Sebaceous adenoma in the region of the medial canthus causing proptosis.
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A case of sebaceous adenoma in the region of the medial canthus causing proptosis is presented along with a review of the medical literature. The clinicopathological aspects of the tumour are discussed. The mode of treatment was surgical excision. A six month follow-up showed a reduction in the proptosis with no recurrence. (+info)
Reoperation in acquired involutional ptosis.
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Postoperative upper lid asymmetry is a common problem following ptosis surgery. Recently we performed multiple ptosis operative procedures to correct lid asymmetry in the management of a patient with bilateral acquired upper eyelid ptosis. The patient's eyelids were corrected successfully after five procedures. We retrospectively reviewed the treatment of this patient with unsatisfactory results. The medical literature was reviewed for further insight into the common problem of reoperation after ptosis surgery. (+info)
The rhomboid flap in medial canthal reconstruction.
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AIM: To describe a series of patients who have undergone a medial canthal reconstruction with a rhomboid flap. METHODS: A non-comparative interventional case series of 27 patients with medial canthal defects after Mohs excision of medial canthal basal cell carcinomas who underwent reconstruction using a rhomboid-shaped transpositional flap of adjoining skin and subcutaneous tissue. 25 cases were performed under local anaesthesia. The remaining two cases were combined with major lid reconstruction and performed under general anaesthesia. The outcome measures were closure of the defect, the cosmetic result, complications, and re-operations. RESULTS: Primary closure of the defect was achieved in all cases. The cosmetic result was highly satisfactory in all cases. There were no major complications or re-operations. Two cases had minor webbing of the medial upper lid. CONCLUSIONS: The rhomboid flap is an effective, quick, and simple technique for medial canthal reconstruction. It provides excellent cosmesis and is associated with minimal complications. It can be modified according to the nature of the periorbital skin and the location, size, and depth of the defect. (+info)
Refractive changes of congenital entropion and epiblepharon on surgical correction.
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In order to investigate the refractive error, amblyopic frequency, and refractive change, if any, following recovery of cornea injury through surgery of epiblepharon and congenital entropion patients, we retrospectively reviewed the sex distribution, age at operation, chief complaints, preoperative and postoperative refractive errors, and best corrected visual acuity in 160 previously operated patients. The average age at operation was 7.9 years. The preoperative best corrected visual acuity of 133 eyes (41.6%) was below 5/9. Ninety-five eyes (29.7%) were preoperative myopes above -1.0D; 77 eyes (24%) were hyperopes above +1.0D; and 163 eyes were astigmatic above -1.0D. Of 228 eyes that were followed up for more than one year, 66 eyes demonstrated a best corrected visual acuity of below 5/9. There was no significant difference in the change in corneal astigmatism following surgery between the group under the age of 7 and the group over the age of 7. However, the mean best corrected visual acuity at postoperative one year was 6/9, which was significantly different from the preoperative value (P=0.006). Concurrent postoperative glasses correction and amblyopic therapy is indicated because the incidence of refractive errors and amblyopia is higher in epiblepharon and congenital entropion. (+info)
Autogenous hard palate mucosa: the ideal lower eyelid spacer?
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BACKGROUND/AIMS: Raising a displaced lower eyelid frequently involves recession of the lower eyelid retractors with interposition of a "spacer," and several materials for this purpose have been described. This study reviewed the results of autogenous palatal mucosa in the treatment of lower eyelid displacement, including assessment of any donor site morbidity. METHODS: A retrospective case note review of consecutive patients treated at Moorfields Eye Hospital between 1993 and 1998. All patients underwent insertion of hard palate mucosa between the inferior border of the tarsus and the recessed conjunctiva and lower eyelid retractors. Parameters studied included the underlying diagnosis, measurements of lower lid displacement or retraction, related previous surgery, the experience of the operating surgeon, intraoperative and postoperative complications, surgical outcome, and length of follow up. The main outcome measure was the position of the lower eyelid relative to the globe in primary position of gaze. RESULTS: 102 lower eyelids of 68 patients were included and a satisfactory lid position was achieved in 87/102 (85%), with inadequate lengthening or significant recurrence of displacement occurring in 15 cases. Donor site haemorrhage requiring treatment in the early postoperative period occurred in seven patients (10%). CONCLUSION: Autogenous hard palate mucosa is an effective eyelid spacer and provides good long term support for the lower eyelid. Donor site complications are the main disadvantage, but may be minimised by attention to meticulous surgical technique and appropriate postoperative management. (+info)
Spontaneous eyelid expansion after full thickness eyelid resection and direct closure.
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BACKGROUND/AIMS: Direct closure of eyelid defects gives excellent functional results but is usually restricted to defects measuring less than a quarter of the eyelid length for fear of distorting the palpebral aperture and compromising lid function. The authors have used direct closure in larger defects. The aim of this study was to establish the effects of direct closure of full thickness eyelid margin defects under tension on the palpebral aperture dimensions. METHODS: A consecutive series of patients who had undergone one eyelid, full thickness lid resection repaired by direct closure were identified and invited to have both eyes photographed. The palpebral apertures of both eyes were measured from the photographs by a masked observer. The amount of eyelid resected was recorded from the operation notes. The unoperated palpebral aperture was used as the control. The result were analysed using a paired samples t test. RESULTS: The photographs of 18 patients were included in the analysis. The mean width of excised full thickness lid tissue was 15 mm (range 7-26 mm). The mean vertical palpebral aperture height was 9.2 (SD 1.4) mm in the operated eye as opposed to 9.3 (SD 1.2) mm in the non-operated eye. The mean horizontal palpebral aperture width was 26.1 (SD 1.9) mm in the operated eye as opposed to 26.4 (SD 1.8) mm in the non-operated eye. There was no statistically significant difference between the operated and unoperated horizontal and vertical palpebral measurements. CONCLUSIONS: Direct closure of large full thickness eyelid defects is possible in selected patients with excellent functional and cosmetic results. Eyelid tissue expansion occurs spontaneously following direct eyelid defect closure under tension, restoring the palpebral aperture dimensions. (+info)
Psychosocial implications of blepharoptosis and dermatochalasis.
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PURPOSE: To investigate, for the first time, the psychosocial implications of blepharoptosis and dermatochalasis. METHODS: Two hundred ten individuals rated whole-face photographs of a series of patients on the basis of 11 different personal characteristics: intelligence, throat, friendliness, health, trustworthiness, hard work, mental illness, financial success, attractiveness, alcoholism, and happiness. Preoperative and postoperative photographs of both male and female patients with bilateral blepharoptosis and/or dermatochalasis were used. The paired t test was used to compare preoperative and postoperative ratings on the 11 characteristics. RESULTS: The preoperative photographs were rated more negatively than the postoperative photographs (P < .01-P < .001) on all 11 characteristics for both male and female patients by the 210 study subjects. CONCLUSIONS: Members of society seem to view individuals with blepharoptosis and dermatochalasis negatively. These psychosocial attitudes may lead to unjust bias toward affected patients, and surgical correction likely provides benefits beyond improved visual function. (+info)
The dehiscent Hughes flap: outcomes and implications.
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PURPOSE: The modified Hughes procedure is used to reconstruct full-thickness lower eyelid defects. A tarsoconjunctival flap from the upper eyelid replaces the posterior lamella, whereas a skin graft, a skin flap, or a skin-muscle flap restores the anterior lamella. The conjunctival pedicle from the upper eyelid is divided after vascularization of the reconstructed lower eyelid is judged to be adequate (traditionally, at least 3 weeks postoperatively). This study reviews the outcomes of patients in whom the conjunctival flap prematurely dehisced. METHODS: Eight patients were identified during a 15-year interval. The posterior lamellar defects ranged in size from 13 to 30 mm horizontally and 5 to 8 mm vertically. The average age at the time of eyelid reconstruction was 72 years (range, 60-84 years). Flap dehiscence, resulting in each case from accidental trauma, occurred between 1 and 11 days postoperatively. Surgical repair of the dehiscence was unsuccessfully attempted in one case; otherwise, the eyelids were permitted to heal spontaneously with the application of erythromycin ophthalmic ointment as the sole therapy. RESULTS: Although the result was satisfactory in each case, one patient, who had dry eyes from Sjogren's syndrome, required secondary surgery to treat mild lagophthalmos and lower eyelid retraction. Follow-up ranged from 3 to 122 months (median, 6.5 months). CONCLUSIONS: The ultimate functional and aesthetic outcomes after premature, traumatic dehiscence of a Hughes flap were surprisingly good, suggesting that elective division of the conjunctival pedicle in routine cases can be performed relatively soon after the primary reconstructive procedure. (+info)