The Role of Tissue Resection Length in the Determination of Post-Operative Eyelid Position for Muller’s Muscle-Conjunctival Resection Surgery

Purpose: To investigate the relationships between pre-operative marginal reflex distance (MRD), tissue resection length, phenylephrine response, and change in MRD with surgery for a cohort of individuals undergoing Muller’s muscle conjunctival resection (MMCR) surgery.

Methods: All cases of MMCR surgery performed over a 13-year period at a single institution were screened for entry. Individuals with adequate photographic documentation and follow up were included. Patients with previous or concurrent upper eyelid, orbital or eyebrow disease of surgery were excluded. Marginal reflex distance (MRD) was calculated based on photographs utilizing public domain software. Data was plotted for inspection and appropriate statistical tests were performed.

Results: During the study period 198 eyes fit criteria for analysis. A loose association between tissue resection length and change in MRD with surgery was found (r?=?0.176, p?p?=?0.367). There was a strong association between MRD change with surgery and pre-operative MRD (r?=?0.498, p?r?=??0.441, p?2?mm and pre-operative MRD as variables revealed a model with pre-operative MRD as the only significant predictor (p?Conclusion: Tissue resection length and phenylephrine response play small roles relative to pre-operative MRD in the determination of change in MRD with MMCR surgery.     

Innervation of the feline eyelids

Abstract

The innervation of the eyelids is incompletely understood. This is a particular problem for those who wish to develop animal models of eyelid dysfunction in humans. Blepharospasm, for example, is a disease of uncontrolled eyelid spasm that is difficult to manage clinically because the aetiology is not understood. The anatomical literature on eyelid innervation is sparse and even conflicting. We attempted to study eyelid innervation, both sensory and motor*, with injection of horseradish peroxidase (HRP) into the superior eyelidinferior eyelidand bulbar conjunctiva. We used 13 anaesthetized weanling cats. Shape and structure of the facial nucleus varied along its rostrocaudal extent, but there was a clear demarcation of lateral and medial division. HRP-filled facial nucleus cells were ipsilateral to the injection site, and label appeared throughout the rostrocaudal length. All injection sites, including bulbar conjunctiva, labelled facial nucleus neurons located with overlapping distribution, predominantly in the dorsal part of the lateral division. Likewise, heavy labelling occurred throughout the entire ipsilateral cranial cervical ganglion and the trigeminal ganglion in all kittens. Injection of upper or lower eyelids caused some labelling in the second through the fourth cervical spinal ganglia. [Neurol Res 1992; 14. 000-000]     

自体角膜缘上皮联合羊膜移植治疗睑球粘连

目的 观察角膜缘上皮联合羊膜移植对睑球粘连临床疗效的影响.方法 采用自体结膜联合羊膜移植治疗睑球粘连23例31只眼,其中部分为复发性胬肉患者,大部分为烧伤所致的睑球粘连.结果 术后随访3～12个月,平均为7个月,角膜缘上皮联合羊膜移植治疗的睑球粘连31只眼中,26只眼恢复了眼球的运动,5只眼再次睑球粘连,粘连面积明显减少.结论 结膜联合羊膜移植是治疗睑球粘连的有效方法.     

Periorbital necrotising fasciitis after minor trauma

Introduction Necrotising fasciitis or streptococcal gangrene is a rare and often fatal soft tissue infection usually affecting the limbs and trunk. Facial involvement is exceedingly rare due to the excellent blood supply of this region. Methods We report a case of initially misdiagnosed streptococcal gangrene of the eyelids precipitated by minor trauma and which progressed despite intensive medical therapy. Results A 53-year-old man with a history of alcohol abuse developed rapidly increasing left-sided periorbital oedema, erythema and skin vesicles soon after sustaining a laceration to his left upper lid. It was initially treated as herpes zoster ophthalmicus complicated by a secondary bacterial cellulitis. Bacterial cultures grew group A β haemolytic Streptococcus pyogenes. Despite 8 days of high-dose parenteral antibiotic therapy and oral acyclovir, characteristic blisters formed and necrosis of the periorbital skin and subcutaneous tissues ensued. Surgical debridement was performed and the fasciitis rapidly resolved. Conclusion Physicians and ophthalmologists must be aware of the risk factors, although rare, for periorbital necrotising fasciitis and the cardinal signs that differentiate this condition from common non-necrotising preseptal cellulitis. Prompt recognition and early surgical debridement are crucial in limiting the morbidity and mortality from severe forms of this disease.     

A modification of the V-Y advancement flap to cover a defect of the outer canthus and both eyelids

We describe the use of a modified V-Y advancement flap from the lateral aspect of the outer canthus to cover a defect with three components on the lateral aspects of the upper and lower eyelids and the outer canthus of the eye.     

外眦锚着术在下睑退缩修复中的应用

目的探讨外眦锚着术在睑袋术后并发下睑退缩修复中的应用，寻找一种理想可靠的修复方法。方法应用外眦锚着术修复下睑退缩126例（207只眼），对其中20例（33只眼）单纯施行经外眦眦固定术，以缩紧外眦腱；35例（57只眼）施行3mm睑板条外眦成形术；26例（45只眼）行经外眦眦固定术，同时行Hamra释放弓状缘和保留眶脂肪的下睑成形术；45例（72只眼）行睑板条技术，同时行Hamra术。结果术后75例（123只眼）得到6～12个月的随访，平均随防时间8个月。除1例（1只眼）较重的下睑退缩矫正不全外，其余美容外观和功能均获得满意效果。没有明显的并发症发生，仅有1例发生轻微的缝线刺激反应，在随访期间恢复正常。结论外眦锚着术在轻到中、重度的下睑退缩修复中是一项有效方法，既能达到改善眼睑外观，又能恢复眼睑功能的目的，并发症少，患者满意。     

Case Series of Morbihan Disease (Extreme Eyelid Oedema Associated with Rosacea): Diagnostic and Therapeutic Approaches

Morbihan disease (MD) is a rare form of rosacea that presents with chronic erythema and solid oedema on the upper half of the face. A diagnosis of MD can be made only after eliminating diseases that are similar in terms of clinical and histopathological presentation. The cause of MD remains unclear and no standardised treatment is yet available. MD often tends to be recalcitrant to therapies commonly used to treat rosacea, including systemic corticosteroids, antibiotics, isotretinoin, and topical regimens. Thus, surgical interventions have been attempted but most cases have exhibited unsatisfactory responses. We treated six patients with extreme eyelid lymphoedema without any other cutaneous manifestation. Surgical eyelid reduction was performed in all patients, because ptosis and narrowing of the visual field were the major complaints. Histopathological tests revealed various extents of perivascular and perifollicular inflammation, and dermal oedema. After surgery, patients with severe inflammatory cell infiltration (including mast cells) exhibited a tendency toward recurrence. Other patients with severe dermal oedema exhibited better responses to surgical reduction, and thus no recurrence. We propose that MD should be included in the differential diagnosis of persistent, chronic eyelid oedema even if eyelid oedema is the only manifestation; the histological features may aid in the selection of appropriate therapeutic strategies. We suggest that eyelid reduction surgery can be a useful treatment option for MD patients when there is no massive mast cell infiltration.     

风筝皮瓣修复眼睑前层及中面部皮肤缺损

目的 评价风筝皮瓣修复合并或不合并中面部皮肤缺损的眼睑前层缺损的疗效.方法 自2008年1月至2010年3月,以面部皮下组织为蒂,设计"风筝"皮瓣,联合或不联合硬腭黏膜移植,修复合并或不合并中面部皮肤缺损的眼睑缺损共10例.眼睑前层或和中面部皮肤缺损面积为(1.2～6.5)cm2、(0.7～4.0)cm2.其中下眼睑中央水平方向4/5、垂直方向完全全层缺损合并颧颊部皮肤缺损1例,下睑内侧水平方向1/2、垂直方向完全全层缺损、下泪小点下泪小管缺损合并中面部皮肤缺损1例,下睑水平及垂直方向均完全全层缺损合并下泪小点及下泪小管缺损1例,上下睑水平方向完全、垂直方向1/3全层缺损合并上下泪小点泪小管缺损1例,下睑中央水平方向4/5、垂直方向完全全层缺损合并颧颊部皮肤缺损1例,全上眼睑前层及颞部皮肤缺损1例,下睑内侧水平方向1/3、垂直方向1/5前层缺损1例,上下睑中央水平方向2/3、上睑垂直方向1/3,下睑垂直方向2/3全层缺损1例,上下睑内侧1/3前层及内呲内侧皮肤缺损合并上下泪小点缺损1例,外眦外侧前层及颞部皮肤缺损1例.结果 皮瓣均无张力修复缺损,皮瓣及硬腭黏膜均全部成活,眼睑外形、功能完全恢复.结论 风筝皮瓣是修复眼睑缺损及面部皮肤缺损的良好方法.

Abstract：

Objective To evaluate the effect of rehabilitating the anterior 1amella of eyelids and midfacial skin defects with kite flap.Methods From January 2008 to March 2010,with or without combination of a hard palate mucosal grafts,the kite flap on a subcutaneous pedicle have been used to repair defect in the anterior lamella of eyelids and midfacial skin in 10 patients.The area of the defect in the anterior lamella of eyelids and midfacial skin ranged from(1.2～6.5)×(0.8～4)cm.Among them,defects span central 4/5 in horizontal direction and complete in vertical direction in full-thickness lower eyelid and partes zygomatica skin in 2 patient,medial 1/2 in horizontal direction and complete in vertical direction and puncta and canaliculus in full-thickness lower eyelid and midface skin in 1 patient,complete lower eyelid and inferior puncta and canaliculus in 1 patient,complete in horizontal direction and 1/3 in vertical direction and puncta and canaliculus both in full-thickness upper and lower eyelids in 1 patient,complete anterior layer of upper eyelid and temples skin in 1 patient,medial 1/3 in horizontal direction and 1/5 in vertical direction in the anterior lamella of lower eyelid in 1 patient,central 2/3 in horizontal direction and 1/3 in vertical direction in full-thickness upper eyelid,and central 2/3 in horizontal direction and 2/3 in vertical direction in full-thickness lower eyelid in 1 patient,medial 1/3 of anterior lamella and puncta and canaliculus both in upper and lower eyelid and inside skin of medial canthus in 1 patient,outside skin of outer canthus and temples skin in 1 patient.Results All flaps and hard palate mucosal grafts were survived.All defects were repaired without tention.The cosmetic appearance and function of eyelids rehabilitated.Conclusions The kite flap provides a competitive method for repairing the anterior lamella of eyelids and facial skin defects.     

不同胚期B6-Co小鼠眼睑组织中血清反应因子的表达变化

背景 C57BL/6角膜混浊表型的突变系(B6-Co)小鼠具有出生眼睑闭合不全(EOB)表型,是研究眼睑发育机制的良好动物模型.探讨血清反应因子(SRF)与B6-Co小鼠EOB表型形成的关系可为人类先天性眼睑发育缺陷产生机制的研究提供理论依据.目的 检测SRF在B6-Co小鼠胚胎眼睑发育关键时期的表达.方法 采用肌内注射戊巴比妥钠安乐死术,分别剖取B6-Co母鼠以及表型正常B6母鼠体内胚胎期(E)16.5 d、E17.5 d和E18.5 d小鼠各9只,分离眼睑组织,分别采用实时定量PCR法和Western blot法检测小鼠眼睑组织中SRF mRNA及其蛋白的相对表达水平.取各胎龄的B6-Co小鼠和B6小鼠制作组织冰冻切片,利用免疫荧光技术检测并比较2种小鼠SRF在眼睑组织中的定位和表达强度.结果 B6-Co小鼠E16.5 d和E17.5 d眼睑组织中SRF mRNA的相对表达水平分别为0.41±0.06和0.24±0.17,明显低于B6小鼠的1.03±0.17和1.01±0.09,差异均有统计学意义(P=0.025、0.017);B6-Co小鼠E16.5 d和E17.5 d眼睑组织中SRF蛋白的表达水平分别为0.08±0.01和0.08±0.01,明显低于B6小鼠的0.12±0.03和0.13 ±0.02,差异均有统计学意义(P=0.036、0.024);而2种小鼠间E18.5 d时眼睑组织中SRF mRNA及其蛋白的表达量差异均无统计学意义(P=0.387、0.774).免疫荧光染色显示,SRF蛋白多表达于B6-Co小鼠和B6小鼠眼睑组织的角质层细胞,但B6-Co小鼠眼睑角质形成细胞中SRF蛋白表达的荧光强度明显弱于B6小鼠.结论 SRF在B6-Co小鼠眼睑组织中的表达量明显下调,SRF可能参与眼睑发育缺陷的发生过程.