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.     

Topographic anatomy of the eyelids, and the effects of sex and age

AIMS: To describe the effects of sex and age on eyeball, eyelid, and eyebrow position. METHODS: A cross sectional cohort study was performed in which both eyes of 320 normal subjects aged between 10 and 89 years were included. Of each 10 year age cohort, there were 20 men and 20 women. Frontal, as well as lateral, slides were taken of both eyes. On projected slides, a reference line through the medial canthi and vertical lines through the pupil centre and the lateral canthus were constructed. Using these lines, we measured the size of the horizontal eyelid fissure, the distance from the reference line to the pupil centre and to the lateral canthus, the distance between the pupil centre and the upper and lower eyelid margin, and the distance between the upper eyelid margin and the skin fold and eyebrow. On lateral slides, the distance between the lateral canthus and the anterior corneal surface was measured. RESULTS: Between the ages of approximately 12 and 25 years, the horizontal eyelid fissure lengthened 3 mm, while the position of other eyelid structures remained virtually unchanged. Between the average ages of 35 and 85 years, the horizontal eyelid fissure gradually shortened again by about 2.5 mm. Meanwhile, the distance between the lateral canthal angle and the anterior corneal surface decreased almost 1.5 mm. Aging caused an increase of the distance between the pupil centre and the lower eyelid of about 1 mm in men, and 0.5 mm in women. Aging also caused a higher skin crease and raised eyebrows in men and women, but it did not affect the position of the pupil centre and the lateral canthus. Men showed an 0.7 mm larger horizontal eyelid fissure than women. In women, however, the eyebrows were situated about 2.5 mm higher than in men. CONCLUSION: Aging mainly affects the size of the horizontal eyelid fissure, which lengthens by about 10% between the ages of 12 and 25, and shortens by almost the same amount between middle age and old age. Aging causes sagging of the lower eyelid, especially in men, and a higher skin fold and eyebrow position in both sexes. Aging does not affect the position of the eyeball proper, or of the lateral canthus.     

Upper eyelid island orbicularis oculi myocutaneous flap for periorbital reconstruction

PURPOSE: To describe the upper eyelid island orbicularis oculi myocutaneous flap, medially or laterally based, for reconstruction of periorbital defects. METHODS: During the past three years we have used the island orbicularis oculi myocutaneous flap in 62 patients with tumors of the periorbital area, with the following indications: (a) anterior lamellar defects of the medial aspect of the upper eyelid, when the peripheral arcade is intact; (b) up to 2/3 anterior lamellar lower eyelid defects; (c) inner and outer canthus defects; and (d) defects of the peripalpebral area (the lateral half of the eyebrow, bridge of the nose and suprazygomatic areas). RESULTS: The flap proved to be flexible, safe, relatively simple, and provided good functional and aesthetic results. Complications were minimal. CONCLUSIONS: The upper eyelid island orbicularis oculi myocutaneous flap may be a useful tool for periorbital reconstruction.     

下睑内翻和上睑肥厚性单睑及内眦赘皮一期手术观察

目的 探讨下睑内翻和上睑肥厚性单睑及内眦赘皮一期进行的手术方法和美容效果.方法 先进行睑裂横径和内眦间距的测量,根据测量值设计新内眦点,采用睫毛周边切口矫治内眦赘皮.平行上下睑缘剪开内眦赘皮达新内眦点,分离上下皮瓣与眼轮匝肌,将原内眦点的皮肤与新内眦点皮肤缝合.下睑睫毛下1.5 mm横贯切口与内眦皮瓣相连,分离皮肤达眶下缘,白睑缘下2 mm分出宽4 mm肌肉瓣,在近外眦处将其缩短3～4 mm,7-0尼龙线间断缝合皮肤.上睑沿重睑设计线切开,下唇分离至睫毛根部,剪除其下多余组织,上唇去除一窄条皮肤直达内眦皮瓣并将其多余处剪除,打开眶隔剪除脱出脂肪组织,中间挂提上睑肌腱膜后间断缝合皮肤.结果 本组16例32只眼,上、下睑内翻均得到矫正,重睑自然,睑裂明显变长开大,内眦赘皮消失.结论 采用此种联合手术方法做出的眼睛,不但治疗了疾病,而且达到了美容的目的,值的推广应用.     

Eyelid retractor surgery as an adjunct to cicatricial ectropion repair

Purpose : To evaluate the effectiveness of eyelid retractor repair in cicatricial ectropion of the lower eyelid. Methods : The study design was a prospective case series. One hundred and twenty eight eyelids were operated on in 100 consecutive patients with cicatricial ectropion. All patients underwent lower eyelid retractor repair via a conjunctival approach combined with skin replacement to the anterior lamella with or without a horizontal lid tightening procedure. When only medial ectropion was present, a medial‐based transpositional skin flap was used to repair the anterior lamella (26 eyelids). The remaining eyelids with ectropion involving all or most of the eyelid underwent upper‐to‐lower eyelid lateral‐based transpositional skin flap repair (92 eyelids), or full thickness free skin grafting (10 eyelids). Horizontal lid tightening was performed by lateral canthoplasty in 123 eyelids. Results : Relief of cicatricial ectropion symptoms was reported in 90% of patients overall. A normal punctum position was achieved in 70% of eyelids, overall, and was highest (88%) with a medial‐based transpositional skin flap. Conclusions : Eyelid retractor repair combined with skin replacement and horizontal lid shortening is an effective procedure for cicatricial ectropion.     

老年性上睑皮肤松弛症成形术术式的研究

目的 探讨预防上睑整形术后睑闭合不全,同时纠正下睑退缩及老年性睑外翻的手术方法。方法 传统上睑重睑切口线,平视状态下确定皮肤去除量,缩短上睑提肌腱膜,内外眦韧带悬吊,恢复睑裂横径。结果 术后上睑下垂及眼睑皮肤松弛同时得到纠正。提紧下睑及上提外眦水平,舒平外眦皱纹,术后恢复快,形态自然。结论 此术式更加符合老年人生理特点和心理状态,既改善了眼睑功能又达到美容效果。     

Eyelid reconstruction using a monopedicle flap and buccal mucosa: report of 15 cases

A method is described for eyelid reconstruction to close a large defect involving the lid margin using a myocutaneous flap over a free buccal mucosal graft. The procedure was performed on 15 patients over a three-year period. Thirteen patients had loss of lower lid tissue alone. One included the lateral canthus and one over 50% of both upper and lower lids. Results were good in all patients except the one with extensive reconstruction of both lids. Advantages over other techniques of lid reconstruction include ease of surgery, adaptability of the technique to any eyelid site, good tissue match and the need for only a one-stage procedure.     

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.     

EYELID RECONSTRUCTION USING A MONOPEDICLE FLAP AND BUCCAL MUCOSA: REPORT OF 15 CASES

A method is described for eyelid reconstruction to close a large defect involving the lid margin using a myocutaneous flap over a free buccal mucosal graft. The procedure was performed on 15 patients over a three-year period. Thirteen patients had loss of lower lid tissue alone. One included the lateral canthus and one over 50% of both upper and lower lids. Results were good in all patients except the one with extensive reconstruction of both lids. Advantages over other techniques of lid reconstruction include ease of surgery, adaptability of the technique to any eyelid site, good tissue match and the need for only a one-stage procedure.     

Modification of Bick's procedure for treatment of eyelid laxity

A modification of Bick's procedure is presented that offers a simple, effective treatment of ectropion and entropion secondary to eyelid laxity. A full-thickness lid-shortening procedure performed at the lateral canthus avoids lid notching, with good cosmetic results. The success of the procedure is determined by suture of the tarsus directly to the orbital periosteum. The modification of Bick's procedure improves the outcome of the operation and simplifies its performance.     

Eyelid lymphatics II: a search for drainage patterns in the monkey and correlations with human lymphatics

PURPOSE: To study the lymphatic drainage of the cynomolgus monkey through the use of lymphoscintigraphy. METHODS: Lymphoscintigraphy with 500 microCi of 99mTechnetium sulfur colloid injected at specific sites around the eyelids was performed with five cynomolgus monkeys in lateral and ventral positions. RESULTS: Lymphoscintigraphy of the monkey eyelid and periocular tissue revealed lymphatic drainage to the parotid lymph nodes from the entire upper eyelid, medial canthus, and lateral lower eyelid and drainage to the submandibular lymph nodes from the medial and central lower eyelid. In addition to draining to the parotid lymph nodes, the central upper eyelid was also seen to drain to the submandibular lymph nodes. CONCLUSIONS: Lymphoscintigraphy of the cynomolgus monkey eyelids reveals discrete lymphatic drainage pathways for the upper and lower eyelids and a dual pathway for the central upper eyelid. Future studies will help to clarify the lymphatic drainage pathways of human eyelids.     

Simultaneous spontaneous and primary surgical repair of eyelids.

Fifteen patients with suspected malignant lesions of the lower eyelids or inner canthal region, needing large excisions, were managed as day cases with spontaneous repair and simultaneous subtotal primary surgical reconstruction under local anaesthesia. For lesions confined to the lower eyelid, only those patients requiring full-thickness margin-inclusive (FTMI) excisions of more than half the horizontal extent of the eyelid are included in this study-the largest excision being 21 x 6 mm. For malignant lesions of the inner canthus, only those patients needing moderate to large excision of inner canthal skin and orbicularis with simultaneous FTMI excision of the medial one-third (8 x 5 mm) of the upper as well as the lower eyelid are included. The 16th patient had traumatic loss of inner canthal tissue. The final cosmetic and functional results in all 16 patients were satisfactory and comparable with the results of competent and in-toto primary surgical reconstructions. For large excisions at the inner canthus spontaneous with partial primary surgical repair allows the use of a less extensive and less elaborate surgical procedure that is within the capabilities of most ophthalmic surgeons.     

黄金分割律在改良型埋线法重睑术中的应用

目的介绍一种方法简便、术后重睑自然而持久的术式。方法采用黄金分割律找到黄金分割点,并用亚甲蓝划出重睑线,并以黄金分割点为中心,设计出等距离的近内眦、外眦部二点。此时,采用改良型埋线法,进行重睑术。结果经3个月随访,未见重睑消失。结论把黄金分割律应用到埋线法重睑术中,具有符合每个人自身的生理、解剖位置和美学标准。     

Idiopathic loss of lateral tarsal suspension

CASE: A 53-year-old man who showed a loss of tarsal suspension in the lateral third of both lower eyelids underwent lateral canthoplasty with a good post-operative result. DISCUSSION: Disinsertion of the union of the inferior tarsus with the lateral canthus, of unknown cause, is a very uncommon finding that has almost never been reported in the world literature. There are two cases described of eyelid elastolysis with loss of lateral tarsal suspension, as in our case, but both showed eyelid skin atrophy and had histopathologic confirmation. Our case did not have skin atrophy.     

改良Ⅰ期重睑成形联合内眦赘皮矫正术的疗效探讨

目的:探索一种设计简单、操作灵活、效果确实的Ⅰ期重睑成形联合内眦赘皮矫正术的新方法,以期达到自然、美观的眼部外形.方法:选取2011-09/2015-05采用Ⅰ期重睑成形术联合内眦赘皮开大术矫治单睑合并内眦赘皮患者62例124眼,包括对双上睑单睑常规行切开法重睑术,向内眦部延长重睑线切口,将内眦切口隐蔽在重睑线内;随后松解纵形内眦韧带,并重新定位理想的内眦形态,以减少内眦部皮肤张力;再根据新定位内眦形态适度去除多余皮肤组织,同时矫正双上睑单睑合并内眦赘皮外形.术后3mo~1a对患者进行随访,随访时间点分别为3、6mo,1a,在以上时间点对患者双上睑重睑的形态及内眦形态、内眦瘢痕等进行观察.结果:患者57例114眼获得3mo~1a的完整随访.通过对随访的57例114眼患者的重睑形态进行评估,永久性重睑、内眦赘皮矫正充分,形态满意者51例102眼,内眦赘皮部分矫正、形态改善者6例12眼,所有随访患者均未见内眦赘皮复发及严重瘢痕增生.结论:将内眦开大术与重睑成形术同期施行,内眦开大充分,切口隐蔽,可按实际皮肤量切除皮肤,术后切口瘢痕隐蔽,能够有效地解决内眦部皮肤的张力分布,获得永久性重睑和自然的内眦开大效果,是矫正单睑合并内眦赘皮的理想手术方法.     

Ophthalmia Neonatorum

The unhappy postblepharoplasty patient with lateral canthal dystopia, round eye, and scleral show presents perhaps the single greatest challenge to the aesthetic reconstructive surgeon. The problem may be as simple as a lax eyelid, which is inferiorly displaced by gravity or as complex as an eyelid, which has full thickness vertical inadequacy in each of the three eyelid lamellae. The transeyelid subperiosteal midface-lift with lower eyelid reconstruction is a reliable procedure for addressing full thickness lower eyelid vertical tissue inadequacy by totally reconstructing the lower eyelid by the classic three individual layer reconstructive technique. Vertical and horizontal adequacy or inadequacy for each of the three eyelid layers is determined and then individually addressed in the total eyelid reconstruction. This procedure has the potential to fully reconstruct and reposition the lower eyelid and lateral canthus such that the final position, function, and appearance is as good or better than it was before the changes caused by time, gravity, and previous surgery.     

Anatomical basis of "senile" ectropion

A study of 20 patients with bilateral ectropion was undertaken to determine the exact anatomical etiology of the horizontal eyelid laxity which leads to "senile" (involutional) ectropion. Two previous studies on normal people have shown a slight increase in the horizontal length of the lateral canthus with increased age. The results of the 20 patients with ectropion revealed that the lateral canthal tendon is significantly increased in horizontal length as compared with normal, age-matched controls. Therefore, surgery directed to the repair of the attenuated, horizontally lax, lateral canthus is more appropriate than full-thickness block or tarsal resection of the normal eyelid in the palpebral fissue. Additionally, since normal full-thickness eyelid tissue is not resected, the horizontal length of the palpebral fissue will not be shortened. This results in a more pleasing cosmetic appearance as well as an improved functional result.     

改良术式治疗重度或复发性老年性下睑内翻

目的探讨应用改良睑板条带外眦固定联合下睑缩肌折叠术治疗重度或复发性老年性下睑内翻的效果。方法对26例（36眼）重度或复发性老年性下睑内翻采用改良睑板条带外眦固定联合下睑缩肌折叠术进行治疗。结果术后均获一期愈合,下睑内翻矫正良好。随访1个月～4年,未见复发。结论本改良术式治疗老年性重度或复发性下睑内翻,可获得较好的美容效果。     

The effect of omitting botulinum toxin from the lower eyelid in blepharospasm treatment

We randomly selected 26 patients with essential blepharospasm to receive either botulinum toxin or saline injection in their lower eyelids to evaluate the necessity of lower eyelid injection to relieve blepharospasm. As diplopia may occur from botulinum toxin injections for blepharospasm, most commonly from injection of the lower eyelid, and surgical relief of blepharospasm is often achieved by excision of only the upper eyelid protractors, omission of toxin from the lower eyelid seemed both desirable and possible. All patients received botulinum toxin in the upper eyelids, above the eyebrows, across the glabella, and near the lateral canthus. Thirteen of 15 patients who received saline in their lower eyelids had relief of spasm, with the same spasm-free interval as those who received toxin. We recommend avoiding injection of toxin in the medial two thirds of the lower eyelid in order to diminish the likelihood of diplopia from inferior oblique muscle paresis.     

Unilateral microblepharon

We report the clinical features and surgical treatment of a 15-year-old girl with unilateral microblepharon. The anomaly was characterized by a vertical shortage of upper and lower eyelid skin, causing nocturnal lagophthalmos, corneal exposure, and cosmetic deformity. Treatment consisted in hard-palate grafting and lateral tarsal strip suspension of the lower eyelid of the affected side. The outcome was considered satisfactory by the surgeon and by the patient. No further surgery was required.