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At least 19 recordsLinked to original sources
PubMed2000

[Classification of eyelid and designs of the double-eyelid operation].

OBJECTIVE: To discuss the morphological characters of eyelids and the designs of double-eyelid operation on various eyelids. METHODS: The classification of eyelids was named according to morphological characters of eyelids from 6847 cases. A survey of 92 cases treated by double-eyelid operation was carried out to compare the external eye morphology of pre-operation with that of post-operation. RESULTS: There were several types of eyelids, which were morphologically classified according to eyes' length and height, eyelid skin thickness, eyeball protrusion and eye shape, including eyelids with long and narrow eyes, eyelids with thin and soft skin, eyelids with thick subcutaneous tissue, eyelids with small and round eyes, eyelids with protruding eyeball, and eyelids with triangle eyes. The aesthetic effects of double-eyelid operation on all these types of eyelids were evaluated. CONCLUSION: The indication of double-eyelid operation should be considered correctly, and the design should be made according to classification of the morphological characters of eyelids. Double-eyelid operation may be not appropriate for the eyelids with small, round and protruding eyes.

Adolescent↗
PubMed1999

The Asian upper eyelid: an anatomical study with comparison to the Caucasian eyelid.

OBJECTIVE: To evaluate the differences between Asian and Caucasian upper eyelid anatomy through cadaver dissection, histopathological study, and magnetic resonance imaging. MATERIALS AND METHODS: Upper eyelids of 9 Korean and 5 Caucasian cadavers were dissected, and then were studied microscopically with hematoxylin-eosin, Masson trichrome, and elastin stains. Four healthy young Korean men were studied by dynamic high-resolution magnetic resonance imaging with regard to demonstration of upper eyelid structure. RESULTS: More subcutaneous and suborbicularis fat, with a pretarsal fat component, is present in Asian eyelids. The Asian double eyelids showed an amount of fat intermediate between Asian single eyelids and Caucasian eyelids. Asian single eyelids showed fusion of the orbital septum to the levator aponeurosis below the superior tarsal border, while fusion is above the superior tarsal border in Caucasians. The preaponeurotic fat pad descends anteriorly to the tarsal plate in the Asian single eyelid, but not in the Caucasian eyelid. A pretarsal fat pad is identified in the Asian single eyelids. CONCLUSIONS: The causes of absent or lower crease in the Asian upper eyelid are as follows: (1) the orbital septum fuses to the levator aponeurosis at variable distances below the superior tarsal border; (2) preaponeurotic fat pad protrusion and a thick subcutaneous fat layer prevent levator fibers from extending toward the skin near the superior tarsal border; and (3) the primary insertion of the levator aponeurosis into the orbicularis muscle and into the upper eyelid skin occurs closer to the eyelid margin in Asians. Structural differences relating to increased fat in the Asian upper eyelid include the presence of a pretarsal fat pad and a moderate fat increase in the double Asian eyelid.

Adipose Tissue↗
PubMed2002

Maximal eyelid donor skin harvesting in eyelid repair after tumor excision.

PURPOSE: A primary defect in the eyelid resulting from tumor excision will benefit from better skin match when the defect is repaired with eyelid skin. The amount of skin harvested by blepharoplasty from a single upper eyelid may be inadequate. This report describes and evaluates the effectiveness of two types of procedure in which maximal eyelid skin is harvested to repair defects in the upper or lower eyelids, respectively. The techniques require the resulting secondary defect being partially replaced by a second graft taken from the contralateral upper eyelid. METHODS: The surgical results of a prospective case series are evaluated. Postoperative upper eyelid graft appearance and patient satisfaction were recorded. RESULTS: Ten patients underwent repair of a large skin defect in the upper eyelid (2 patients) or lower eyelid (8 patients), using maximum upper eyelid skin from above the skin crease. The primary donor site upper eyelid defect was closed after partial secondary grafting with skin from the side contralateral to the upper eyelid from which the maximal graft was taken. All patients were satisfied with the appearance of the grafted and donor areas. CONCLUSIONS: Maximal eyelid donor skin harvesting achieved satisfactory results and is a useful technique in eyelid reconstructive surgery.

Adult↗
PubMed2001

Anatomic microstructure of the upper eyelid in the Oriental double eyelid.

The anatomic differences in the microstructure of the upper eyelid between the double eyelid and the nondouble eyelid are compared to determine the mechanism of double eyelid formation. Tissue from the upper eyelids of normal adult women was categorized into three groups: in one group, the double eyelid was formed primarily (at birth); in a second group, the double eyelid was formed gradually; and those in a third group had nondouble eyelids. A total of 56 eyelids were studied using electron microscopy and light microscopy. The results indicated that there is a significant difference between the three groups using scanning electron microscopy. In the upper eyelid of the double eyelid, bunched fibers of levator aponeurosis penetrate through orbicularis muscle to fuse with the skin in palpebral sulcus. This structure was not observed in the group with nondouble eyelids. However, when using light microscopy, this disparity was not observed. It was concluded that a fiber-linked structure between eyelid skin and levator aponeurosis is essential for the formation of the double eyelid.

Adolescent↗
PubMed1992

Present status of eyelid phototherapy. Clinical efficacy and transmittance of ultraviolet and visible radiation through human eyelids.

BACKGROUND: Phototherapy for the eyelid has not previously been recognized as a safe and effective treatment of photoresponsive dermatoses of the eyelid, such as atopic dermatitis, vitiligo, psoriasis, lymphomatoid papulosis, and parapsoriasis. OBJECTIVE: The purpose of this study was to demonstrate the efficacy and safety of this treatment. METHODS: Two cases are presented to demonstrate clinical efficacy. In addition, a retrospective eye evaluation of seven patients receiving a combined total of greater than 1300 eyelid phototherapy treatments was performed. To determine whether potentially harmful UV radiation is significantly transmitted through eyelid skin, an in vitro study was conducted to measure the percentage transmittance of ultraviolet-visible radiation through five excised eyelids. RESULTS: In the two cases presented, remarkable improvement occurred without adverse side effects, suggesting that it is possible to deliver incremental UV dosages to eyelid skin to achieve clearing of skin disease. Retrospective analysis of patients' records revealed no ocular disease from the phototherapy. In vitro eyelid examination produced data that indicated negligible quantities of UV radiation were transmitted through eyelid skin compared with the visible spectrum, in which up to 77% of the radiation was transmitted through the tissue. CONCLUSION: The combined clinical experience and transmittance data suggest that eyelid phototherapy is a safe and effective treatment in selected patients.

Adult↗
PubMed1999

Lower eyelid blepharoplasty: the aging eyelid.

The aging process affects the underlying structural integrity of the eyelids as well as the overlying skin, muscle, and fat. Gravitational descent of the deep supporting soft tissues of the eyelid complex coupled with skin texture changes exemplified by loss of skin elasticity, solar actinic changes, and dynamic and static rhytids result in the aged eyelid. Surgery of the lower eyelid on the youthful face usually involves excisional fat sculpting without skin removal. Lower eyelid blepharoplasty performed on the mature face often requires excision of periorbital fat combined with some treatment of the lower eyelid skin. In the aging eyelid, the surgeon must also be prepared to address lower eyelid laxity to prevent the potential complications of lower eyelid retraction or scleral show.

Blepharoplasty↗
PubMed1994

Single tarsoconjunctival flap (lower eyelid) for upper eyelid reconstruction ("reverse" modified Hughes procedure).

We present a two-stage reconstruction of partial or total full-thickness upper eyelid defects. In the first stage, a single tarsoconjunctival flap from the donor lower eyelid reconstitutes the posterior lamella, and a full-thickness skin graft reconstructs the anterior lamella. In the second stage, 5 to 8 weeks later, the skin tarsoconjunctival flap is severed. The single tarsoconjunctival flap we describe is analogous to the modified Hughes reconstruction for full-thickness lower eyelid defects and thus may be termed a "reverse" modified Hughes procedure. In the lid-sharing Cutler-Beard procedure, the popular alternative, the full-thickness lower lid is advanced into the upper eyelid defect. Our procedure provides greater stability due to the increased amount of vertical tarsus in the reconstructed eyelid. Also, in our procedure, the tarsoconjunctival flap is incised 1.5 to 2 mm from the lower eyelid margin rather than the 4 to 6 mm necessary to preserve the marginal artery in the Cutler-Beard procedure. With a follow up ranging from at least 6 months to over 2 years, the only complications among the 10 patients in our series were pyogenic granuloma at the edge of the donor lower eyelid, and mild, medial upper eyelid blepharoptosis. There were no cases of cicatricial entropion of the upper eyelid, a known complication of the Cutler-Beard procedure.

Aged↗
PubMed1998

Role of integrins in mouse eyelid development: studies in normal embryos and embryos in which there is a failure of eyelid fusion.

Eyelid fusion normally occurs between E15.5 and E16.5 of mouse embryonic development and results from the migration of a population of periderm-derived epithelial cells over the corneal surface. Cell migration is known to depend on extracellular matrix receptors of the integrin family and to be regulated by growth factors. We were therefore interested that a failure of eyelid fusion has been reported in mice that are homozygous null for the transforming growth factor alpha (TGF-alpha) gene and in mice (invalpha5beta1) in which a transgenic alpha5beta1 integrin under the control of the involucrin promoter is misexpressed in differentiating keratinocytes. We examined expression of the alpha2beta1, alpha3beta1, alpha5beta1 and alpha6beta4 integrins during eyelid fusion in wild-type embryos and found selective upregulation of the alpha5beta1 integrin and its ligand, fibronectin, in the migrating eyelid tip cells. In TGF-alpha null embryos, the failure of eyelid fusion was correlated with a failure to upregulate the alpha5beta1 integrin and fibronectin in the tip cells. Using beta-galactosidase as a reporter gene in transgenic mice, we observed specific activity of the involucrin promoter in the eyelid tip cells. In invalpha5beta1 mice the transgenic human integrin was overexpressed not only in the tip cells but throughout the eyelid epidermis. In contrast, the endogenous, murine, alpha5beta1 integrin was only weakly expressed in the tip cells. We speculate that selective and coordinated expression of the alpha5beta1 integrin and fibronectin in eyelid tip cells is required for eyelid fusion and may be under the control of growth factors that include TGF-alpha.

Animals↗
PubMed2001

Correction of lower eyelid retraction with high density porous polyethylene: The Medpor((R)) Lower Eyelid Spacer.

PURPOSE. To describe the use of a new alloplastic implant for the correction of complex lower eyelid retraction. METHODS. A retrospective review of patient charts and photographs was performed to evaluate the efficacy of the first 50 porous polyethylene lower eyelid spacers (LES) used in the correction of complex eyelid retraction. RESULTS. Fifty LES were implanted in 38 patients. Follow-up ranged from 18 to 32 months. The average number of surgical procedures attempted for eyelid retraction repair prior to referral to our practice and implantation of the LES was 5, range 0 to 16. After LES implantation, all patients had improvement of their lower eyelid retraction. Three LES implants were revised for eyelid contour deformity ('lateral winging') and one for exposure through the anterior eyelid margin. In two cases, full-thickness skin grafts were placed directly over the porous implants with good success. DISCUSSION. Lower eyelid spacers (LES) constructed of porous polyethylene provide a rigid, bio-integrated support for eyelids with severe malposition that are recalcitrant to other corrective efforts.

Journal Article↗
PubMed1999

Correction of lower eyelid retraction by transconjunctival retractor excision and lateral eyelid suspension.

PURPOSE: To investigate the effectiveness of a procedure that addresses both the lower eyelid retractors and the lateral canthus in the treatment of patients with lower eyelid retraction. METHODS: Through a combined lateral canthotomy and full-length transconjunctival incision, the lower eyelid retractors were disinserted across the horizontal length of the eyelid, recessed to the inferior fornix, and excised. A lateral canthopexy elevated the mobilized eyelid, and horizontal length disparity was corrected. RESULTS: Forty lower eyelid operations in 23 patients yielded good results; all patients attained significant improvement in both eyelid position and function. No reoperations were required during a mean follow-up period of 28 months. CONCLUSION: Although not ideal for severe cases requiring posterior lamellar spacers or anterior lamellar (skin) grafts, this union of techniques successfully treats many types of lower eyelid retraction.

Adult↗
PubMed2001

Spontaneous eyelid expansion after full thickness eyelid resection and direct closure.

BACKGROUND/AIMS: Direct closure of eyelid defects gives excellent functional results but is usually restricted to defects measuring less than a quarter of the eyelid length for fear of distorting the palpebral aperture and compromising lid function. The authors have used direct closure in larger defects. The aim of this study was to establish the effects of direct closure of full thickness eyelid margin defects under tension on the palpebral aperture dimensions. METHODS: A consecutive series of patients who had undergone one eyelid, full thickness lid resection repaired by direct closure were identified and invited to have both eyes photographed. The palpebral apertures of both eyes were measured from the photographs by a masked observer. The amount of eyelid resected was recorded from the operation notes. The unoperated palpebral aperture was used as the control. The result were analysed using a paired samples t test. RESULTS: The photographs of 18 patients were included in the analysis. The mean width of excised full thickness lid tissue was 15 mm (range 7-26 mm). The mean vertical palpebral aperture height was 9.2 (SD 1.4) mm in the operated eye as opposed to 9.3 (SD 1.2) mm in the non-operated eye. The mean horizontal palpebral aperture width was 26.1 (SD 1.9) mm in the operated eye as opposed to 26.4 (SD 1.8) mm in the non-operated eye. There was no statistically significant difference between the operated and unoperated horizontal and vertical palpebral measurements. CONCLUSIONS: Direct closure of large full thickness eyelid defects is possible in selected patients with excellent functional and cosmetic results. Eyelid tissue expansion occurs spontaneously following direct eyelid defect closure under tension, restoring the palpebral aperture dimensions.

Adult↗
PubMed1986

The management of eyelid laxity during lower eyelid blepharoplasty.

Lower eyelid and lateral canthal angle malposition or frank ectropion are the most common complications of lower eyelid blepharoplasty. Although these complications may result from excessive skin excision, from surgical imbrication of the orbital septum or lower eyelid retractors, or from scar formation within the eyelid, failure to correct preexisting lower eyelid laxity is the most common cause. Recently published data have established laxity at the lateral canthus as the primary cause of involutional lower eyelid laxity. We review the pathophysiology of lower eyelid laxity and present an anatomic approach for the correction of lower eyelid laxity during blepharoplasty.

Aging↗
PubMed2003

Anchored flaps in post-Mohs reconstruction of the lower eyelid, cheek, and lateral canthus: avoiding eyelid distortion.

PURPOSE: To describe a system of post-Mohs reconstruction that addresses lower eyelid susceptibility to unopposed tractional, cicatricial, and gravitational forces. Large flaps are anchored to fixed tissue to avoid transmitting flap tension to the eyelids. METHODS: This is a retrospective, cohort study drawn from approximately 40 patients with post-Mohs defects of the nonmarginal lower eyelid, cheek, and lateral canthus. Surgical intervention involved horizontally oriented, relaxed skin tension line-designed advancement flaps, usually with eyelid margin stabilization. The use of anchoring sutures and any requirement for flap-graft combinations were based on defect size and the elasticity of adjacent tissues. RESULTS: Anchoring eyelid and cheek flaps to underlying periosteum permitted broad flap dissection and advancement without distortion, as the semimobile eyelid and canthi were protected from the resulting flap tension. Anticipated defect size limits for flap reconstruction often were exceeded. Defects too broad for flap reconstruction alone could be downsized, leaving a relatively small area for graft resurfacing. CONCLUSIONS: Anchored cheek flaps extend recognition of the continuity of the lower eyelid and midface to the primary reconstruction of tumor-free defects, and they address the relation by restoring deep attachments that minimize eyelid and canthal dystopia.

Basal Cell Carcinoma↗
PubMed1999

[Prevention and treatment of eyelid retraction and ectropion following lower eyelid blepharoplasty with tarsal tuck procedure].

OBJECTIVE: To prevent or decrease eyelid retraction and ectropion following lower eyelid blepharoplasty. METHODS: The tarsal tuck procedure was performed during lower eyelid blepharoplasty to tighten the lower eyelid. This method had been used since 1991. RESULTS: After the operation, the lower eyelid was tensional and steady. The complications of eyelid retraction and ectropion were diminished. CONCLUSION: The pathologic basis of the eyelid bag is that the supporting tissues become lax so that the lower eyelid and lateral canthus move downwards. The exact aim of the tarsal tuck procedure is to correct these pathologic changes.

Blepharoplasty↗
PubMed1991

Multilevel full-thickness eyelid resection for the correction of severe acquired ptosis in the poorly functioning eyelid.

Six eyelids (4 patients) with severe myogenic (4 eyelids), neurogenic (1 eyelid), or mechanical (1 eyelid) ptosis underwent surgical correction with a multilevel full-thickness resection of eyelid tissue combined with a plication of the levator aponeurosis-Müller's muscle complex. All eyelids had poor levator function, fair to poor orbicularis function, and a poor Bell's phenomenon. In all cases, the upper eyelids were elevated to an acceptable functional level without exposure keratopathy. This resection procedure preserves orbicularis function while allowing correction of severely ptotic eyelids with poor levator function, providing an acceptable alternative to other techniques for correcting this problem.

Adult↗
PubMed1995

Morphogenetic study of the eyelids in NC-eob mice fetuses with an open-eyelid malformation at birth.

The NC-eob mice are mutants having open eyelids at birth with complete penetrance. Detailed scanning electron microscopy and light microscopy for study of the eyelid development of NC-eob embryos/fetuses were performed at days 13 to 17 of gestation and compared with normal NC mice, with the aim of investigating the etiopathogenesis of the open eyelids at birth. No difference was observed between NC and NC-eob embryos by scanning electron microscopy and histologic examination at days 13 and 14 of gestation. At day 15 the epithelium at the tip of the eyelids had 2 to 3 layers, and clumps of round periderm cells appeared on the outer surface of the margin of the lids in NC and NC-eob embryos. However, these clumps in NC-eob embryos were not as remarkable in number and in size compared with NC embryos. At day 16 the eyelids of NC fetuses extended over the cornea and began to fuse. The epithelium at the tip of the eyelids consisted of 4 to 5 layers with the following elongated area. The surface of the tip of the elongated epithelium was covered with a large number of round periderm cells. In NC-eob fetuses the epithelium remained stationary at 2 to 3 layers. Only a small number of round cells were noted at the tip of the eyelids, and fusion did not occur. At day 17, although the upper and lower eyelids of NC fetuses were entirely fused, no change occurred in NC-eob fetuses, either in the periderm or in the epithelium.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Primary infratarsal lower eyelid retractor lysis to prevent eyelid retraction after inferior rectus muscle recession.

PURPOSE: To evaluate a procedure to prevent lower eyelid retraction, which may occur after inferior rectus muscle recession surgery as a direct consequence of the intimate anatomic connections between the inferior rectus muscle and lower eyelid retractors. METHODS: We evaluated the technique of primary infratarsal lower eyelid retractor lysis on 12 eyelids of ten patients undergoing inferior rectus muscle recession of 3 mm or more. Indications for surgery included restrictive strabismus related to Graves' ophthalmopathy, orbital blowout fracture, and orbital fibrosis syndrome. RESULTS: For the 12 eyes, inferior rectus muscle recession ranged from 3 to 10 mm (mean, 5.3 mm). Postoperatively there was no significant change in mean lower eyelid position (P > .82), and no patient developed inferior scleral show. CONCLUSION: Primary infratarsal eyelid retractor lysis is an effective technique for preventing lower eyelid retraction after inferior rectus muscle recession strabismus surgery.

Aged↗