Lower Eyelid Epiblepharon Associated with Lower Eyelid Retraction

Purpose

To describe a series of patients with lower eyelid epiblepharon associated with lower eyelid retraction.

Methods

We retrospectively reviewed the medical records of patients who underwent surgery for lower eyelid retraction, epiblepharon, or thyroid-associated ophthalmopathy (TAO) between October 1999 and March 2007. Patients with both lower eyelid retraction and epiblepharon on preoperative examination were included in this study.

Results

Twenty-seven eyelids of 20 patients with both lower eyelid retraction and epiblepharon were enrolled. The underlying causes of lower eyelid retraction included congenital retraction (seven eyelids), congenital fibrosis of the extraocular muscles (CFEOM; seven eyelids), TAO (seven eyelids), post-operative cicatricial retraction (five eyelids), and facial nerve palsy (one eyelid). Eight of 27 eyelids were successfully corrected after the repair of retraction without the repair of epiblepharon, regardless of the cause of lower eyelid retraction. Another four eyelids with epiblepharon associated with TAO resolved after only orbital decompression. Cilia-everting sutures were additionally applied for epiblepharon in another 14 eyelids, 12 of which did not require the excision of a skin fold or the orbicularis muscles. Only one eyelid with mild retraction and epiblepharon underwent simple epiblepharon repair. Recurrence of retraction or epiblepharon developed in three eyelids during follow-up.

Conclusions

In cases with both lower eyelid retraction and epiblepharon, the retraction should be repaired first, and then the epiblepharon can be corrected selectively according to the severity of the case.     

Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroid-associated Ophthalmopathy

Purpose

To evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO).

Methods

Twenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneously performed. The patients had a minimum preoperative period of 3 months of stable range of ocular motility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperative and postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performed in all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0).

Results

Forty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 ± 11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 ± 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertel measurement of 17.6 ± 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle in three cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increased in all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgical session in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgical session in two cases. Margin reflex distance decreased from a preoperative average of 4.3 ± 0.8 to 3.8 ± 0.5 mm postoperatively.

Conclusions

The customized orbital decompression procedure decreased proptosis and improved diplopia, in a range comparable to those achieved through more stepwise techniques, and had favorable cosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.     

Changes in Eyelid Parameters after Orbital Decompression according to the Surgical Approach in Thyroid Eye Disease

PurposeTo evaluate the changes in eyelid parameters after the endonasal approach compared with transcaruncular medial wall decompression combined with the transconjunctival inferior wall decompression approach with inferomedial strut preservation.MethodsIn total, 71 patients with thyroid eye disease who underwent orbital decompression were retrospectively evaluated. The data collected included Hertel exophthalmometry, marginal reflex distance 1, marginal reflex distance 2, interpalpebral fissure, levator function test measures, and complications related to surgery.ResultsProptosis reduction produced a statistically significant improvement across all decompression groups. Lower eyelid retraction produced a statistically significant improvement in the two-wall decompression groups but not in the one-wall decompression groups. No statistical difference was observed in the upper eyelid retraction and levator function after surgery across all decompression groups. In the post-hoc analysis, statistical improvement was not observed in the lower eyelid retraction between the endonasal and transcaruncular approach in the one-wall and two-wall decompression groups, although statistically significant exophthalmos reduction and improvement in the lower eyelid retraction was noted in the two-wall decompression subgroups compared with one-wall decompression subgroups.ConclusionsOur study showed no differences in eyelid parameters between the endonasal and transcaruncular decompression approaches in one-wall and two-wall decompression. In the two-wall decompression group, proptosis reduction was greater with the endonasal approach than with the transcaruncular approach when the strut was preserved; however, it does not lead to a significant difference in the improvement of lower eyelid retraction.     

应用异体巩膜治疗甲状腺相关眼病下睑退缩

目的 评估应用异体巩膜延长下睑缩肌矫正甲状腺相关眼病下睑退缩的临床疗效.方法 对15例(25眼)以下睑挛缩为主要表现的静止期甲状腺相关眼病患者,采取异体巩膜延长下睑缩肌术矫正退缩的下睑,并观察其临床疗效 .结果 术后患者自觉症状均不同程度减轻或消失,术后所有患者睑裂宽度与术前比差异均有统计学意义(P＜0.01),术后6月、1年随访无眼睑退缩复发.结论 异体巩膜下睑缩肌延长术能有效矫正甲状腺相关眼病下睑退缩.     

Preaponeurotic Fat Advancement for Prevention of Unexpected Higher Eyelid Crease in Upper Eyelid-Lengthening Surgery

Purpose: To present a modified technique based on preaponeurotic fat advancement for preventing higher eyelid crease in upper eyelid-lengthening surgery.

Methods: Outcomes of Japanese patients with Graves’ orbitopathy-related upper eyelid retraction who underwent transcutaneous upper eyelid-lengthening surgery were reviewed. The minimum follow-up period was 6 months. A total of 17 upper eyelids in 11 patients (average age, 38.4 years) were included. After confirming appropriate upper eyelid lowering with good contour, preaponeurotic fat was fully exposed and fixed on the upper tarsal plate 1?mm superior to the planned eyelid crease with 5 sutures. Skin-tarsus-skin sutures were placed to create an eyelid crease and close the skin. Simple suture tarsorrhaphy was performed with 2 sutures.

Results: No upper eyelids demonstrated higher eyelid crease postsurgically. Upper eyelid fullness caused by the advanced preaponeurotic fat was not conspicuous.

Conclusions: Our technique is a countermeasure against higher eyelid crease in upper eyelid-lengthening surgery.     

同种异体巩膜下睑缩肌延长术治疗甲状腺相关眼病下睑挛缩

目的:评估同种异体巩膜下睑缩肌延长术矫正甲状腺相关眼病下睑挛缩的临床疗效。方法:对12例16眼以下睑挛缩为主要表现的静止期的甲状腺相关眼病患者,采用同种异体巩膜下睑缩肌延长术矫正挛缩的下睑,并观察其临床疗效。结果:术后所有患者睑裂高度均明显下降,自觉症状不同程度减轻或消失。术后普遍存在的并发症是眼睑肿胀,且持续时间长。结论:同种异体巩膜下睑缩肌延长术能有效矫正甲状腺相关眼病的中重度下睑挛缩。     

Magnetic Resonance Imaging of Pre- and Postoperative Lower Eyelid States in Involutional Entropion

Purpose To disclose pre- and postoperative lower eyelid gradients in involutional entropion using sagittal magnetic resonance imaging (MRI).Methods Three female patients, average age 82 (two right eyes and one left), were operated on for involutional entropion by the Jones procedure. Before and after the surgery, the lower eyelid gradient was evaluated by MRI and photography.Results Preoperatively, each lower eyelid presented anterior protrusion, and the retractor was apart from the globe. Postoperatively, no anterior protrusion was observed, and the retractor was pulled posteroinferiorly and located parallel to the globe.Conclusions The MRI visualization of pre- and postoperative changes of gradient in the lower involutional entropion supports surgical reconstruction. Jpn J Ophthalmol 2004;48:364–367 © Japanese Ophthalmological Society 2004     

儿童眼球突出继发下睑退缩的手术探讨

目的 探讨儿童眼球突出继发下睑退缩的手术方式和效果.设计回顾性病例系列.研究对象北京儿童医院不同原因所致眼球突出合并下睑退缩、内翻倒睫患儿8例(14眼),年龄1岁3个月～8岁4个月.方法 所有病例采用下睑缩肌后徙联合睑板内固定术.术后随访6～12个月.主要指标术前术后下睑缘中央至瞳孔反光点距离(MRD2)、下睑内翻倒睫...     

Effect of Smoking on Retinal Thickness and Vascular Density in Thyroid Eye Disease

PurposeTo evaluate the effect of smoking on retinal thickness and macular and peripapillary vascular density in thyroid eye disease (TED).MethodsIn this cross-sectional study, subjects diagnosed with TED were analyzed in three groups: smokers, passive smokers, and non-smokers. Ganglion cell complex thickness, total retinal thickness, macular superficial vascular plexus densities, deep vascular plexus densities, optic nerve head, and radial peripapillary capillary density were measured in each group.ResultsTwenty-two eyes (21.6%) of active smokers, 11 eyes (10.8%) of passive smokers, and 69 eyes (67.6%) of non-smokers constitute the study subjects. Twenty-one eyes (12.6%) had active status (clinical activity score ≥3), 77 eyes (46.1%) were neither active nor compressive, four eyes (2.4%) of two patients constituted the compressive group. Age and disease activity adjusted analysis was performed. Ganglion cell complex thickness of smokers was significantly higher than non-smokers in the inferior hemi-parafoveal sector (p = 0.04). Active smokers had significantly higher (p < 0.01) retinal thickness in all sectors compared to non-smokers, except the foveal sector. Smokers had lower superficial vessel density in the superior parafoveal sector compared to non-smokers (p = 0.04). Considering deep vessel densities between smokers and non-smokers, no significant difference was observed. Radial peripapillary capillary densities (significant difference was observed in the whole image and infranasal peripapillary sector), Macular vascular densities (significant difference was observed in parafoveal sectors), and optic nerve head (not reaching statistical significance level in any sectors) were highest in passive smokers.ConclusionsSmoking is associated with increased total retinal thickness. Macular vascular densities were not different between smokers and non-smokers in TED.     

Surgical Outcomes of Balanced Deep Lateral and Medial Orbital Wall Decompression in Korean Population: Clinical and Computed Tomography-based Analysis

PurposeTo evaluate the clinical outcomes of balanced deep lateral and medial orbital wall decompression and to estimate surgical effects using computed tomography (CT) images in Korean patients with thyroid-associated ophthalmopathy (TAO).MethodsRetrospective chart review was conducted in TAO patients with exophthalmos who underwent balanced deep lateral and medial orbital wall decompression. Exophthalmos was measured preoperatively and postoperatively at 1 and 3 months. Postoperative complications were evaluated in all study periods. In addition, decompressed bone volume was estimated using CT images. Thereafter, decompression volume in each decompressed orbital wall was analyzed to evaluate the surgical effect and predictability.ResultsTwenty-four patients (48 orbits) with an average age of 34.08 ± 7.03 years were evaluated. The mean preoperative and postoperative exophthalmos at 1 and 3 months was 18.91 ± 1.43, 15.10 ± 1.53, and 14.91 ± 1.49 mm, respectively. Bony decompression volume was 0.80 ± 0.29 cm³ at the medial wall and 0.68 ± 0.23 cm³ at the deep lateral wall. Postoperative complications included strabismus (one patient, 2.08%), upper eyelid fold change (four patients, 8.33%), and dysesthesia (four patients, 8.33%). Postsurgical exophthalmos reduction was more highly correlated with the deep lateral wall than the medial wall.ConclusionsIn TAO patients with exophthalmos, balanced deep lateral and medial orbital wall decompression is a good surgical method with a low-risk of complications. In addition, deep lateral wall decompression has higher surgical predictability than medial wall decompression, as seen with CT analysis.