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PubMed2005

Familial Bell's palsy in females: a phenotype with a predilection for eyelids and lacrimal gland.

The authors report a family with familial Bell's palsy affecting seven individuals, six of whom are females. This is a distinct subtype of Bell's palsy with a predilection for juvenile females, previously reported only very rarely. In conjunction with a review of the literature, this case suggests that this phenotype carries with it a greater risk of serious complications affecting the eyelids and lacrimal gland. These carry significant functional and cosmetic implications owing to aberrant regeneration of the seventh, sixth and possibly third cranial nerves, chronicity and relapses. Clinical features include synkinesis of the eyelids with the orbicularis oris causing synkinetic ptosis, recurrent paralytic ectropion, paralysis of facial muscles of expression with dry eye, hyperlacrimation (crocodile tears), and transient strabismus. Clinically, the decision to offer surgery in place of conservative treatment should consider the natural history of chronicity and relapses often seen with this subtype of familial Bell's palsy. Botulinum toxin injections are especially versatile in managing the complications associated with this phenotype.

Adult↗

PubMed2005

Periocular necrotising fasciitis--a case report.

PURPOSE: To document the step-by-step reconstructive surgical rehabilitation, over a 12-month period, of a patient with severe periocular necrotising fasciitis. METHODS: This is a retrospective interventional case note review of a 68-year-old man who developed necrotising fasciitis a few days after an insect bite. He had severe facial cellulitis with subsequent necrosis of all four eyelids despite broad spectrum antibiotics. RESULTS: The initial management included performing a wide surgical debridement, with the removal of infected and necrotic tissue extending bilaterally from the forehead to the mouth. Split skin grafts were used to cover the extensive tissue defects. Subsequent horizontal eyelid shortening and full-thickness skin was required to correct severe cicatricial ectropions, eyelid displacement and improve lagophthalmos. CONCLUSIONS: Necrotising fasciitis is an acute fulminant infection of the subcutaneous fat and deep fascia. The initial appearance may look like cellulitis but necrosis quickly follows. Facial disease with extensive periocular involvement represents a significant management challenge.

Aged↗

PubMed1987

Pneumococci in ocular disease of children and their treatment.

A total of 171 isolates of Streptococcus pneumoniae were obtained from eyes of children who had congenital dacryocystitis, congenital cataract and glaucoma, acute bacterial conjunctivitis, corneal ulceration, nasolacrimal duct block, or discharging socket, or who had developed ectropion, endophthalmitis and orbital cellulitis. The highest number of strains was obtained from cases of dacryocystitis (74.4%), followed by conjunctivitis (8.2%) and those having developed nasolacrimal duct block (7.6%). The least overall resistance was to erythromycin (17.6%) and chloramphenicol (31.0%). Erythromycin being unavailable for ocular use in India, chloramphenicol was reported to be one of the best drugs against pneumococcal ocular infections in children, the other being cloxacillin, a 2.5% solution of which is made from injectable cloxacillin and used as an ophthalmic preparation. Their use on patients has met with considerable success. Nineteen out of 20 isolates were typeable--the types being 3, 46, 8, 28, 29, 45, 21 and 18. To the best of our knowledge, this is the first report from a developing country of serotyping ocular strains of pneumococci.

Adolescent↗

PubMed2004

Treatment of paralytic lagophthalmos by loading the lid with a gold plate and lateral canthopexy.

Various methods of managing patients with lagophthalmos secondary to paralysis of the facial nerve have been reported. While addition of a gold plate facilitates displacement of the upper eyelid downwards, coaptation of the lid margin is often incomplete because of coexisting ectropion of the lower lid. The outcome obtainable from loading the lid with a gold plate alone is often unsatisfactory. To manage the deformity by combining the loading of the lid with gold plate and lateral canthopexy is technically simple. Morbidity is minimal as it can be done under local anaesthesia. Adequacy of coaption of the palpebral margin could be assessed immediately. We have managed a total of seven (mainly elderly) such patients between 1999 and 2000 in our hospitals. The outcome was generally satisfactory and there were no complications.

Adult↗

PubMed2004

Use of deep inferior epigastric artery flaps for reconstruction of the female genitalia.

Free skin grafts have been the most conventional choice for reconstructing the female genital area after excision of malignant tumours. However, some patients have developed scar contractures, or depressed deformities or ectropion of the mucosal membrane of the urethra or vagina. We discuss here the use of deep inferior epigastric artery (DIEA) flaps. Although the method leaves a scar in the abdominal region, it can be hidden by underwear. We have operated on six patients with satisfactory results.

Adult↗

PubMedDate not supplied

Severe blepharoconjunctivitis induced by a peeling mask containing trichloroacetic acid.

PURPOSE: To report a case of severe blepharoconjunctivitis induced by a peeling mask. METHODS: A 32-year-old healthy female was examined one day after undergoing a face-peeling procedure with a mask containing trichloroacetic acid. She complained of severe burning, redness, and epiphora in her left eye that started several hours after the procedure. RESULTS: Her vision was LE 0.2, RE 0.8. Mild upper eyelid edema of the right eye and severe edema of the left eyelids, LE inferior ectropion, and LE blepharoconjunctivitis were noted. The conjunctiva was severely hyperemic with papillary reaction and chemosis. The corneas, anterior chambers, irides, lenses, and posterior segments were normal. The patient was treated with Dexamethasone 0.1% q2h and ocular lubrication. The reaction subsided after 3-4 days. CONCLUSION: Face-peeling masks containing trichloroacetic acid can sometimes severely irritate the eyelids and the ocular surface.

Adult↗

PubMed1999

Safety and efficacy of high fluence CO2 laser skin resurfacing with a single pass.

BACKGROUND: Carbon dioxide (CO2) laser skin resurfacing has nearly replaced more traditional methods of superficial skin rejuvenation. Post-treatment erythema is the most common side effect of this method of skin resurfacing. Sublethal thermal damage to the dermis has been proposed as an etiology for post laser erythema. Recent developments in laser resurfacing technology have aimed at minimizing thermal damage to the dermis. OBJECTIVE: To determine depth of skin ablation, extent of thermal injury, and ideal laser parameters for the FeatherTouch laser system. To assess the safety and efficacy of laser resurfacing at high energy fluences with a single pass. DESIGN: Laser resurfacing was performed in the preauricular skin of five patients undergoing rhytidectomy. A total of 60 sites were tested with fluences of 7 to 17 Joules/cm2. Histologic evaluation of excised skin showed maximal thermal injury to be restricted to 60 microns in the papillary dermis. The reticular dermis showed no evidence of injury. Based on these findings, laser resurfacing at 17 J/cm2 (70 watts) was performed on 30 patients (in the periorbital area, a maximum of 9 J/cm2 or 36 watts was used). Follow up ranged between 12 and 18 months. RESULTS: Based on histologic comparison of average and high fluence laser resurfacing, high fluence laser resurfacing did not cause added thermal damage to the reticular dermis. In the clinical group, no major complications such as scarring, scleral show, infection or ectropion were encountered. Transient hyperpigmentation was noted in three patients. Overall patient satisfaction was good to excellent. Post-treatment erythema lasted an average of 4 weeks. CONCLUSION: We conclude that CO2 laser resurfacing of the face (excluding the periorbital region) can be performed safely and effectively, with the FeatherTouch laser, at 17 J/cm2 with one pass. In our group of patients, laser resurfacing with a single pass at 17 J/cm2 caused less post-operative erythema than two or more passes at 9 J/cm2.

Adult↗

PubMed1995

Conjunctivitis in a long-term care facility.

OBJECTIVE: To determine the prevalence, incidence, and etiology of conjunctivitis in residents of a long-term care facility. DESIGN: Prospective surveillance of episodes of conjunctivitis during two 6-month periods. SETTING: Three-building, 319-bed, multipurpose, long-term care facility including units for personal care, chronic care, palliative care, rehabilitation, respiratory rehabilitation, and chronic ventilator patients. RESULTS: The incidence of conjunctivitis on different units varied from 0.6 to 3.5 per 1,000 patient-days. One building had a significantly higher rate of acute conjunctivitis and, within that facility, the most highly impaired patients had significantly more disease. Patients with chronic conjunctivitis generally were admitted with conjunctivitis; institutionally acquired conjunctivitis proceeding to chronic conjunctivitis seldom was observed except on the chronic ventilator unit. Residents with chronic conjunctivitis were significantly more likely to have a diagnosis of glaucoma, ectropion, or entropion. Potential bacterial pathogens were isolated from 3 (21%) of 14 and 24 (38%) of 69 acute episodes for which cultures were available in the two study periods. Staphylococcus aureus was the most frequent pathogen isolated. Empiric therapy was usually with topical sodium sulamyd or gentamicin, with substantial interphysician variability in prescribing patterns. Symptom duration did not differ for episodes which did or did not receive topical antimicrobials. CONCLUSION: Conjunctivitis is common in this facility and occurs with increased frequency in more highly impaired residents. Most episodes may not be due to bacterial infection. Further study of optimal management approaches to conjunctivitis is necessary.

Acute Disease↗

PubMed1993

The surgical management of facial syringomas using the superpulsed CO 2 laser.

Syringomas are benign tumors of eccrine origin that occur primarily in the lower eyelid region of females. Since they do not involute and are typically refractory to conventional forms of therapy, they may grow to become considerable, chronic cosmetic and functional deficits. The current study reports on a patient with familial syringomas, previously refractory to two different standard therapies, who was successfully treated with the superpulsed CO 2 laser. A simple, accurate, and reproducible method of dosimetry of laser energy was used to treat these lesions with the Sharplan 700 CO 2 laser connected to the operating microscope. Each lesion was irradiated separately with single pulses at a calculated energy density of 1 J/cm 2. Superficial scabbing was observed 1 week postoperatively, with no edema or pain. Mild erythema persisted for 1 month, with complete healing thereafter. No recurrences were noted after a 2 year follow-up. There was no evidence of scarring, ectropion, or changes in pigmentation. The disease and methods of treatment are reviewed.

Adenoma↗

PubMed1994

Ultrapulse carbon dioxide laser removal of periocular wrinkles in association with laser blepharoplasty.

Removal of periocular wrinkles is a common yet difficult problem. There are many techniques currently available, all of which have some drawbacks. With the advent of new generation ultrapulse carbon dioxide lasers, skin can now be resurfaced successfully with minimal risk and side effects. In our study of 36 patients we assessed the benefit of using ultrapulse carbon dioxide (CO 2) laser to resurface the periorbital skin in association with transconjunctival lower lid CO 2 laser blepharoplasty. We found that 36/36 (100%) patients had good to excellent results. The incidence of side effects was very low. We also found that 2/36 (5.6%) of patients developed mild clinically insignificant hypopigmentation and 1/36 (2.8%) developed mild scarring, which resolved with one injection of triamanalone 10 mg/ml. No patients had hyperpigmentation. In addition, 1/36 (2.8%) patients developed transient ectropion, which resolved spontaneously in 6 weeks. We conclude that ultrapulse CO 2 laser is an excellent method for treating periocular wrinkle lines and can be readily performed in conjunction with a transconjunctival lower lid blepharoplasty.

Adult↗

PubMed1989

V-Y advancement flaps for tumor excision defects of the eyelids.

Resection of cutaneous malignancies of the medial canthus and lower lid create challenging wound closure problems. The V-Y flap closure technique achieves wound closure using adjacent tissue while minimizing closure tension. Twenty-three patients underwent resection of basal cell carcinomas in these two anatomical regions. In 22 patients a single V-Y flap was used to close the defect. In 1 patient two flaps were used. There were 2 patients with transient ectropion. No tissue loss or other complications occurred.

Basal Cell Carcinoma↗

PubMed1991

The chemical peel.

Chemical peeling of facial skin has become a valuable adjunct in the armamentarium of the facial aesthetic surgeon. Among the various techniques available, phenol solutions are the most commonly used. Peeling produces a controlled, partial-thickness chemical burn of the epidermis and the outer dermis. Several techniques are available to "fine tune" the depth of the peel. Regeneration of peeled skin results in a fresh, orderly, organized epidermis. In the dermis, a new 2- to 3-mm band of dense, compact, orderly collagen is formed between the epidermis and the underlying damaged dermis, which results in effective ablation of the fine wrinkles in the skin and a reduction of pigmentation. These clinical and histological changes are long lasting (15-20 years) and may be permanent in some patients. Because of the metabolism and systemic complications of phenol, patient selection should involve systemic evaluation of liver, renal, and cardiac function, as well as an evaluation of the skin quality and medication status of the patient. Because of potential cardiac arrhythmias, peeling must be performed in a medically supervised environment, with continuous cardiac monitoring. The local complications of peeling include pigmentation changes, scarring, milia, ectropion, infection, activation of herpes simplex, and toxic shock syndrome.

Adult↗

PubMed1994

Lower lid reconstruction with a chondromucosal alar graft and upper lid musculocutaneous flap.

Partial or total lower lid reconstruction implies the repair of three layers: the skin, the tarsus, and the conjunctiva. The method of reconstruction must, therefore, aim at three objectives: ensuring the stability of the lid by repairing the tarsoconjunctival layer, achieving an aesthetic result with the repair of the skin, and taking into consideration the primary role of the upper lid in the ocular protective system. We recommend a musculocutaneous flap, taken from the upper lid, with a single lateral or medial pedicle combined with a chondromucosal alar graft. During the last 10 years, 41 patients were operated on with malignant skin tumors requiring marginal, partial, and total lower lid reconstruction. The results were quite satisfactory from a functional and aesthetic point of view. We noticed two cases of partial flap necrosis and two cases of ectropion needing revision. We believe that the procedure described can be a tool in the armamentarium of the plastic surgeon involved in the field of the orbitopalpebral area.

Eyelid Neoplasms↗

PubMed1996

Transconjunctival blepharoplasty with chemoexfoliation.

Transcutaneous blepharoplasty has been the standard for improving the overall appearance of the lower eyelid, as it addresses skin, muscle, and pseudoherniated orbital fat. Postoperative problems, including poor scarring, scleral show, and even frank ectropion, have led many surgeons to alternate techniques. Transconjunctival blepharoplasty is known to be a reliable method of removing lower eyelid fat, but has been touted as inadequate for those possessing excessive skin and has even been cited as being responsible for increasing lower eyelid wrinkling. Chemoexfoliation, utilizing trichloroacetic acid and phenol, was performed simultaneously with transconjunctival blepharoplasty in 146 patients, whose data are retrospectively reviewed. Excellent results were obtained in lower eyelid skin appearance and pseudoherniated fat in the majority of patients, without an external lower eyelid scar.

Chemexfoliation↗

PubMed2001

Experience in upper eyelid reconstruction with the Cutler-Beard technique.

Reconstruction of full-thickness upper eyelid defects has to supply a movable lid with perfect corneal protection, good aesthetic quality, and acceptable sequelae at the donor site. The Cutler-Beard procedure, a full-thickness cutaneoconjunctival inferior eyelid advancement flap, is a reliable method for reconstruction of total or partial upper eyelid defects. Especially in older individuals, the skin of the donor site is loose and provides sufficient tissue to stretch. Color and texture of the donor matches the recipient site perfectly. Destabilization or ectropion of the donor site, the lower lid, and retraction or entropion of the recipient site, the upper lid, are the main complications. Therefore, a modification of the classic technique should be considered by implantation of an enforcing inlay in the reconstructed lid (eye bank sclera, fascia lata, ear cartilage), especially in reconstruction of extended defects of the upper lid.

Aged↗

PubMed2002

Laser blepharoplasty in Asians.

Traditional blepharoplasty removes periorbital wrinkles by cutting and stretching the skin. However, this method has a substantial risk of producing ectropion or scleral show. In addition, fine periocular wrinkles may persist because this method does not change skin texture. The pulsed CO2 laser has recently become a primary surgical tool in treating aging eyelids. Periorbital wrinkles vary in depth not only from person to person, but also among different races. Compared with whites, most Asians have a thicker dermis, so more laser passes and a higher power may be required to remove periorbital wrinkles, but concerns about hyperpigmentation and prolonged erythema have limited its use on Asian skin. In this study, 346 patients underwent laser blepharoplasty at the Korea University Medical Center and at Dr Choi's Aesthetic Clinic. They were followed for 12 months on average from September 1995 to September 1999. The CO2 laser was used in resurfacing periorbital wrinkles, transcutaneous skin excision, and transconjunctival blepharoplasty, including fat removal. The authors assessed the benefit of using the UltraPulse CO2 laser in Asian blepharoplasty. They found that 291 patients (84%) had good to excellent results. The incidence of side effects was very low. Prolonged erythema occurred in 19 patients (5%) and hyperpigmentation occurred in 35 patients (10%), but the erythema disappeared spontaneously within 2 months and the hyperpigmentation could be managed readily by the topical use of retinoids and hydroquinone cream. Therefore, the authors conclude that postoperative hyperpigmentation is no longer a problem limiting laser resurfacing in Asian blepharoplasty. The UltraPulse CO2 laser is a safe and effective rejuvenation method for treating aging eyelids in Asians.

Adult↗

PubMed1997

Endoscopic repair of a complex midfacial fracture.

Inadequate treatment of complex midfacial fractures involving the orbit and zygomatic arch can result in important functional and aesthetic deformity. Accurate repair of fractures at the zygomatic arch and orbital floor has traditionally necessitated coronal scalp and lower eyelid incisions respectively. Complications such as facial nerve injury, alopecia, external scarring, ectropion, and eyelid edema have been associated with these traditionally open surgical techniques. We report an endoscopic-assisted technique of open reduction and rigid fixation of a complex midfacial fracture. The endoscopic-assisted technique facilitated the anatomic repair of associated zygomatic arch and orbital floor fractures. The technique minimized ocular globe manipulation and eliminated the need for coronal scalp and lower eyelid incisions.

Adult↗

PubMed2003

Use of skin substitutes in pediatric patients.

There are various artificial skin substitutes available commercially. The authors have used Integra, cultured epithelium, and Apligraf in their clinic. In the present report, they present their experiences based on two case reports. The first patient was a 12-year-old boy with widespread skin defects and left axillary contracture due to epidermolysis bullosa (EB). Apligraf was used to cover the skin defects on the trunk and face and to manage ectropion and axillary contracture. The second patient was a 6-year-old boy who suffered neurocutaneous melanosis. Partial excision of a pigmented lesion on the back created a large defect. Integra application followed by repair with cultured autologous skin was accomplished, and the results were satisfactory. Skin substitute products 1) are commercially immediately available; 2) are effective for management of contractures, chronic wounds, and chronic skin illnesses; 3) decrease or avoid the risk of donor area morbidity, which is more difficult to treat in children; 4) provide long-term coverage of the wound; and 5) can be used in conjunction with autologous tissue (e.g., Integra followed by cultured epithelium applications).

Biocompatible Materials↗