痉挛性下睑外翻的手术治疗

目的 探讨严重面肌痉挛合并痉挛性下睑外翻的手术治疗方法并观察其疗效.方法 睑缘下水平切口,去除部分眶部轮匝肌而保留睑部轮匝肌;联合下睑缩短,即近外眦部楔形切除适量眼睑组织后缝合.结果 5例严重面肌痉挛的老年患者,就诊是整个半侧脸包括眼部都不断抽动,下睑严重外翻1年有余,其下睑及穹隆结膜由于长期暴露已经十分粗糙并水肿增厚.接受此手术后,下睑外翻矫正良好;经观察半年,下睑及穹隆结膜水肿逐渐消退,下睑外翻无复发.结论 严重面肌痉挛合并痉挛性下睑外翻,当神经科治疗无效时,由于眶部轮匝肌痉挛等因素持续存在,外翻难自然恢复.施行眶部轮匝肌切除,能改善眼部肌肉痉挛抽搐的症状,联合下睑缩短可矫正下睑外翻.     

应用外翻严重度评分评价涤纶心脏补片联合睑板缩短术治疗麻痹性下睑外翻的手术疗效

目的 应用外翻严重度评分（ESS）评价涤纶心脏补片联合睑板缩短术治疗麻痹性下睑外翻的手术疗效。设计 回顾性病例系列。研究对象 2017年5月至2019年6月北京同仁医院手术治疗的麻痹性下睑外翻患者7例（7眼）,其中男性5例（5眼）,平均年龄（70±9）岁。方法 手术方法为将涤纶心脏补片修剪至合适尺寸后内侧固定于内眦韧带及内侧眶缘,外侧固定于外侧眶缘,同时联合行睑板缩短术。基于眼外观照相的ESS对下睑外翻的位置和程度,有无巩膜暴露、睑结膜暴露、泪膜过多、结膜充血、眦角圆顿、泪小点外翻的体征逐项评分,最高分为8分。应用ESS评分评价术前下睑外翻严重度及术后疗效。平均随访（19±10）个月。主要指标 ESS评分及手术并发症。结果 术前ESS评分4.5~8分,中位数为8分;术后随访终点ESS评分0~1分,中位数为0分;较术前显著好转（Z=-0.756,P=0.017）。无欠矫及复发,成功率100%。植入物无移位或脱位。结论 涤纶心脏补片联合睑板缩短术应用于麻痹性下睑外翻的治疗安全有效,外翻严重度评分是一种直观并可量化的评价方法。（眼科, 2020, 29： 386-390）     

下睑外翻的手术矫正

目的 观察不同手术方法矫正下睑外翻的疗效。方法 根据外翻的不同原因和程度,采用睑缘缩短术＋下穹窿成形术、旋转异位皮瓣矫正术治疗下睑外翻。结果 11例患者13只眼采用不同手术,均获得满意效果。随访观察3－36个月无复发。结论 矫正下睑外翻的手术设计要合理,严格掌握皮瓣设计原则,才能使外翻获得矫正。     

Y-V成形联合重睑术矫正内眦赘皮合并内眦间距增宽疗效分析

目的 观察Y-V成形联合重睑术对内眦赘皮合并眼距增宽的疗效.方法 将内眦部Y-V切口延长至下睑缘内侧,通过彻底松解局部错构的眼轮匝肌,充分显露内眦韧带前支鼻侧骨膜止点,将其与内眦韧带起点缝合,缩短内眦韧带,矫正内眦赘皮,并同期行双眼重睑成形术.结果 临床应用40例,随访半年以上,内眦赘皮矫正效果良好,内眦间距缩短、眼型自然美观,切口瘢痕不明显.结论 Y-V成形内眦赘皮矫正同期行切开重睑术,疗效明确,切口更加隐蔽、恢复快,对内眦赘皮合并眼距增宽的患者有较好疗效,值得在临床推广应用.     

扩展外侧睑板剥离缝合术治疗麻痹性睑外翻

常用于矫正麻痹性睑外翻的手术方法———外侧睑板剥离术和外侧睑缘缝合术,不能完全解决面神经麻痹引起的严重眼睑松弛、下坠,也不能有效保护角膜,而且后者由于缩短了睑裂长度,可致患者颞侧视野缩小。由传统外侧睑板剥离术发展而来的扩展外侧睑板剥离缝合术,较外侧睑缘缝合术有     

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.     

探讨Medpor下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻

目的　探讨Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻的临床疗效。方法　回顾性系列病例研究。收集１６例（１６眼）重度麻痹性下睑外翻患者的临床资料,所有患者均采用Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗。记录并比较１６例患者术前及术后１周、３个月、１２个月的眼睑闭合不全量、下睑退缩量、角膜上皮分级、下睑水平及垂直松弛度等级。结果　１６例患者术后下睑外翻均矫正,随访期内均未见复发。术后１周、３个月、１２个月,下睑退缩量、眼睑闭合不全量均较术前明显下降,差异均有统计学意义（均为Ｐ＜０．０５）;术后各时间点间比较,差异均无统计学意义（均为Ｐ＞０．０５）。随访期间各患者的角膜上皮分级、水平及垂直松弛度等级均较术前明显改善,随访期末均为０级或１级。无１例患者术后出现眶内出血、感染及内植入物暴露、排斥、移位等严重并发症。结论　采用Ｍｅｄｐｏｒ下睑插片联合外眦睑板条悬吊术治疗重度麻痹性下睑外翻,可在保留患者视功能的前提下矫正下睑外翻及眼睑闭合不全,有效改善患者眼表状况及外观,且术后效果较为稳定。     

麻风麻痹性下睑外翻矫治的效果分析

目的分析麻风所致麻痹性下睑外翻手术矫治的效果。方法2000～2004年笔者在文山州为63例麻风麻痹性下睑外翻患者施行了内眦成形、内眦韧带悬吊、内眦切除、外侧睑板悬吊、外眦成形、睑缩短术。于2006年4月对资料完整的56例（78跟）手术病例进行随访。结果手术效果：优21眼（26．92％），良27眼（34．62％），一般21眼（26．92％），差9眼（11．54％）。眼结膜充血从术前62眼减少到45眼；溢泪从70眼减少47眼；眼睑闭合不全（轻闭时）从平均6．2mm下降到3．7mm；手术前后平均视力无变化。结论采用综合术式方法矫正麻风麻痹性下睑外翻，对患者的角膜有一定保护作用，并可改善结膜充血和溢泪等症状。     

睑缘切口延伸皮瓣联合眼轮匝肌深层固定术矫正瘢痕性下睑外翻的临床观察

目的 评价睑缘切口延伸皮瓣联合眼轮匝肌深层固定术矫正瘢痕性下睑外翻的临床效果.方法 回顾性病例研究.分析我院2014年1月至2018年12月间采用睑缘切口延伸皮瓣联合眼轮匝肌深层固定术矫正瘢痕性下睑外翻的35例患者的临床资料,所有患者为单眼,年龄在5～65岁之间,其中男性22例,女性13例,随访12个月.结果 35例下...     

内眦韧带修复在治疗泪小管断裂伴下睑外翻中的疗效观察

目的:研究内眦韧带修复在治疗泪小管断裂伴下睑外翻中的疗效。方法:对2007年入院治疗的18例泪小管断裂伴下睑外翻的患者其中断裂位置距泪小点>2mm的14例采用泪小管吻合联合下睑睑板-内眦韧带修复术;<2mm的4例采用行泪小管吻合术的方法进行治疗,术后随访1~3mo。结果:18例均无下睑、泪小点外翻,冲洗泪道均通畅。结论:泪小管吻合合并下睑睑板-内眦韧带修复术治疗下睑撕裂伴泪小管断裂,效果显著,未见溢泪及下睑外翻。     

Anterior lamella actinic changes as a factor in involutional eyelid malposition

PURPOSE: We conducted a noncomparative, retrospective chart review of 45 patients and 51 eyelids with the diagnosis of involutional entropion or ectropion that underwent full-thickness lower eyelid shortening between June 2001 and February 2004, in whom the severity of actinic damage was analyzed in relation to the eyelid position. Patients with any different surgical approach or other primary causes of abnormal eyelid position, such as paralytic, congenital, or mechanical factors, were excluded. METHODS: After excision, all eyelid specimens were examined by a single anatomic pathologist, who was masked to the type of eyelid malposition. The extent of dermal actinic change was evaluated under light microscopy, according to a previously validated grading system. RESULTS: Fifty-one eyelids from 26 male and 19 female patients were analyzed. The mean age at the surgery was 76 +/- 10 years (range, 52 to 92 years), affecting one side in 39 cases and both sides in 6 cases. The most frequent eyelid malposition was ectropion, which affected two thirds of the cases (35 eyelids). Half of the patients presented with mild actinic skin changes; however, the severity of the histologic skin actinic changes was significantly worse in patients with ectropion in comparison to those with entropion (p < 0.0001). CONCLUSIONS: Actinic damage affecting the anterior lamella of the lower eyelid contributes as an additional factor in final eyelid position in patients with involutional eyelid changes. More severe and extensive actinic changes were present in eyelids with ectropion.     

Ectropion

Ectropion is the most frequent eyelid malposition, characterized by the eversion of the margin and exposure of the conjunctiva and the cornea. It is classified as congenital (primary and secondary) and acquired (involutional, paralytic, mechanical and cicatricial). Congenital ectropion is rare and it is usually associated with other malformations such as euryblepharon, ptosis, epicanthus inversus, and blepharophimosis syndrome. Involutional ectropion is the most frequent form of acquired eyelid eversion and a result of multiple factors. The mechanisms involved in its pathogenesis are discussed in this review. Cicatricial ectropion is caused by the shortening of the anterior lamella of the lid, secondary to congenital malformations, trauma, burns, skin conditions, scarring skin tumors, medications, allergies, blepharoplasty complications, and involutional changes that result in loss of skin elasticity. Mechanical ectropion is caused by eyelid tumors or inflammatory disorders that cause orbicularis spasm. The evaluation of the patient, selection of treatment and surgical techniques are described in detail.     

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.     

Operative Ektropiumkorrektur

In view of demographic changes in the population pyramid age structure an increase in eyelid malpositions such as ectropion is likely to occur. The surgical correction of ectropion requires a detailed knowledge of anatomical and pathophysiological factors to be able to effectively evaluate changes of the anterior and posterior lamellae with shortening, weakness, dehiscence and paralytic components. The choice of surgical procedure considering the age of the patient, genesis and the exact localization of the pathological change is of utmost importance in order to achieve ideal cosmetic and functional results.     

异体阔筋膜兜带术矫正下睑松弛及外翻

目的:探讨阔筋膜兜带术矫正下睑松弛及外翻的疗效。方法:1994～2001年采用异体阔筋膜兜带术矫正8例下睑松弛或外翻病例,术后随访6～24月。结果:8例患者下睑松弛外翻均得到矫正,无并发症发生。结论:异体阔筋膜兜带术对于麻痹性脸外翻和其他睑松弛外翻矫正术后失败者疗效良好。     

Bilateral lagophthalmos in lepromatous leprosy. Case report

CASE REPORT: A case of bilateral facial palsy with paralytic ectropion, lagophthalmos and corneal damage secondary to corneal exposure in a long-standing patient with lepromatous leprosy is presented. Correction of paralytic ectropion was performed by medial cantoplasty, tarsal strip and Medpor lower eyelid spacer implantation. Lagophthalmos was corrected by gold weight implant in the upper tarsus. DISCUSSION: Ocular findings in leprosy appear in 72% of patients. Facial nerve palsy occurs in 3-19.8%, being bilateral in 5%. In long standing cases with corneal complications secondary to exposure, surgical treatment is required.     

The correction of the paralytic ectropion by simple belpharoplastic methods (author's transl)]

In cases of paralytic ectropion the slackened skin must not be resected but has to be used for the lifting of the lower eyelid. This aim can be reached by an antidromic skin shifting with an ypsiliform incision or in less difficult cases by a hook-shaped skin flap, who becomes effective as a curb of the lower eyelid by the exchange of the flaps.     

Endoscopic subperiosteal midface lift: surgical technique with indications and outcomes

PURPOSE: To review the surgical technique of the endoscopic subperiosteal midface lift and present our clinical outcome in 22 consecutive patients. METHODS: We retrospectively evaluated the clinical outcomes of 39 endoscopic subperiosteal midface lifts in 22 consecutive patients. Of the 39 sides, 21 had a lower eye conjunctival spacer graft inserted (15 hard palate mucosal graft, 6 AlloDerm). The success of the procedure was graded based on the aesthetic and functional results. Subjective and objective assessments were made using history, examination, and photos. RESULTS: Results for the clinical outcome were graded as excellent, good, fair, or poor. Among the 39 sides, indications for the procedure included facial rejuvenation (41%), postblepharoplasty lower eyelid retraction (26%), eyelid retraction secondary to midfacial ptosis (15%), severe cicatricial ectropion (13%), and paralytic ectropion secondary to 7th nerve palsy (5%). The operating surgeons evaluated the clinical outcome as "excellent" in 24 sides (61%), "good" in 10 sides (26%), "fair" in 2 sides (5%), and "poor" in 3 sides (8%). The procedure was successful at increasing malar projection, improving lower eyelid fullness, and elevating the lower eyelid in cases of lower eyelid retraction. The procedure was less effective in decreasing the prominence of the deep nasolabial fold. CONCLUSIONS: The endoscopic subperiosteal midface lift is an effective method for elevating the midface. A more youthful appearance is achieved with the procedure, and when necessary, recruitment of anterior lamella allows elevation of the lower eyelid to correct retraction.