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At least 19 recordsLinked to original sources
PubMed2005

Medial upper eyelid shortening to correct medial eyelid laxity in floppy eyelid syndrome: a new surgical approach.

PURPOSE: To describe and present the results of a new surgical technique for patients with floppy eyelid syndrome, based on the medial upper eyelid stretching encountered in this condition. METHODS: A case series of 24 patients with floppy eyelid syndrome who where found to have symptomatic predominately medial upper eyelid laxity was analyzed. The history, clinical features, histopathology, and outcome were reviewed after patients underwent medial upper eyelid shortening with or without upper eyelid skin reduction as the first surgical procedure. RESULTS: Of the 24 patients, 18 were men (75%) with a mean age at referral of 56 years, having ocular discomfort and conjunctival irritation/papillary conjunctivitis as the main complaints at presentation. Obesity was present in 96% of cases, with lower eyelid laxity/ectropion (50%) and upper eyelid eyelash ptosis (29%) in conjunction with the upper eyelid laxity. The affected side was related to sleeping habits or recurrent mechanical eyelid trauma. Histologic studies showed a nonspecific inflammatory cell infiltrate and loss of elastin with loose dermal connective tissue. After surgery, complete relief of ocular symptoms and good functional and cosmetic results were present in all cases after 18 months of follow-up. CONCLUSIONS: This new surgical approach is based on the presence of predominately medial upper laxity in patients with floppy eyelid syndrome. The excision of this stretched area stabilized the upper eyelid in an anatomic fashion, providing a good and stable long-term result. The possible mechanisms involved in the medial upper eyelid stretching are discussed.

Adolescent↗
PubMed2006

[Correction of lower eyelid retraction with a porous polyethylene (Medpor) lower eyelid spacer--Medpor spacer in lower eyelid retraction].

BACKGROUND: The correction of lower eyelid retraction remains a challenge with established techniques having disadvantages. A recently described alternative is implantation of an ultrathin high density porous polyethylene lower eyelid spacer (Medpor LES). We report our experience on implanting this Medpor LES, especially in patients with lower eyelid retraction due to Graves' orbitopathy. PATIENTS AND METHODS: All patients receiving a Medpor LES between March 2003 and November 2004 in the Rotterdam Eye Hospital were included. Indications and preceding procedures as well as the degree of proptosis were noted. Preoperative and postoperative lower eyelid retraction were compared by measuring scleral show inferior to the limbus (LSS). Postoperative complications, recurrent retraction and secondary surgical procedures were recorded. RESULTS: Out of 12 patients (16 eyelids) in whom a Medpor LES was inserted 8 patients suffered from Graves' orbitopathy. Mean follow-up was 7.5 months (range 4 - 11 months). Final cosmetic outcome was good in 8/16 eyelids and improved in 7/16 eyelids. Lower eyelid retraction (LSS) was reduced significantly (1.34 mm +/- 0.214 (mean +/- std. error of mean), p = 0.004). Complications included eyelid contour deformity (4/16 eyelids), remaining irritation of the eye (1/16) and problems in down gaze (4/16) as well as recurrent lower eyelid retraction (2/16) requiring further surgery in 3 of 11 patients. CONCLUSIONS: In selected patients, insertion of a Medpor lower eyelid spacer may be a good alternative to correct lower eyelid retraction.

Adult↗
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↗
PubMed2006

[Reconstruction of eyelid with hard palate mucosa autograft after resection of Malignant tumor of eyelid].

OBJECTIVE: To evaluate the clinical effect of the eyelid reconstruction using hard palate mucosa graft after resection of malignant tumor of eyelid. METHODS: From January 1998 to October 2003, 18 cases of malignant tumor of eyelid underwent the eyelid reconstruction with local flap grafting and hard palate mucosa autotransplantation. Of 18 cases, there were 10 males and 8 females, aging from 35 to 67 years. The defect was caused by basal cell carcinoma of eyelid in 10 cases, by carcinoma of meibomian glands in 6 cases and by squamous cell carcinoma of eyelid in 2 cases, including 12 cases of complete eyelid defect and 6 cases of 2/3 eyelid defect. RESULTS: The appearance and function of the eyelid in all cases were almost normal after the eyelid reconstruction with hard palate mucosa autotransplantation in replacing posterior layer of eyelid. The complete eyelid closure and no entropion were observed in all cases. The infection and contracture of the graft, immunologic rejection were not observed in all cases during the follow-up period of 6 to 48 months. CONCLUSION: The eyelid reconstruction using autotransplantation with hard palate mucosa in replacing posterior layer of eyelid was easy-to-operate and has satisfactory clinical effect. The hard palate mucosa as substitute of tarsus is superior to the traditional substitute.

Adult↗
PubMed2005

Horizontal eyelid movement on eyelid closure.

PURPOSE: When performing ptosis surgery, a suture is placed between the levator and the tarsal plate at the point of the desired peak. This placement is done while the patient's eye is closed, but its effects are observed with the patient's eye open. Unaccounted-for horizontal eyelid movement on eyelid closing may therefore adversely affect the desired outcome. The purpose of this study was to characterize the horizontal translation of the eyelid on closing the eyes. METHODS: In this experimental case series study, a randomly selected upper eyelid of normal subjects, subjects with ptosis, and subjects with exophthalmos, ages 21 through 70, was studied to determine the horizontal eyelid movement on closing the eyes by videotape analysis of the movement of dots placed above the eyelid margin and on the eyelid crease above the center of the pupil. RESULTS: The eyelid translation on closing the eye is medial and varies among subjects from 0.1 mm to 3.5 mm. The movement is usually greater at the eyelid margin than at the eyelid crease. CONCLUSIONS: The amount of horizontal eyelid translation on closing the eyes is clinically significant in many people. The clinical impact of this finding should affect how ptosis surgery is performed. The desired point of peaking of the eyelid should be marked at the beginning of the case with the eyes open and the mark used as a guideline for placing the suture that will determine the peak.

Adult↗
PubMed2004

Quantitative evaluation of eyelid elasticity using the cutometer SEM575 and its clinical application in assessing the efficacy of tacrolimus ointment treatment in eyelid atopic dermatitis.

PURPOSE: To study the clinical efficacy of a noninvasive suction device that measures eyelid skin elasticity in the treatment of eyelid atopic dermatitis using tacrolimus (FK-506) ointment. METHODS: Ten patients with eyelid atopic dermatitis treated with tacrolimus ointment and 10 normal volunteers participated in this study. The cutometer SEM575 was used to quantitatively evaluate eyelid skin elasticity. Severity of the eyelid atopic dermatitis was scored, and comparisons were made before and after treatment. RESULTS: Skin elasticity of patients with eyelid atopic dermatitis was significantly lower than that of normal volunteers (31.3 +/- 5.2% vs 40.2 +/- 7.8%, respectively). Skin elasticity of patients with eyelid atopic dermatitis improved significantly to 37.5 +/- 6.3% after treatment with tacrolimus ointment. The total severity score for eyelid atopic dermatitis also improved from 2.77 +/- 1.11 to 1.77 +/- 1.15. CONCLUSION: Measurement of skin elasticity using the cutometer SEM575 is a useful and reliable method for objective and quantitative evaluation of eyelid skin condition in patients with eyelid atopic dermatitis. The efficacy of short-term tacrolimus ointment treatment in patients with eyelid atopic dermatitis was confirmed quantitatively using this apparatus.

Adult↗
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↗
PubMed2004

Lax eyelid syndrome or 'progeria' of eyelid tissues.

PURPOSE: The lax eyelid syndrome was described by Van den Bosch and Lemij as an uncommon disorder seen in non-obese elderly people and characterised by chronic ocular surface irritation symptoms and a "floppy upper eyelid". The authors present some new features of the lax eyelid syndrome. METHODS: The authors report five patients, belonging to a younger age group, who presented with premature laxity of all the eyelid tissues. This caused medial and lateral canthal dystopia and eyelid malposition including ptosis, entropion and ectropion. Initial surgical correction was often followed by recurrence after some time. CONCLUSIONS: The authors highlight the differences between lax eyelid syndrome, cutis laxa, floppy eyelid syndrome and the blepharochalasis syndrome and suggest that lax eyelid syndrome can be thought of as "progeria" or premature ageing of the eyelid tissues to distinguish it clearly from these other conditions.

Adult↗
PubMedDate not supplied

Reconstruction of the lower eyelid by third eyelid lateral advancement and local transposition cutaneous flap after "en bloc" resection of squamous cell carcinoma in 5 cats.

OBJECTIVE: To describe a novel technique for blepharoplasty to cover a tissue defect involving >/=50% of the lower eyelid. STUDY DESIGN: Prospective clinical study. ANIMALS: Five cats with lower eyelid squamous cell carcinoma (SCC). METHODS: En bloc resection of SCC by removing >/=50% of the lower lid with either the medial or lateral canthus was performed without other adjunctive treatment for SCC. The lid defect was reconstructed with a transposition skin flap derived from the frontal (medial defect) or temporal (lateral defect) region. The third eyelid was advanced laterally without dissection from its insertion; its outer conjunctival layer was removed, and the skin flap was sutured with single interrupted sutures dorsally over the nictitating membrane, ventrally to the cutaneous edge of the surgical wound and medially or laterally (depending on the canthus removed) to the skin of the remaining lower lid. RESULTS: Satisfactory cosmetic and functional results were achieved and the Schirmer tear tests were normal. In 2 cats, the skin flap needed monthly hair trimming to avoid corneal lesions. CONCLUSIONS: After en bloc resection of SCC involving >/=50% of the lower eyelid, reconstruction can be achieved by relocation of the third eyelid and use of a cutaneous transposition flap sutured to the scarified external surface of the third eyelid. Eyelid apposition and lacrimal function were preserved. CLINICAL RELEVANCE: Blepharoplasty using a cutaneous transposition flap sutured to the scarified surface of a relocated third eyelid should be considered for reconstruction of lower eyelid defects with >/=50% tissue loss of the lid margin.

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↗