Evaluation of eyelid features' changes before and after COVID-19 pandemic amongst healthcare and home office workers.

PURPOSE: To evaluate the eyelid features' changes after N95 face mask (FM) usage in healthcare workers through the new type of Coronavirus Disease 2019 (COVID-19) pandemic and make a comparison with home-office workers as a control group with a computer vision algorithm. MATERIALS AND METHODS: Sixty healthcare workers and forty control participants with similar demographic features included. Standardized biometric photographs which were taken before and after the COVID-19 pandemic, analyzed by the ImageJ program (NIH, Bethesda, Md.) software. The distances between the central light reflex on the cornea and the upper (UE) and lower eyelid (LE) were recorded as the marginal reflex distances. (MRD1, MRD2 respectively) Parameters of pretarsal show (PTS) of UE and brow pupil diameter (BPD) were analyzed for both of the eyes. RESULTS: There were no significant differences among the groups' measurements before the COVID-19 pandemic. In healthcare workers' group after the pandemic, values of MRD1, PTS, BPD showed a significant decrease in their right eye (p = 0.001, p = 0.002, p = 0.001 respectively) and same values reduced in the left eyes as well when compared with pre-pandemic measurements. (p = 0.048, p = 0.001, p = 0.001 respectively) PTS and BPD values were decreased for both right and left eyes of the controls. (p = 0.044, p = 0.001 and p = 0.001, p = 0.001 respectively) MRD1 measurements after the pandemic showed no difference either in the right or left eyes of the control group after the pandemic. (p = 0.071 and p = 0.065 respectively). DISCUSSION: Results showed that both BPD and PTS values decreased independently from the previous FM usage in both of the groups. Even though MRD1 values remained within the normal values, a significant decrease was detected in the healthcare workers group which suggested the cause was newly developed upper eyelid (UE) dermatochalasis after long hours of FM usage. Although it is hard to make a truly objective evaluation both usage of standardized biometric photographs and a computer-based measurement system makes the results reliable.

Relationship between histopathological findings of patients with dermatochalasis and vitamin D deficiency.

PURPOSE: To compare the histopathological findings of patients who had been diagnosed with dermatochalasis (DC) and had undergone upper eyelid blepharoplasty (ULB) as well as those of controls (C-Group) according to their serum vitamin D (SVD) levels. METHODS: The prospective study included 136 upper eyelid skin from 68 patients who underwent surgery for DC and 53 upper eyelid skin from 53 patients who underwent levator surgery with ULB. The DC Group was then divided into 3 subgroups according to the marginal reflex distance (MRD4). The lymphatic vessel (LV) count and diameter of the largest LV (DLLV) were recorded, the stromal collagen bed (SCB) was observed, and its depth was measured, the interfibrillar edema was examined, and the elastic fiber and macrophage counts and recorded, respectively, and then all of these were evaluated. The SVD levels were compared between the DC patients and the C-Group. RESULTS: In comparison to the C-Group, significant changes were seen in the dilated LV, DLLV, SCB depth, interfibrillar edema, elastic fiber density, and macrophage count in the DC sub-Groups (P < 0.001 for all). While no difference was found between DC sub-Group 1 (MRD4 > 4 mm) and the C-Group (P > 0.05), a significant difference was found between DC sub-Group 2 (MRD4 2-4 mm) and DC sub-Group 3 (MRD4 < 2 mm) for all of the parameters (P < 0.05). A statistically significant difference was also found in the SVD levels between the DC sub-Group 1 and DC sub-Groups 2-3 (P < 0.017, P < 0.001 respectively). CONCLUSION: According to the results of this study, SVD level was significantly lower in DC group. Moreover, an increased LV count and diameter, decreased elastic fiber count, collagen fiber and stromal edema irregularity, and increased macrophage count were found to be associated with the SVD level.

The Effect of Conjunctiva-Müller Muscle Resection on Tear Oxidative Stress Levels in Patients with Blepharoptosis

Objectives: To examine changes in tear oxidative stress levels and tear film functions in patients with blepharoptosis and dermatochalasis following conjunctiva-Müller muscle resection (CMMR) and blepharoplasty surgeries. Materials and Methods: This prospective study included 32 healthy controls and 62 patients with blepharoptosis or dermatochalasis. CMMR surgery was performed in 20 eyes and upper blepharoplasty was performed in 42 eyes. Tear oxidative stress markers (8-hydroxy-2'-deoxyguanosine [8-OHdG] and 4-hydroxy-2-nonenal [4-HNE]) were quantified by enzyme-linked immunosorbent assay and tear film functions were evaluated preoperatively and at 1 and 6 months postoperatively. The same assessments were performed in the control group at the same time points. Results: Preoperative tear 8-OHdG and 4-HNE levels were lower in healthy controls (52.8±13.5 ng/mL and 27.8±6.4 ng/mL, respectively) compared to patients with dermatochalasis (86.1±37.2 ng/mL and 29.8±11.1 ng/mL, respectively) and blepharoptosis (90.4±39.3 ng/mL and 43.1±4.2 ng/mL, respectively) (p<0.001). 8-OHdG levels were increased at 1 month after CMMR, while both markers were decreased 1 month postoperatively in the blepharoplasty group (p=0.034). Schirmer 1 and OSDI scores did not change throughout the visits in both patient groups, but a temporary decrease in tear break-up time (TBUT) was observed after CMMR (p=0.017). Conclusion: Dermatochalasis and blepharoptosis were associated with higher tear oxidative stress levels. CMMR surgery caused a temporary decrease in TBUT scores and an increase in oxidative stress in the first postoperative month.

Refractive changes associated with oculoplastic surgeries: A scoping review.

PURPOSE: To carry out a comprehensive critical review of the peer-reviewed literature on the refractive changes associated with oculoplastic surgeries. METHODS: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) statement recommendations. Following specific inclusion and exclusion criteria, 20 articles were selected for the current scoping review. Each of them was analyzed carefully and their risk of bias was assessed with the Quality Assessment Tool for case Series Studies from the National Heart, Lung and Blood Institute. RESULTS: Data of 1428 eyes from 1051 patients were analyzed. All studies were case series. Regarding the oculoplastic pathologies, five articles focused on dermatochalasis, four on chalazion, five on ptosis and six on congenital ptosis. Most articles did not report changes in the spherical equivalent (SE), astigmatism changes of less than 0.5 diopters (D), changes in astigmatism axis of less than 11 degrees and changes in uncorrected distance visual acuity (UDVA) of less than 0.06 logMAR. Out of the 20 articles reviewed, 6 achieved a risk of bias score between 6 and 8, representing a low level of evidence and highlighting the limitations in the study design. CONCLUSIONS: Based on the findings of this study, there is no evidence to suggest clinically significant refractive changes following oculoplastic surgeries. The most notable changes may occur after surgery for severe ptosis; however, further research is needed to confirm this observation.

A novel classification of senile dermatochalasis: insights from clinical and histological analysis.

PURPOSE: Dermatochalasis is a common disorder of the elderly, often requiring upper blepharoplasty. Although it is mainly accepted as a process of aging, its clinical and histological findings vary among patients. The aim of this study was to classify types of dermatochalasis based on their clinical and histological findings. METHODS: This retrospective study included patients with dermatochalasis who had undergone senile blepharoplasty at a single center. Clinical parameters such as margin-to-reflex distance 1 (MRD1), eyelid contour, visual field, and pre-existing medical conditions were assessed. Histological analysis was conducted of eyelid tissues stained with hematoxylin and eosin (H&E) and D2-40 to evaluate dermal edema, inflammation, lymphatic changes, and stromal depth. RESULTS: This study included 67 eyes of 35 patients. The mean age of the patients was 69.0 ± 8.3 years, and the average MRD1 was 1.8 ± 1.3 mm. In correlation analysis, two distinct types of dermatochalasis based on the histological findings were identified: lymphangiectasia-dominant and stromal edema-dominant types. The difference between nasal and temporal side MRD1(NT-MRD1) showed the area under the ROC curve of 0.718 of for distinguishing the two histological types of dermatochalasis was 0.718. CONCLUSION: Our novel classification of senile dermatochalasis based on morphological and histological analysis provides insights into the underlying pathology and may help to predict surgical outcomes and complications.

Evaluating for unrecognized deficits in perimetry associated with functional upper eyelid malposition.

Objective: To investigate whether functional upper eyelid malposition is associated with unrecognized deficits in automated perimetry among glaucoma patients by examining patients undergoing eyelid surgery who had not been identified as requiring eyelid taping during glaucoma field testing. Methods: In this retrospective pre-post study, an automated database search followed by manual chart review was used to identify eligible patients from January 2012 to March 2020. Included patients had reliable visual field testing within two years before and after functional upper blepharoplasty or ptosis repair and no comorbid ocular diagnoses. As part of routine practice, glaucoma visual field technicians taped patients with pupil-obstructing eyelid malposition; taped examinations were excluded from analysis. Clinical and demographic characteristics, mean deviation, and pattern standard deviation were evaluated within a two year period before and after eyelid surgery. Results: The final analysis included 60 eyes of 38 patients. Change in visual field parameters after eyelid surgery did not reach statistical significance in crude or adjusted analyses. Among patients with ptosis, the margin reflex distance-1 was not associated with change in mean deviation after surgery (Pearson R2 â€‹= â€‹0.0061; P â€‹= â€‹0.700). Five of 17 eyes excluded from analysis due to unreliable pre-operative visual fields demonstrated substantial improvement after surgery. Conclusions: Functional upper eyelid malposition does not appear to cause spurious visual field abnormalities among glaucoma patients with reliable visual fields who were determined not to require eyelid taping at the time of their visual fields. Unreliable visual fields could be a sign of eyelid interference in this population.

Effect of Ptosis Surgery on Tear Oxidative Stress Levels in Patients with Blepharoptosis and Pseudoptosis.

Objectives: Investigation of the surgical correction effect on tear film functions and tear oxidative stress levels in patients with blepharoptosis and pseudoptosis. Methods: Sixty patients with blepharoptosis or pseudoptosis due to dermatochalasis and 30 healthy controls were included in the study. Forty eyes underwent upper blepharoplasty and 20 eyes underwent levator surgery. The tear oxidative stress levels (8-hydroxydeoxyguanosine [8-OHdG] and 4-hydroxy-2-nonenal [4-HNE]) were determined by enzyme-linked immunosorbent assay and tear film functions were evaluated pre-operatively and at the post-operative 1st and 6th months. Results: 8-OHdG and 4-HNE levels in tears were found higher in patients with dermatochalasis (86.3±38.2 ng/mL; 29.8±11.4 ng/mL, respectively) and blepharoptosis (95.3±43.8 ng/mL; 40.8±3.8 ng/mL, respectively) compared to healthy controls (52.9±14.0 ng/mL; 27.8±6.6 ng/mL, respectively). Both levels decreased 1 month after blepharoplasty surgery. The 8-OHdG level in tears of patients who underwent levator surgery increased 1 month after the surgery (p=0.008). No change was detected in tear function tests findings between visits in any patient group. Conclusion: Dermatochalasis and blepharoptosis may lead to an increase in the tear oxidative stress levels. Contrary to a decrease in these levels after blepharoplasty, they may increase in the early period after levator surgery followed by a return to normal levels at the 6th-month visit.

Quantifying Dermatochalasis Using 3-Dimensional Photogrammetry.

BACKGROUND: Creating an appropriate treatment plan for patients with dermatochalasis requires careful investigation of the periocular region. Utilizing photographic documentation can assist physicians in conducting preoperative analysis and managing expectations regarding surgical outcomes. OBJECTIVES: This study aimed to quantify the periocular characteristics of dermatochalasis patients using standardized 3D imaging and to compare age and sex-related changes in periocular features. METHODS: In this cross-sectional study, we recruited 145 Caucasian patients with periocular dermatochalasis, comprising 48 men and 97 women, aged between 35 and 91 years. Standardized three-dimensional facial photographs were taken using the 3D Imaging system VECTRA M3. Linear dimensions, curve length, angle, indices, and sizes were measured and analyzed, including palpebral fissure height (PFH), palpebral fissure width (PFW), upper lid fold-palpebral margin distance (FPD), upper palpebral margin length (UPML), lower palpebral margin length (LPML), canthal tilt (CT), palpebral fissure index (PFI), upper eyelid area, and ocular surface area. RESULTS: In the female group, the left-side PFH was slightly larger than the right-side PFH (P = 0.023), but the difference was less than 1mm. The corresponding PFI also showed a difference in the female group (P = 0.009). Statistically significant differences were shown in genders for specific parameters, except PFI (P = 0.251) and CT (P = 0.098). Among males, PFW (R = -0.523, p < 0.001) and LPML (R = -0.514, P = 0.264) decreased moderately with age. The correlation between UPML and age was weak (R = -0.367, P = 0.010). Similarly, among females, moderate correlations were found between age and PFW (R = -0.566, P < 0.001) and LPML (R = -0.537, P < 0.001). Additionally, PFH (R = -0.315, P = 0.002), UPML (R = -0.381, P < 0.001), and ocular surface area (R = -0.457, P < 0.001) showed weak correlations with age. CONCLUSIONS: The study found that dermatochalasis usually affects both eyes simultaneously, and age is a significant factor in the morphological changes of certain periocular features regardless of sex. The PFI is not influenced by age or sex. These findings may provide useful information for surgical planning and understanding age-related changes in the periocular area. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tratamiento de la dermatochalasis con cirugía de ondas de radio / Dermatochalasis Treatment with Radiowave Surgery

Objetivo: Describir los resultados de la blefaroplastia de los párpados superiores realizada con radiocirugía a pacientes con dermatochalasis del párpado superior. Métodos: Se realizó un estudio descriptivo longitudinal con pacientes del servicio de Oftalmología en el Hospital Clínico Quirúrgico Hermanos Ameijeiras en el período entre enero de 2021 a diciembre de 2022. Después de aplicar los criterios de selección la muestra quedó constituida por los primeros 50 pacientes que asistieron de forma consecutiva. Resultados: Predominaron los pacientes entre los 60 a 79 años de edad, el sexo femenino y los de color de piel blanca (p > 0,05). Se logró una reducción completa de la piel redundante en más de un 50 por ciento. El tiempo quirúrgico promedio con radiofrecuencia fue de 35.9 min. La satisfacción de los pacientes fue buena en un 96 por ciento. Las complicaciones posoperatorias se manifestaron en un 32 por ciento de los pacientes, solo en dos pacientes fueron serias, las cuales no dejaron secuelas. Conclusiones: La cirugía con ondas de radios para el tratamiento de la dermatochalasis permite alcanzar el resultado estético que se desea, con satisfacción tanto para el médico, como para los pacientes quienes logran mejorar su calidad de vida(AU)

Objective: To describe the results of upper eyelid blepharoplasty performed with radiosurgery in patients with upper eyelid dermatochalasis. Methods: A longitudinal descriptive study was carried out with patients from the ophthalmology service at Hospital Clínico Quirúrgico Hermanos Ameijeiras, from January 2021 to December 2022. After applying the selection criteria, the sample was made up of the first 50 patients who attended consecutively. Results: Patients aged 60-79 years predominated, as well as the female sex and the white skin color (p > 0.05). A complete reduction of redundant skin was achieved in more than 50 percent. The average surgical time with radiofrequency was 35.9 min. Patient satisfaction was good in 96 percent. Postoperative complications were present in 32 percent of patients, only in two patients were they serious, but did not leave any sequelae. Conclusions: Radiowave surgery for treating dermatochalasis allows to achieve the desired aesthetic outcome, with satisfaction for both the physician and the patients, who achieve an improvement in their quality of life(AU)

Influence of Upper Eyelid Surgeries on Corneal Morphology Detected with Pentacam.

PURPOSE: To analyze the corneal morphological parameters before and one month after the upper eyelid (UE) blepharoplasty and external levator resection (ELR) for ptosis surgery. MATERIALS AND METHODS: Seventy eyes of 70 patients with dermatochalasis (50 eyes) and acquired aponeurotic ptosis (AAP) (20 eyes) included in this prospective study. Detailed ophthalmologic examination was performed including the best corrected visual acuity (BCVA), slit lamp examination and dilated fundoscopy. Measurements were made before and one month after the surgeries using Pentacam. Central corneal thickness (CCT), pupil center pachymetry (PCP) and thinnest pachymetry (TP), cornea front astigmatism (AST), flat keratometry (K1), steep keratometry (K2) and mean keratometry (Km) values were evaluated. RESULTS: Higher postoperative Km measurements were observed in dermatochalasis (p = 0.038) patients. Postoperative AST values were significantly lower in both dermatochalasis and ptosis cases (p = 0.034, p = 0.003, respectively). Increased PCP and TP were found in the AAP patients (p = 0.014, p = 0.015, respectively). DISCUSSION: UE blepharoplasty and ELR surgeries both lead to some significant changes on corneal structure post-operatively. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Modern blepharoplasty: From bench to bedside.

The demand for procedures aiming to rejuvenate the upper third part of the face and the periocular region has increased in the past several years. Blepharoplasty is one of the most frequently performed procedures worldwide to date. Surgery is currently the first choice in order to achieve permanent and effective results; however, it is burdened by potential surgical complications feared by patients. There is an increasing trend in individuals to request less invasive, non-surgical, effective, and safe procedures for eyelid treatment. The aim of this minireview is to present a brief overview of non-surgical blepharoplasty techniques that have been reported in the literature in the past 10 years. Numerous modern techniques that provide a rejuvenation of the entire area have been described. Numerous less invasive methods have been proposed in the current literature and in modern-day routine clinical settings. Dermal fillers are a commonly chosen option for providing enhanced aesthetic results, especially considering that volume loss can be one of the main underlying causes of facial and periorbital aging. Deoxycholic acid use may be considered when the problem is represented by periorbital excess fat deposits. The simultaneous excess and loss of elasticity of the skin can be assessed with techniques such as lasers and plasma exeresis. Furthermore, techniques such as platelet-rich plasma injections and the insertion of twisted polydioxanone threads are emerging as viable methods to rejuvenate the periorbital region.

Evaluation of 25-Hydroxyvitamin D levels in patients with dermatochalasis.

PURPOSE: To compare serum 25-hydroxyvitamin D (25(OH)D) levels of patients with dermatochalasis who underwent upper lid blepharoplasty and healthy controls. METHODS: This retrospective comparative study included dermatochalasis patients who underwent upper lid blepharoplasty and age-and sex-matched controls from January 2019 to January 2021. The data, including comprehensive ophthalmological examination, internal medicine outpatient examination, and laboratory results of the dermatochalasis patients and healthy controls, were collected from the electronic patient records. Serum 25(OH)D, creatinine, calcium (Ca), phosphate (P), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels were evaluated and compared between the dermatochalasis patients and healthy controls. RESULT: Of our participants, consisting of 46 patients with dermatochalasis and 52 healthy controls, 54 (55.10%) were female and 44 (44.90%) were male. A statistically significant difference was observed in vitamin D levels between the healthy and dermatochalasis groups (p ≤ 0.001). The percentage of individuals with vitamin D deficiency (< 20 ng/mL) was significantly higher in the dermatochalasis group (p = 0.001). In addition, the percentage of individuals with severe vitamin D deficiency (< 10 ng/mL) was again significantly higher in the dermatochalasis group (p = 0.001). The risk of dermatochalasis incidence was found to increase in cases of low vitamin D (OR = 1.210; p = 0.017). CONCLUSION: Low serum 25(OH)D levels may play a role in the etiopathogenesis of dermatochalasis. Future research should include longitudinal studies and prospective clinical studies to investigate the mechanism responsible for the low vitamin D observed in dermatochalasis patients.

Evaluation of the Effect of Dermatochalasis and Upper Eyelid Blepharoplasty Surgery on Corneal Epithelial Thickness Alterations.

BACKGROUND: The aim of this study was to assess the effect of different grades of dermatochalasis (DC) and upper eyelid blepharoplasty (UEB) surgery on corneal epithelial thickness (CET), objectively using anterior segment-optical coherence tomography (AS-OCT) measurements. METHODS: 90 eyes of patients with DC were divided into three groups according to the severity of the DC. Forty-one eyes of age and sex-matched patients without DC were randomly selected as the control group. The study did not include patients with more than 2 D of spherical refractive error and more than 1.5 D of astigmatism, a history of previous eyelid surgery, ocular surface disease, contact lens use, and ophthalmic eye drop use. CET measurements of all the patients were performed with an AS-OCT (RTVue-XR, Optovue Inc., USA). RESULTS: There were statistically significant differences in the CET of the superior, superonasal, superotemporal, inferotemporal, and temporal sectors between the DC and control groups (p = 0.001, p = 0.02, p = 0.03, p = 0.02, p = 0.04, respectively). While there were no differences in CET among the sectors of the control group, there was a difference in CET among some sectors of the DC group. When the DC group was subdivided by severity, there was no difference between subgroups for CET across all sectors both preoperatively and postoperatively. In the measurements made 6 months after UEB surgery, the CET in all sectors increased statistically significantly compared to those measured in the preoperative period. CONCLUSION: This study revealed that DC reshaped the corneal epithelium and UEB surgery restored this remodeling 6 months after surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Blefaroplastia realizada con láser de CO2 versus radiocirugía en pacientes con dermatochalasis / Blepharoplasty performed with CO2 laser versus radiosurgery in patients with dermatochalasis

Objetivo: Describir los resultados de las blefaroplastias con láser de CO2 y radiocirugía realizada a pacientes con dermatochalasis del párpado superior en el Hospital "Hermanos Ameijeiras". Métodos: Se realizó un estudio descriptivo longitudinal en pacientes del servicio de Oftalmología. Después de aplicar los criterios de selección la muestra quedó conformada por los primeros 100 pacientes que asistieron de forma consecutiva y se dividieron al azar en dos grupos de 50 casos cada uno, al grupo A se le realizó blefaroplastia superior transcutánea con radiofrecuencia y al grupo B se le realizó blefaroplastia superior transcutánea con láser de CO2. Resultados: En ambos predominaron los pacientes entre los 60 a 79 años, el sexo femenino y los de color de piel blanca (p>0,05); se logró una reducción completa de la piel redundante en más de un 50 pr ciento. El tiempo quirúrgico promedio con el láser de CO2 fue de 31.5 min y con radiofrecuencia de 35,9 min. El sangrado intraoperatorio fue menor en operados con el láser de CO2. La satisfacción de los pacientes fue buena en ambos grupos. Complicaciones posoperatorias: el 16 del grupo A y el 11% del B, presentaron alguna complicación. Conclusiones: Se observó que con el uso del láser de CO2 el tiempo quirúrgico, el sangrado intraoperatorio y las complicaciones disminuyeron; con lo cual mejoró el aprovechamiento del salón. Ambas técnicas mostraron un elevado grado de satisfacción y mejoría de la estética palpebral por lo que son efectivas y seguras(AU)

Objective: To describe the results of CO2 laser blepharoplasty and radiosurgery performed in patients with upper eyelid dermatochalasis. Methods: A descriptive longitudinal study was carried out in patients of the Ophthalmology Service of the Clinical Surgical Hospital "Hermanos Ameijeiras". After applying the selection criteria, the sample consisted of the first 100 patients who attended consecutively and were randomly divided into two groups of 50 cases each. Group A underwent transcutaneous upper blepharoplasty with radiofrequency and group B underwent transcutaneous upper blepharoplasty with CO2 laser. Results: In both groups, patients between 60 and 79 years of age, female gender and white skin color predominated (p>0.05); a complete reduction of redundant skin was achieved in more than 50 percnt. The average surgical time with CO2 laser was 31.5 min and with radiofrequency 35.9 min. Intraoperative bleeding was lower in those operated with the CO2 laser. Patient satisfaction was good in both groups. Postoperative complications: 16 por ciento of group A and 11 percent of group B presented some complication. Conclusions: It was observed that with the use of CO2 laser the surgical time, intraoperative bleeding and complications decreased; thus improving room utilization. Both techniques showed a high degree of satisfaction and improvement of palpebral aesthetics, so they are effective and safe(AU)

Dermatochalasis Aggravates Meibomian Gland Dysfunction Related Dry Eyes.

This study aimed to investigate the relationships between subjective symptoms, objective signs, and dermatochalasis severity in dry-eye patients and the effects of lid hygiene on dry-eye parameters. We retrospectively enrolled 2328 patients who underwent dry-eye examinations and classified them into four groups by dermatochalasis severity. The SPEED and OSDI questionnaires were used to evaluate subjective symptoms. LipiView® II interferometry was used to measure lipid-layer thickness (LLT) and blink/incomplete blink rates and perform meibography. A slit-lamp-aided standardized evaluator measured meibomian gland expressibility (MGE). A meiboscale was used to grade meibomian gland dropout. Fluorescein tear-film break-up time (FTBUT) and superficial punctate keratitis (SPK) were recorded. The Schirmer test II with anesthetics was used to evaluate aqueous tear secretion. The effects of lid hygiene were evaluated in 644 patients who underwent second comprehensive examinations. The median age of patients was 55.3 [46.0-66.0] years (76.0% female). Patients with more severe dermatochalasis were less symptomatic and had less MGE, higher meiboscale grades and average LLT. Dermatochalasis severity was significantly associated with MGE and meiboscale grade in the upper lid. There were no significant differences in the Schirmer test, FTBUT, and SPK among the severity groups. Females were older and had higher LLT and less severe dermatochalasis. Lid hygiene significantly decreased subjective symptoms, LLT, and Schirmer results, increased FTBUT, but did not change MGE or meiboscale grades. Dermatochalasis severity participated in the pathophysiology of dry eyes. Lid hygiene significantly improved subjective symptoms and reduced LLT, more significantly in patients with less severe dermatochalasis.

The histopathological findings in excised upper eyelids of patients with dermatochalasis following collagen cross-linking treatment.

PURPOSE: To evaluate the histopathological effects of collagen cross-linking (CCL) on excised skin samples of patients undergoing upper eyelid blepharoplasty due to dermatochalasis. METHODS: This study examined 74 excised eyelid skin samples from 37 dermatochalasis patients. Following an upper eyelid blepharoplasty, CCL with hypotonic riboflavin (0.1%) was applied. Both treated (right eyelid, CCL group) and untreated eyelid specimen (left eyelid, non-CCL group) sections were stained with hematoxylin-eosin and Masson's trichrome. The sections were evaluated for the following parameters: the collagen status (parallel, oblique, and perpendicular), the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers. RESULTS: There were no statistically significant differences in the collagen status, the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers between the CCL and non-CCL groups (p > 0.05 for all). Although the lack of statistically significant differences, the structure of the treated eyelid collagen fibers was more parallel in 48% of the participants than in the untreated ones. For male patients, a statistically significant shorter distance between collagen fibers was observed in the CCL group (8.05 ± 2.04 µm) compared to the non-CCL group (9.97 ± 2.33 µm) (p = 0.042). CONCLUSION: In this study, more parallel collagen structures and tightly packed collagen fibers were detected in eyelid samples following CCL treatment. The authors note that the results of this study may be promising for further research, so the effect of CCL therapy on the eyelid may be an interesting subject for the treatment of non-severe or surgically inadequately corrected dermatochalasis.

Changes in Intraocular Pressure and Ocular Biometry After Blepharoplasty.

PURPOSE: To investigate the effects of blepharoplasty on intraocular pressure (IOP) and ocular biometric parameters. METHODS: A total of 112 eyelids of 56 patients undergoing bilateral blepharoplasty due to upper eyelid dermatochalasis was included. The patients were classified into three groups according to margin reflex distance (MRD) (Group 1 >4 mm MRD, Group 2 2-4 mm MRD, and Group 3 <2 mm MRD). The IOP and ocular biometric parameters obtained baseline and postoperative 3rd month were compared. RESULTS: The demographic characteristics of the groups were similar (p > 0.05, for all). IOP (p = 0.002) and central corneal thickness (p = 0.038) increased in Group 3. The mean amount of the increase in IOP was 0.95mmHg. The keratometric values increased in all groups and corneal astigmatism was also increased in Group 2 and Group 3 (p < 0.001, for all). The mean amount of the increase in corneal astigmatism was 0.54D in Group 3. Anterior chamber depth and axial length did not change (p > 0.05, for all). The intraocular lens powers calculated by six different formulas decreased in Group 3 (p < 0.001, for all), and the mean amount of the decrease was 0.40D. CONCLUSIONS: Clinicians should be aware of the potential change in IOP and ocular biometric parameters in patients who underwent blepharoplasty. If a patient has glaucoma risk factors, close follow-up is needed after blepharoplasty. Change in strategy or timing may also be needed for dermatochalasis patients when planning corneal refractive surgery or cataract surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of the efficacy and safety of plasma exeresis in periorbital rejuvenation using the Reviscometer®.

BACKGROUND: Periorbital rejuvenation is performed through various methods. Recently, plasma exeresis has been suggested for the treatment of dermatochalasis and periorbital wrinkles. AIMS: To evaluate the clinical efficacy and safety of plasma exeresis in periorbital rejuvenation and palpebral laxity and assess its effectiveness using the Reviscometer® . PATIENTS/METHODS: Fifty-six women with mild-to-severe dermatochalasis and periorbital wrinkles volunteered to participate in this clinical trial. They received plasma exeresis thrice at one-month intervals. The efficacy of the intervention was evaluated according to the Cutaneous Resonance Running Time (CRRT) value changes, photographic changes, patients' satisfaction, and clinical side effects. RESULTS: This study showed significant clinical improvements in dermatochalasis and palpebral laxity after treatment compared with the baseline (p < 0.001). Most of the participants had relative satisfaction, and no significant or permanent side effects were observed. CONCLUSION: The findings of this study suggest that plasma exeresis is a safe and effective nonsurgical method for periorbital rejuvenation. Furthermore, the procedure has no serious adverse effects if performed correctly and for the right patient.

Evaluation of plasma exeresis as a new technique for non surgical treatment of dermatochalasis.

BACKGROUND: Dermatochalasis is frequently associated with tissue ageing and leads to multiple functional and cosmetic issues. There are several possible medical and surgical treatments available, such as blepharoplasty and laser therapy. OBJECTIVE: The aim of this work was to evaluate plasma exeresis as a new technique for nonsurgical treatment of dermatochalasis of the upper eyelid. PATIENT AND METHODS: This clinical trial included 40 female patients with dermatochalasis. Each patient received 3 sessions of treatment with the technology of plasma exeresis with one-month interval. Final evaluation was performed three months after the last session by 2 blinded dermatologists and 2 ophthalmologists, lid laxity according to facial laxity rating scale (FLRS), marginal crease distance (MCD) before and after treatment and patient satisfaction score. RESULTS: There was a significant decrease in eye lid laxity (FLRS) after treatment where p < .001; 36 (90%) patients had change and 4 (10%) patients without change in general. There was a significant increase in MCD after treatment (p = .001). CONCLUSION: Plasma exeresis seems to improve appearance of the upper eyelid, without any serious adverse events and could be a valid solution for dermatochalasis especially in mild and moderate cases.