricial bands maintaining the overcorrection. Placement of sutures maintains the lid in a normal position.

Adult↗
PubMed1987

Complications of eyelid reconstruction using a semicircular flap.

Complications of the semicircular flap technique of eyelid reconstruction include lateral canthal webbing, ectropion, lid notching, symblepharon, and tissue fullness of the lateral lid. These difficulties occur infrequently and rarely cause significant problems. Attention to surgical details, however, can minimize unfavorable results. It should be emphasized that the semicircular flap remains a superb technique for reconstruction of defects involving up to 80% of the lower eyelid.

Ectropion↗
PubMed1986

The development of a new tissue expander for use in ophthalmic plastic surgery.

We describe the first-time use of the tissue expansion principle in oculoplastic surgery. We have designed a tissue expander for use in eyelid surgery. This instrument was successfully used to treat difficult cases of cicatricial ectropion from multiple causes, avoiding the need for tissue grafting. It was also utilized preoperatively so a large forehead scar could be removed with good resultant cosmesis. The potential for this device in oculoplastic surgery is exciting.

Adult↗
PubMedDate not supplied

[Ocular manifestations in progeria].

The observation of a 17-year-old teenager with progeria, ventricular septal shortcoming with wide anterolateral [correction of arteriolateral] myocardial ischemia. From an ocular point of view, he shows senescence with senile ectropion, evolutive cataract, retinal angiosclerosis. The role of the manifestation of ocular senescence in Hutchinson-Gilford Syndrome is emphasized.

Adolescent↗
PubMed1993

High-frequency radio wave electrosection of full-thickness eyelid tissues.

The Ellman Surgitron, commonly used in dermatology practice, is an electrosurgical instrument with a high-frequency waveform that is modified by filtering and undamping the current so that an almost pure cut is possible, yet with a small amount of coagulation. This device was used in six patients undergoing full-thickness eyelid resection (unilateral in three and bilateral in three) for involutional entropion or ectropion. Nine lid margins were cut with scissors, and nine with the electrosurgical instrument. The latter was found to cause minimal tissue damage and to modify the superficial epithelial cell layer very slightly, without causing it to slough. The tissue was cut cleanly, with less bleeding than occurred with scissors incision.

Cautery↗
PubMed1996

[The contribution of Germanicus Mirault to maxillofacial surgery in general and to surgery of the cleft lip in particular].

Germanicus Mirault is a French surgeon born in Angers in 1796. With Malgaigne, he was the first to introduce the concept of flap transposition for closure of a cleft-lip. This skillful and innovative surgeon made also very important contributions to other fields of maxillofacial surgery, including the first ligature of the lingual artery on a human being in 1833 and a method of temporary occlusion of the eyelids to correct a post-burn ectropion which is still used now. This latter work was awarded by the "Académie des Sciences" in 1869.

Cleft Lip↗
PubMed1998

Monopolar electrosurgical flash fire.

A 78-year-old man underwent ectropion repair with a monopolar electrosurgical unit. A flash fire occurred, resulting in a loss of eyelashes of the left upper and lower eyelids. A retrospective analysis of the case was conducted, including a review of the relevant literature. Although rare, the possibility of a flash fire should be considered when performing surgery with an electrosurgical unit. Minimizing supplemental oxygen and electrosurgical power settings may help to avoid such an incident.

Aged↗
PubMed1998

[Isolated and primary palpebro-conjunctival amylosis. Apropos of 2 cases].

Ocular amyloidosis a an uncommon condition and conjunctival involvement rarely occurs, representing 15% of all ocular localizations. Clinical manifestations show a polymorphism requiring a histological diagnosis. Based on two cases of primary isolated conjunctivo-palpebral amyloidosis, we discuss the different ocular sites. The first case involved false ptosis, a conjunctival infiltration and a lower eyelid tumefaction; all located in the left eye. The second case had ptosis, a right lower eyelid tumefaction with ectropion and esthetic damage. Amyloidosis was confirmed at histologic examination of the conjunctival mucous after a special congo red coloration. In order to affirm the isolated conjunctival localization, it is necessary to eliminate another amyloidis site. The treatment was surgical with excision and cure of ptosis. Ocular amyloidosis is a rare condition with polymorphism manifestations. Confirmation is histological. The greatest difficulty is management due to disease recurrence.

Adult↗
PubMed2004

Harlequin fetus.

We report a case of harlequin fetus born to the consanguineous parents. She had the typical skin manifestations of thick armour like scales with fissures, complete ectropion and eclabium, atrophic and crumpled ears and swollen extremities with gangrenous digits. Supportive treatment was given but the neonate died on the 4th day.

Consanguinity↗
PubMed1987

Xeroderma pigmentosum. Cutaneous, ocular, and neurologic abnormalities in 830 published cases.

Quantitative frequencies of clinical abnormalities in xeroderma pigmentosum were estimated by abstracting published descriptions of 830 patients in 297 articles obtained from a survey of the medical literature from 1874 to 1982. The median patient age was 12 years with nearly equal numbers of male and female patients. Cutaneous symptoms (sun sensitivity or freckling) had a median age of onset of between 1 and 2 years. Forty-five percent of the patients described had basal cell carcinoma or squamous cell carcinoma of the skin. The median age of first nonmelanoma skin cancer among patients with xeroderma pigmentosum was 8 years, more than 50 years less than that among patients with skin cancer in the United States. Melanomas were reported in 5% of patients. Ninety-seven percent of the reported basal and squamous cell carcinomas and 65% of the melanomas in patients with xeroderma pigmentosum occurred on the face, head, or neck. Seventy percent probability of survival was attained at age 40 years, a 28-year reduction in comparison with the US general population. Ocular abnormalities were reported in 40% of the patients described and were restricted to tissues exposed to ultraviolet radiation (lid, conjunctiva, and cornea) and included ectropion, corneal opacity leading to blindness, and neoplasms. Neurologic abnormalities were found in 18% of the cases reported, consisting of progressive mental deterioration, hyporeflexia or areflexia, and progressive deafness in some patients in association with dwarfism and immature sexual development. There was scant information concerning the efficacy of any therapeutic regimen.

DNA Repair↗
PubMedDate not supplied

Long-term results of lower-lid suspension blepharoplasty: a 30-year experience.

BACKGROUND: Muscle suspension blepharoplasty remains a reliable method to tighten the loose skin and muscle of the lower eyelid. OBJECTIVE: To evaluate the 30-year experience of the senior author (N.J.P.) with the skin-muscle suspension technique for lower-lid blepharoplasty. PATIENTS AND METHODS: Of 4395 patients who underwent lower-lid blepharoplasty, 3988 had muscle suspension blepahroplasty performed with adequate follow-up. RESULTS: Results of the 30-year review showed that most patients were very satisfied with the procedure. There were 67 complications (2 hematomas, 1 poor scar, 24 cases of scleral show <1 mm, and 40 cases of chemosis). Chemosis resolved in 2 to 8 weeks, and there were no cases of ectropion, scleral show greater than 1 mm, dry eye, or vision loss. Revision surgery was needed in 41 patients, all of whom were satisfied after the secondary procedure. CONCLUSION: Despite the recent drift toward orbital fat preservation for lower-lid blepharoplasty, conventional lower-lid muscle suspension offers the surgeon a reliable method to tighten the loose skin and muscle of the lower eyelid and give the patient a more attractive, youthful appearance.

Blepharoplasty↗
PubMedDate not supplied

Use of precontoured positioning plates and pericranial flaps in midfacial reconstruction to optimize aesthetic and functional outcomes.

OBJECTIVES: To present our experience with reconstruction of midfacial defects using "precontoured positioning plates" with or without pericranial flaps and to describe our technique in detail. METHODS: Thirty-two consecutive patients with midfacial defects subsequent to oncologic resection that were reconstructed primarily with cranial bone grafts and precontoured positioning plates were reviewed for type of defect, functional outcome, complications, and postoperative appearance. RESULTS: Primary reconstruction of all defects in this series was performed. Defects involved the orbital rim, orbital floor, or both in 28 patients (88%), the body of the zygoma in 24 patients (75%), and extended to the skull base in 16 patients (50%). Pericranial flaps were used to cover the bone grafts in 22 patients (69%). Postoperative radiotherapy was performed in 22 patients (69%), preoperative radiotherapy in 5 (16%), and the other 5 (16%) had no radiotherapy. There were no intraoperative complications, and postoperative complications included plate exposure (n = 2), ectropion (n = 3), and partial bone graft loss or resorption subsequent to completion of radiotherapy (n = 2). Postoperatively, appearance was excellent in 24 patients, fair in 6 patients, and poor in 2 patients. Secondary reconstructive procedures were performed in 4 patients (12%). Follow-up ranged from 12 months to 6 years (median, 4.2 years). CONCLUSIONS: Precontoured positioning plates with or without pericranial flaps enable precise reconstruction of midfacial defects with precise incorporation of cranial bone grafts. In our series we routinely covered the bone grafts with well-vascularized tissues, leading to a low incidence of complications and excellent aesthetic results.

Adolescent↗
PubMed1999

Combined trabeculotomy and trabeculectomy as an initial procedure in uncomplicated congenital glaucoma.

OBJECTIVE: To review the results of combined trabeculotomy and trabeculectomy as a primary procedure in congenital glaucoma. METHODS: A retrospective review of 100 consecutive eyes in 60 children undergoing surgery from December 30, 1991, to April 17, 1996. Features at initial examination, ie, corneal size and clarity, presence or absence of anterior segment structural abnormalities, and intraocular pressure (IOP), were noted. Data pertaining to perioperative use of mitomycin and the occurrence of complications were collected. After surgery, all patients had IOP, corneal integrity, and any postoperative complication recorded under chloral hydrate sedation. RESULTS: Mean preoperative IOP was 31 mm Hg. Average horizontal corneal diameter was 12.60 mm. Ninety-five eyes had corneal opacification. Twenty-nine eyes had additional anterior segment anomalies, with ectropion uveae (n = 11), Peters anomaly (n = 9), and partial aniridia (n = 7) being the most common. Mitomycin (0.2 or 0.4 mg/mL) was used in 87 eyes. Eleven eyes sustained hyphemas during or just after surgery. Total average follow-up was 304 days. Eyes in which no coexistent anterior segment anomalies were present had a 78% (49 eyes) operative success (IOP, <21 mm Hg); however, in eyes with associated anterior segment anomalies, the success rate was much lower (45% [18 eyes]). The difference in success rates between both groups was statistically significant (P = .03, chi2 test). CONCLUSIONS: Primary combined trabeculotomy and trabeculectomy was a useful initial procedure in uncomplicated congenital glaucoma. This was particularly true where corneal opacification, as in nearly all our eyes, precluded goniotomy, however, where other stigmata of anterior segment dysgenesis coexisted, results were significantly poorer.

Chemotherapy, Adjuvant↗
PubMed2001

Pediatric enucleation: analysis of volume replacement.

OBJECTIVES: To determine the percent volume replacement by an implant and prosthesis, the long-term sequelae of poor volume replacement, and specific guidelines for volume replacement in pediatric patients. METHODS: A retrospective observational study of 16 pediatric patients who underwent enucleation (group 1) and 31 adult patients enucleated in childhood (group 2) was performed. The total volume replacement and the volume replacement by the implant were determined. The incidence of secondary surgical procedures for superior sulcus deformity, enophthalmos, ptosis, ectropion, and socket contraction was determined. RESULTS: The average percent volume replaced by the implants in group 1 patients was 68%. The average percent volume replaced by the implants in group 2 patients was 21%. Seventy-one percent of patients in group 2 underwent secondary implant surgery to augment volume and eliminate superior sulcus deformity and enophthalmos. CONCLUSIONS: The placement of an adequately sized implant in pediatric patients may obviate the need for secondary augmentation of socket volume in adulthood. The authors suggest an implant 2 mm less in diameter than the axial length of the eye in pediatric patients.

Adolescent↗
PubMed1975

Iris nevus (Cogan-Reese) syndrome. A cause of unilateral glaucoma.

Fourteen patients (ten women, four men) with iris nevus (Cogan-Reese) syndrome, all having unilateral glaucoma, were studied clinically. Many had corneal edema, and all had changes in the iris consisting of one or more of the following: iris whorls or nodules or both, atrophy of iris stroma, heterochromia (the darker iris usually involved), or ectropion uveae. All had peripheral anterior synechias. Material for histological study was available from ten patients and showed a nonmalignant diffuse nevus of the anterior surface of the iris. An overgrowth of endothelium and Descemet membrane extending onto the iris surface may be a characteristic part of the process. Patients tended to be women in middle age. Conservative treatment avoiding enucleation is advised. Whenever a patient with suspected iris nevus syndrome or essential iris atrophy is subjected to glaucoma surgery, a biopsy specimen of the iris should be obtained for histological study.

Adolescent↗
PubMed1977

The clinical spectrum of posterior polymorphous dystrophy.

We examined 61 affected members of eight families with an inherited corneal dystrophy. The corneal abnormalities varied greatly from one member of a family to another. Some patients had only a few isolated endothelial vesicles, while others in the same family had severe secondary stromal and epithelial edema. In some patients edema was present at birth or in early childhood; in others it developed later in life. The wide variation of corneal abnormalities suggests the possibility that several conditions previously described as separate disease entities, such as grouped vesicles, Schnyder's posterior herpes, posterior polymorphous dystrophy, and congenital hereditary endothelial dystrophy, are part of the clinical spectrum of expression of a single familial corneal dystrophy. Some affected family members also had ocular hypertension or open-angle glaucoma. Broad iridocorneal adhesions were present in some of the patients with glaucoma and in others with normal intraocular pressures. Other ocular abnormalities present in a few patients include pupillary ectropion, "glass membranes" on the anterior iris surface, and bands in Descemet's membrane. The transmission in most of the families was autosomal dominant. In two families it appeared to be autosomal recessive.

Adolescent↗
PubMed1979

The tarsal strip procedure.

We have developed a procedure that is particularly useful for (1) paralytic or senile upper and lower eyelid laxity, (2) lateral canthal tendon laxity or malposition, and (3) iatrogenic phimosis associated with recurrent entropion or ectropion after traditional lid-shortening procedures. Lateral canthal tendon laxity or elongation is the primary problem in the majority of these cases, and eyelid tightening with use of lateral tarsal strips corrects this deformity. The midtarsal portion of the eyelid, which is usually resected in traditional lid-shortening procedures, is seldom elongated, and recurrences of laxity are common secondary to further stretching of lax tendons. The technique involves a lateral canthotomy and transection of the appropriate crus of the lateral canthal tendon. The eyelid is then split into anterior and posterior lamellae, and tarsal strips are fashioned from the posterior lamella. The tarsal strips are sutured to periosteum at the lateral orbital wall, adjusting the height and tension of the lateral canthus. This technique gives a normal appearance to the lateral canthal angle and has yielded good results in 51 cases.

Aged↗