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We examined three adult Japanese patients who had a history of decreased hepatic glucose-6-phosphatase activity. All three patients had increased bilateral subcutaneous (SC) fat in the lower eyelids and inverted eyelashes. One patient additionally showed retinal hemorrhages and microaneurysms in both fundi. The inverted eyelashes may have been related to type 1a glycogen storage disease.
We treated two patients with dacryolithiasis secondary to an eyelash. The first patient underwent dacryocystorhinostomy for a stone within the lacrimal sac. In the second patient the dacryolith was removed from a lacrimal gland ductule. Eyelashes found in the tear film or conjunctival fornices during routine examination should be removed to prevent the possible occurrence of dacryolithiasis.
Epilation, electrolysis, cryotherapy, and argon laser thermal ablation were used to remove eyelashes of rabbits. Epilation and electrolysis were done in the standard fashion. Nitrous oxide cryotherapy was applied in a double rapid-freeze/slow-thaw manner for either 30 or 60 seconds. Argon laser settings were 1 W, 50-micron spot size, and durations of 0.2, 0.5, or 1.0 second. The rabbits were euthanized immediately, 24 hours, 2 weeks, or 3 months after the procedure. Epilation was followed by total regrowth of eyelashes within 2 weeks. Electrolysis showed focal destruction of follicles with variable regrowth. Cryotherapy resulted in moderate-to-severe eyelid scarring with minimal regrowth. Argon laser thermal ablation produced focal necrosis and variable follicle destruction. Argon laser thermal ablation may be a suitable alternative to electrolysis or cryotherapy in selected cases of trichiasis.
The eyebrows, eyelashes, and eyelids are important protective structures for the eye and are also of considerable cosmetic value. The dermatologist should understand the available cosmetic and surgical techniques for helping patients with eyebrow loss, eyelash loss, and dermatochalasis.
A 9-year-old child was admitted because of a penetrating corneal wound with a solitary eyelash in the anterior chamber. Anterior uveitis, posterior synechias, and localized anterior subcapsular cataract subsequently developed. As the latter complications did not respond to conservative treatment, the eyelash was removed surgically. The expected complications of an intraocular cilium and the surgical indications for its removal are discussed in detail.
Previously described surgical techniques for distichiasis correction are likely to have complications of trichiasis, entropion, and eyelid margin distortion. A new technique to remove distichiasis eyelashes through a tarsoconjunctival trapdoor achieves a satisfactory functional and cosmetic result and descreases the likelihood of these complications.
Acquired trichomegaly of the eyelashes was found in seven patients infected with human immunodeficiency virus type 1. These patients had advanced infection with severe T-helper cell depletion, high levels of p24 antigenemia, and inability to tolerate zidovudine therapy. Control of infection with other antiretroviral agents caused the trichomegaly to regress. Acquired trichomegaly may be a useful clinical marker for assessment of severity of infection.
The variety of lesions that can cause alopecia of the eyelashes (Table 1) demonstrates the need for accurate diagnosis. A full-thickness biopsy of lid margin with appropriate three-suture closure can leave an imperceptible defect and may provide invaluable information. Although a partial-thickness lid biopsy is certainly appropriate for many common eyelid tumors such as basal-cell carcinomas or nevi, we feel strongly that a full-thickness lid biopsy is indicated when discussing chronic eyelid lesions that cause alopecia. The information gathered from a full-thickness biopsy is far superior especially in those lesions which cause chronic blepharitis or especially in a case of a recurrent chalazion where the conjunctival surface and skin surface are both equally significant. The high mortality associated with sebaceous-cell carcinomas makes a good pathologic specimen allowing for accurate diagnosis essential. Partial-thickness eyelid biopsies, especially in cases of sebaceous carcinoma, may lead the pathologist to an erroneous, more benign, diagnosis and the clinician to a false sense of security. While many of the nonscarring alopecias may be diagnosed on their clinical characteristics alone, the scarring alopecias will frequently need a lid biopsy to ascertain diagnosis and gauge treatment.
A dacryolith was discovered in the lacrimal sac during a dacryocystorhinostomy for chronic dacryocystitis in which there was mucocele formation. Morphological examination confirmed the presence of an eyelash at the centre of the stone and electron microscopy demonstrated the presence of fungi (Candida sp.) in a matrix which was of markedly vairable morphology. The mechanism by which a hair enters the punctum and passes along the canaliculus may be attributed to the step-like pattern of ridges on the surface of a hair. The directional nature of these ridges dictates preferential movement towards the root end of the hair and prevents movements in the opposite direction.
Epiblepharon commonly occurs in Japanese infants and tends to disappear spontaneously with age. We examined 4449 Japanese children aged 3 months to 18 years for epiblepharon associated with inverted eyelashes touching the cornea. The condition was evident in 441 cases. We found that the incidence of epiblepharon decreased with age, but about 2% of high school students still had the condition. No sexual predilection was found. Lower eyelids were commonly involved bilaterally. Most cases of epiblepharon produced no or mild symptoms.
We used lid bracing sutures, buried sutures, and skin resection operations to correct epiblepharon in Japanese children. Epiblepharon and ocular irritation in 103 children (254 eyelids) were treated first with lid bracing sutures. Postoperatively the inversion of eyelashes resolved in 73 patients (196 eyelids). Of these 103 patients 30 (58 eyelids) developed recurrences, which included 11 who also complained of foreign body sensation and ocular pain. These 11 patients (22 eyelids) underwent a second surgical procedure (buried sutures or skin resection) before they became free of symptoms. No severe complications were noted in any of the 103 patients. We believe that lid bracing sutures correct most cases of mild epiblepharon in children and that buried sutures or skin resection are valuable for more severe conditions.
Two children with abnormally long eyelashes and bushy brows ("trichomegaly") present at birth and associated with pigmentary degeneration of the retina and general growth retardation are described. This combination of findings has been observed previously in three cases. Mental retardation, sparse scalp hair, endocrinologic deficiencies and (in one of our cases) koilonychia may be found in addition, but not necessarily.
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A review of the literature has been undertaken and the diagnostic criteria relating to this group of carcinomas found to be misleading. We encourage the reporting of all cases of apocrine carcinoma in order to draw valid conclusions regarding the behaviour and management of these unusual tumours.
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