[Surgical Treatment of Medial Epicanthus by Skin Replacement]. / Chirurgische Behandlung des medialen Epikanthus durch Hautersatz.

Epicanthus is a skin fold covering the inner angle of the eyelid. This fold is typical in the Asian population. It can be observed in a great variety of degrees. In the Caucasian population, epicanthus is associated with some syndromes, such as blepharophimosis syndrome and Down's syndrome. The epicanthal fold originates from excessive tension in the skin and is caused by skin deficit and/or by bridging subcutaneous tissue. The epicanthal fold can be surgically corrected by reducing tension and fully replacing the skin defect by skin redraping or skin grafting.

[Descriptive study on basal cell eyelid carcinoma]. / Estudio descriptivo sobre el carcinoma basocelular en el párpado.

OBJECTIVE: To describe a series of cases of basal cell carcinomas of the eyelid. METHODS: A descriptive and retrospective study was conducted by reviewing the medical outcome, histopathological history, and photographic images of 200 patients with basal cell eyelid carcinomas. All were treated in the Herzog Carl Theodor Eye Hospital in Munich, Germany, between 2000 and 2013. RESULTS: In the present study, it was found that females are more affected than males. The mean age of presentation of the tumor occurred at the age of 70 years. In 50% of the cases the tumor was found on the lower lid, especially medially from the center of the lid. The lid margin was involved in 47% of all tumors. The mean diameter was 9.2mm. The recurrence rate after surgery with histologically clear resection margins was 5%. There was a significant relationship between tumor diameter and age. As tumors where located farther away from medial and closer to the lid margin, they became larger. CONCLUSIONS: There is a predominance of women affected by this tumor. This may be related to the fact that the sample was taken from those attending an oculoplastic surgery clinic, where there are generally more women than men attending. The formation of basal cell carcinomas increases with age. The infrequent involvement of the upper lid could be explained by the protection of the the eyebrow. The frequent involvement of the lower lid may be due to the light reflection (total reflection) by the cornea on the lower lid margin. Also chemical and physical effects of the tears may be more harmful on the lower lid. Patients tend to ask for medical help when they are females, younger, when the tumor is closer to the medial canthus or when the tumor is away from the lid margin.

[Surgical treatment of festoons]. / Chirurgische Behandlung von Festoons.

The well introduced surgical techniques of lower lid blepharoplasty can only repair aesthetic problems between the lid margin and the orbital rim. The neighbouring malar area is located outside the orbit and requires specialised procedures to reposition the sunken malar orbicularis muscle (festoon) and the malar fat pad. A small incision at the lateral canthus provides the access to combine three procedures: transconjunctival lower lid blepharoplasty, lateral canthoplasty and malar lift.

[Eyelid nevi: differential diagnosis and surgical treatment]. / Nävi der Lider: Differenzialdiagnose und chirurgische Behandlung.

Congenital nevi are very rare. Acquired nevi belong to the most common group of skin tumours. Eyelid nevi occur frequently in a great variety. They are treated for cosmetic reasons or due to the risk of malignant transformation. This contribution explains the differential diagnosis of various types of nevus and the surgical techniques of resection and plastic reconstruction.

[Optimised frontal suspension for correction of complicated ptosis]. / Optimierte Frontalissuspension zur Korrektur der komplizierten Ptosis.

Complicated ptosis can be corrected by frontal suspension with autologous fascia lata. Via an open approach, the fascia is implanted between the brow and the tarsal plate behind the septum. The oblique implantation between the tarsus and the brow preserves the flexibility of elevation, closure and blinking of the upper lid. Additionally, the skin crease is improved by this technique.

[Challenges in the surgical correction of complicated ectropion cases]. / Herausforderungen der operativen Korrektur des komplizierten Ektropiums.

BACKGROUND: Simple forms of involutional ectropion may be corrected by a horizontal shortening and a medial retractor-advancement procedure. In long-standing cases secondary changes of the skin and lid margin have to be corrected. This requires additional surgical steps. A complicated ectropion can develop to gross deformities of the lid margins so that resection and reconstruction of the margins become necessary. This study differentiates the indication of simple or complicated ectropion surgery and elucidates the surgical options for the complicated ectropion. MATERIALS AND METHODS: We reviewed our corrected ectropion cases operated between January 2000 and December 2008. The cases were categorised according to the indicated surgical technique into simple (grade 1), simple combined (grade 2), complicated (grade 3) forms and complicated forms with major lid margin deformities (grade 4). RESULTS: Out of the 1101 corrected lids, we found 19 % to be simple ectropion cases (grade 1) that received a lateral tarsal strip procedure. An additional retractor advancement to correct the medial punctual eversion was necessary in 38 % of the cases of combined ectropion (grade 2). About the same number of the lids (41 %) was staged as complicated ectropion (grade 3) and required a subciliary skin graft and a lid margin reshaping. The remaining 2 % (grade 4) needed a lid margin reconstruction. CONCLUSIONS: In ectropion cases we find progressive pathological changes due to the duration of the everted lid position. Such changes vary from simple forms of ectropion to more complicated forms. In order to achieve good postoperative results and avoid recurrences, the surgical correction should be based on the degree of lid alteration. In the initial stage of simple ectropion (grade 1) it is sufficient to correct the lid laxity. More advanced stages of simple combined ectropion require a medial, inverting retractor correction in addition to the lid shortening procedure (grade 2). These two surgical steps are insufficient to manage the complicated ectropion stage (grade 3), where additional skin grafting and lid margin reshaping are required. Sometimes the lid margin cannot be reshaped if a major deformity is found (grade 4). The solution in such cases is to excise and reconstruct the lid margin.

The significance of intraoperative measurements in acquired ptosis surgery.

During a series of 101 levator procedures to correct acquired ptosis we measured the motility of the aponeurosis, the necessary advancement of the aponeurosis to adjust the eyelid height and the motility of Whitnall's ligament. We compared these intraoperative data with the data of the preoperative examination and did not find any correlation. The necessary amount of advancement of the aponeurosis to adjust the height of the eyelid was not related to the motility of the aponeurosis, the levator function or the amount of ptosis. However, we did find that the motility of Whitnall's ligament is closely related to the motility of the aponeurosis. Therefore connecting both structures is useful in ptosis adjustment without risking limited eyelid motility.

[Adjustment of eyelid level in levator surgery for ptosis. Surgical aspects]. / Justierung der Lidhöhe in der Levatorchirurgie bei Ptosis. Operationstechnische Aspekte.

The main aim in ptosis surgery is to achieve a sufficient and symmetric adjustment of the lids. Successful adjustment is possible when consideration is given to preoperative factors and intraoperative findings. Any necessary postoperative readjustment using adjustable sutures or revision surgery in the 1st week can optimize results in some cases. This article reviews the relevant surgical aspects of adjustment. We made a comparative analysis of diagnostic and surgical factors that influence the adjustment of the lid level.

[Alternatives to lid reconstruction. Systematic presentation]. / Alternativen der Lidrekonstruktion. Eine systematische Darstellung.

Eyelid reconstruction cannot be planned only by following current concepts. A systematic analysis of the defect considering the concentric zones, function, esthetics, and surgical trauma can help to select the appropriate technique among the possible alternatives.