经典提上睑肌缩短术治疗重度先天性上睑下垂

目的评估经典提上睑肌缩短术治疗重度先天性上睑下垂及手术治疗效果。方法重度先天性上睑下垂20眼行经典提上睑肌缩短术结果本文16例20眼,平均随访6个月。术后睑裂高度7～9mm者18眼,6mm者2眼,双眼睑裂对称,重睑弧度自然,部分病例有轻度睑裂闭合不全,4眼一过性轻度结膜脱垂。结论该术式矫正重度先天性上睑下垂效果良好。     

Management of exposure keratopathy associated with severe craniofacial trauma

We describe a case of severe craniofacial trauma with resultant exposure keratopathy that was refractive to traditional treatment measures including aggressive lubrication, tarsorrhaphy, platinum lid weight implantation, punctal plugs, correction of lid retraction, amniotic membrane application, and multiple bandage contact lenses. Through combined Boston scleral lens placement and traumatic cataract extraction with intraocular lens (IOL) implantation using scleral lens IOL power calculations, we were able to maximize patient comfort and attain superior visual acuity. To our knowledge, calculation of IOL power through a scleral lens has not been described.     

Cosmetic Lower Lid Blepharoplasty

This article will review the topic of cosmetic lower lid blepharoplasty including: preoperative patient evaluation and selection; blepharoplasty surgery; postoperative patient care; and complications of surgery. The emphasis of this article is surgical techniques, including standard lower lid blepharoplasty via a subciliary skin incision, lower lid blepharoplasty combined with lateral canthal lower lid tightening procedures, and the transconjunctival lower lid blepharoplasty procedure. Preoperative and postoperative surgical results are presented.     

Graves'' ophthalmopathy: V. Aetiology of upper eyelid retraction in Graves'' ophthalmopathy.

The volume of the levator superior rectus muscle complex was determined from computed tomography scans of 152 orbits from 76 patients with Graves' ophthalmopathy. Clinically observed lid retraction and lid lag did not correlate with the levator/superior rectus muscle volume and did not correlate with limitation of vertical eye movements or inferior rectus muscle volume. These results do not support previously published hypotheses that muscle hypertrophy or levator/superior rectus muscle overaction secondary to inferior rectus muscle restriction are major causes of lid retraction and lid lag. Local adhesion of the levator muscle to fixed orbital tissues is postulated to be the most likely basis for the characteristic lid retraction and lid lag of Graves' ophthalmopathy.     

术中提上睑肌肌张力评估后单纯提上睑肌缩短术的临床疗效观察

目的 探讨根据术中对提上睑肌肌张力评估采取的单纯提上睑肌缩短术对儿童重症先天性上睑下垂的疗效方法 对169例(216只眼)重症先天性上睑下垂患儿,根据术中实际提上睑肌肌张力的评估,设计手术方式及手术量,其中143例(182只眼)行单纯提上睑肌缩短术,结果 169例(216只眼)术后6个月至2年随访,上睑缘位置均在瞳孔以...     

A technique for reconstruction of upper lid marginal defects

BACKGROUND/AIMS: Reconstruction of large full thickness upper lid defects that cannot be closed directly often rely on utilising the lower lid. An example is the Cutler Beard procedure. A one stage technique for repair of large horizontal upper lid defects utilising local posterior and anterior lamella advancement flaps is described and the results reported. METHOD: Eight cases with upper lid defects repaired utilising this technique were reviewed retrospectively. The procedures were carried out by one surgeon. The upper lid lesions were removed under frozen section control. The mean follow up time was 35 months. RESULTS: All patients had a good cosmetic result. One patient had a recurrence of the upper lid lesion. Two patients complained of corneal irritation from lanugo hairs. The technique was modified to prevent this complication. CONCLUSIONS: Large upper lid marginal defects can be readily repaired using the technique described with local advancement flaps with no significant complications.     

The Aponeurotic Approach to Eyelid Retraction

A technique for the upper lid retraction that involves an anterior approach similar to aponeurotic ptosis surgery is presented. Instead of advancing the aponeurosis, it is recessed and Moller's muscle is completely extirpated. The lateral horn of the levator must be cut to relieve the marked temporal elevation of the eyelid. Lid height and contour are adjusted intraoperatively with patient cooperation. In the lower lid, the retractors are recessed via a conjunctival approach unless simultaneously performed with orbital decompression. Any amount of lid retraction may be corrected by this technique in the upper lid and up to 3 mm of lower lid retraction can be corrected. Lid height in both the upper and lower lid is lasting and predictable. Thirty-one patients (63 eyelids) have been operated on using this technique with good results. Results in 17 patients (35 eyelids) with follow-up ranging from 8 to 42 months are presented.     

The synkinesis between antero-posterior eye position and lid fissure width

We have investigated the antero-posterior position of the eye during normal blinking, gentle and hard lid closing and voluntary lid widening with 12 young subjects. Computer- assisted video analysis was used to measure relative eye position. Involuntary blinks were accompanied by retraction of the eye, which was of similar magnitude to the retraction measured witfi lids restrained, while the lids of the contralateral eye gently closed. Eye retraction is accentuated with hard voluntary lid closure, while voluntary lid fissure widening produced slight proptosis of the globe. Preliminary data suggests a small degree of instability of antero-posterior eye position between blinks. Our results are consistent with previous studies of the association between antero-posterior eye position and lid fissure width.     

CONGENITAL UPPER lid COLOBOMA

Twenty-two patients with congenital upper lid colobomas were assessed Strabismus occurred in 13 cases and was associated with bands of fibrous tissue or adhesions, high refractive errors and opacities in the ocular media A traction test is strongly recommended early in all children with congenital upper lid colobomas A lateral cantholysis and direct closure was the commonest type of surgery, but unless the coloboma closed easily a lower lid rotation flap gave the best results.     

Congenital upper lid coloboma

Twenty-two patients with congenital upper lid colobomas were assessed. Strabismus occurred in 13 cases and was associated with bands of fibrous tissue or adhesions, high refractive errors and opacities in the ocular media. A traction test is strongly recommended early in all children with congenital upper lid colobomas. A lateral cantholysis and direct closure was the commonest type of surgery, but unless the coloboma closed easily a lower lid rotation flap gave the best results.     

Involutional entropion of the upper lid

Involutional entropion is an inturning of the eyelid margin caused by changes of lid tissues due to aging. Two patients with the uncommon finding of involutional entropion of the upper lid were treated with surgery based on the principles used to treat common lower lid entropion. The causes of lower lid entropion include increased horizontal and vertical lid laxity, and correcting these same factors in the upper lid resulted in a satisfactory repair of the entropion. Treatment of involutional entropion in the upper lid is compared and contrasted with that of the lower lid.     

The relation between eyelid tension, corneal toricity, and age

It has been demonstrated that corneal toricity can be altered by lifting the lids from the surface of the eye. Thus, corneal curvature is modified by the position or tension of the lids. Does it follow that differences in lid tension between individuals are related to variations in corneal toricity? A lid tensiometer was designed that measured the force exerted by a lid as it was pulled away from its resting place on the eye. When this force was plotted as a function of the displacement of the lid, an elastic coefficient of the lid was obtained. This elastic coefficient was used to denote lid tension. In a sample of 195 eyes, the elastic coefficient of the lid had a mean of 3.22 g/mm (SD +/- 1.12), with a range from 1.16 to 6.78 g/mm. The results showed no correlation between the elastic coefficient and corneal toricity. Both the elastic coefficient and with-the-rule corneal toricity showed a statistically significant decrease with age. However, there was no significant relation between the elastic coefficient and corneal toricity when the effect of age was ruled out. From this experiment, and a reading of the literature, we conclude that there is no experimental evidence to show that lid tension determines corneal toricity.     

Modified grey line split with anterior lamellar repositioning for treatment of cicatricial lid entropion

To determine the success rate of surgery of modified grey line split with anterior lamellar repositioning in patients with cicatricial lid entropion and to determine the risk factors of failure of the procedure, 40 patients (84 lids) with either lid involvement caused by cicatricial lid entropion of different etiologies were enrolled in this study. All the lids were operated on using the technique of modified grey line split and anterior lamellar repositioning. The success of the procedure was assessed by restoration of anatomical and physiological functioning of the lid without any residual symptom to the patient. Patients were examined initially at weekly intervals for 1 month and subsequently followed up at 2, 3, and 12 months following surgery. Among the various causes for cicatricial lid entropion, infectious etiology (72/84 lids) was found to be the most common one. A success rate of modified grey line split with anterior lamellar repositioning was 88.09% (74/84 lids). The underlying etiology of cicatricial lid entropion was the sole predictor of failure of surgery. Those with the etiology of infection had more than 6 times the odds of surgery failure (OR: 6.73; 95% CI: 2.79-16.73) as compared to a patient without infectious etiology. The role of other factors such as the age of the patient, degree of entropion, previous entropion surgery, the lid (upper or lower) involved, irregular lid margin, and defective lid closure were statistically insignificant. The underlying etiology of cicatricial lid entropion is the only risk factor that significantly influences the outcome of surgery with this technique. Otherwise, this procedure gives good results with fewer complications in patients with cicatricial lid entropion.     

A new material for frontal sling operation in congenital ptosis

Congenital ptosis with poor levator function is mainly treated by frontalis suspension. Of all the different suspensory materials tried, autologous fascia lata has been found to offer the most advantages. After the new Gore-tex soft-tissue patch had been used successfully in lid, lacrimal and orbital surgery it was tried with the frontalis suspension technique. When using Gore-tex strips it is not necessary to obtain fascia lata, which is especially difficult in children. A tight connection between the upper lid and the frontalis muscle can be achieved by ingrowth of connective tissue into the PTFE suspensory material. The frontalis muscle then lifts the upper lid. In spite of this, complete lid closure is possible. The surgical results are very satisfactory and are presented in this paper.     

Four-snip procedure for involutional lower lid entropion: modification of Quickert and Jones procedures

Involutional lower lid entropion results from a faulty lower lid retractor complex, lid laxity and overriding of preseptal orbicularis fibres on the tarsal and pretarsal fibres. The author describes the anatomy of the lower lid and presents a four-snip procedure for correcting this condition in which the Quickert and Jones techniques are combined.     

Avoidance of complications in lower lid blepharoplasty

The most common complication of lower lid blepharoplasty is lower lid malposition either lower lid retraction or frank ectropion. This is caused by the vertical pull of skin shortage or shrinkage on a lax tarso-ligamentous sling. A method of tightening the tarso-ligamentous sling combined with a lower lid blepharoplasty is presented. An alternate method of lower lid fat removal through the fornix without skin incision is presented to be used in patients with taut lower lid skin.     

Techniques of facial nerve block.

The efficacy of different techniques of facial nerve block for cataract surgery was investigated. Forty four patients underwent either modified O'Brien, Atkinson, van Lint, or lid blocks. Intentional muscle activity of the orbicularis oculi muscle was recorded and the area under the EMG curve calculated for quantitative comparison of muscle activity between the groups before and after injection of lignocaine with the vasoconstrictor naphazoline nitrate. In addition, the force of lid closure was measured and lid motility determined on a subjective score scale. Whereas the modified O'Brien and lid blocks nearly abolished the muscle activity recorded in the EMG (p < 0.003), the Atkinson and van Lint blocks did not significantly affect these variables. The O'Brien and lid blocks decreased the force of lid closure and lid movements far more effectively than the Atkinson and van Lint blocks (p < 0.0001). The topographic distribution of a mixture of metrizamide and lignocaine solutions was evaluated radiographically in eight additional patients, to assess potential causes for differences in the efficacy of the block techniques. The radiological results showed involvement of the region of the facial nerve trunk and its temporal and cervical divisions by the modified O'Brien block. The lid block, on the other hand, affected terminal branches of the facial nerve's temporal division. In this study, complete lid akinesia was achieved by both the modified O'Brien block and the lid block. However, because the modified O'Brien block involves the risk of neural injury to the facial nerve or its main divisions, the lid block is recommended as the most effective and safe method to achieve akinesia of the orbicularis oculi muscle.     

Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease: a case series

PURPOSE: To report the results of subconjunctival injection of triamcinolone in the treatment of thyroid eye disease-related lid retraction. INTERVENTION: Patients with either unilateral or bilateral upper lid retraction, secondary to thyroid eye disease, diagnosed during the period of February 2004 to June 2005 were recruited. An injection of 0.5 ml of triamcinolone acetonide (40 mg/ml kenalog) with 0.1 ml of 2% lignocaine was injected into the subconjunctival region of the lid between the conjunctiva and Muller's muscle under topical anaesthesia on upper lid eversion. Pre- and post-procedure measurements included lid aperture, marginal reflex distance, the amount of lagophthalmos, and intraocular pressure measurements. Photographs were also obtained before the procedure and at subsequent visits. Follow-up was done at 2 weeks, 1, 3, 6 months and at 1 year. RESULTS: Three of the four patients had resolution of their upper lid retraction within 1 month of treatment, with one patient requiring a repeat triamcinolone injection. The patient who had fibrotic muscles did not respond to triamcinolone injections and required surgical correction. CONCLUSION: Upper lid subconjunctival triamcinolone appears to be an effective treatment option in reducing lid retraction in patients with recent onset of thyroid eye disease.     

对位睑板结膜瓣滑行修复眼睑缺损

目的：评价对位睑板结膜瓣滑行修复眼瞪缺损的效果。方法：对41例眼瞪全层缺损患者,其中上睑10例,下睑31例,切除肿瘤导致缺损者33例。外伤导致缺损者8例,缺损范围在1/3-2/3,年龄24-79岁,采用与缺损眼睑相对应的眼睑睑板结膜瓣滑行至缺损区来修补眼睑缺损。结果：术后随访31例,随访时间3月-5年,除缺损外,1例出现轻度上睑退缩（退缩量为1-2mm),1例出现轻度下睑外翻,余眼睑外形及功能均基本恢复,眼睑活动自如,闭合完全,无严重并发症发生,结论：对位睑板结膜瓣滑行可用于修复眼睑后层缺损,且不受有无睑板替代物的限制。不需另添手术创口,可更好地恢复眼睑的功能及外观。     

Reconstruction of the lower lid.

As the lower eyelid is frequently the site of malignant disease, lower lid replacement is a common task in oculoplastic surgery. As a rule the reconstruction of larger defects (more than one-third) can be accomplished with free grafts or with flaps. Different forms of pedicle flaps (full thickness, tarsoconjunctival, combined) from the upper lid provide better results than free grafts. A convenient method of lower lid replacement is the use of a medial pedicle rotation flap of the cheek. This has advantages over the temporal pedicle cheek flap or the frontal flap.