Evaluation of lidocaine for auriculopalpebral nerve block in dogs: Onset, duration, and effects on intraocular pressure and eye examination.

OBJECTIVES: Accurate intraocular pressure (IOP) measurement is essential for managing glaucoma, requiring tonometry. Local anesthesia is typically used, but nerve blocks may be needed for blepharospasm. This study investigated the efficacy of auriculopalpebral nerve block with lidocaine in achieving eyelid akinesia and its influence on IOP in dogs. ANIMALS AND PROCEDURES: In a randomized, blinded trial, 12 healthy adult mixed-breed dogs (24 eyes) received either auriculopalpebral nerve block with 2% lidocaine (n = 12 eyes) or no block (n = 12 eyes). Tetracaine drops were used for topical anesthesia in half of blocked/non-blocked eyes, and the rest of the eyes got artificial tears as control. The impact of nerve block was evaluated through assessments of menace response, palpebral reflex, and IOP before the block, after drop instillation, and at 15-min intervals until block dissipation. RESULTS: Auriculopalpebral nerve block provided effective eyelid akinesia in 58.5% (7/12 eyes) at 15 min, reaching 91.7% (11/12 eyes) at 30 min, indicating peak efficacy. Subsequently, the block gradually diminished, with 66.7% (8/12 eyes) and 33.3% (4/12 eyes) maintaining akinesia at 45 and 60 min, respectively. Importantly, neither auriculopalpebral nerve block nor tetracaine administration significantly affected IOP measurements (p > .05). CONCLUSIONS: Auriculopalpebral nerve block using lidocaine demonstrated efficient eyelid akinesia, peaking at 30 min postinjection. This technique proved to be safe with no notable alterations in IOP, suggesting its potential utility in canine ophthalmology for procedures requiring eyelid akinesia, particularly in the management of glaucoma where maintaining accurate IOP measurements is crucial for diagnosis, treatment, and monitoring the disease.

Normative data of corneal diameter and palpebral fissure height in a large cohort of South Indian children.

The purpose of this study was to establish the normative data of horizontal visible iris diameter (HVID), vertical visible iris diameter (VVID), and palpebral fissure height (PFH) in a cohort of South Indian children. The study included 1,234 children from six schools of different regions of Tamil Nadu state, India. HVID, VVID, and PFH were measured using a simple millimeter ruler by three optometrists. Based on their age, the children were divided into three groups: preprimary school children (4-5 years), primary school children (6-10 years), and high school children (11-15 years). Mean age was 4.49 ± 0.50 years, 8.00 ± 1.41 years, and 12.87 ± 1.42 years in the three groups, respectively. Mean HVID was 10.45 mm, 10.54 mm, and 10.73 mm, respectively. Mean VVID was 9.18 mm, 9.32 mm, and 9.57 mm, respectively. Similarly, mean PFH was 8.15 mm, 8.30 mm, and 8.52 mm, respectively. There was a significant difference in HVID, VVID, and PFH among the three age groups (P ≤ 0.001), as well as among male and female children in the 6-10 years age group (P ≤ 0.05) but not in the other groups. Intraclass correlation coefficient values (0.78-0.95) show good agreement among the three optometrists for all parameters. The normal range of HVID, VVID, and PFH presented in the current study can help practitioners in the diagnosis of corneal disorders, serve as a basis for the design of contact lenses, and enable accurate intraocular lens power calculations for South Indian children.

Lateral Rectus Disabling and Simultaneous Modified Nishida Procedure for Exotropic Duane Retraction Syndrome.

Exotropic-Duane Syndrome (XT-DRS) is a congenital cranial nerve dysinnervation disorder characterized by exotropia, anomalous head posture (contralateral face turn), limited adduction, globe retraction, palpebral fissure narrowing, upshoot and downshoot in adduction, and varying levels of limitation of abduction. Patients with XT-DRS often have poor convergence because attempted convergence induces co-contraction of the lateral rectus muscle (LR) due to anomalous LR innervation. We describe two patients with XT-DRS who underwent simultaneous lateral rectus muscle (LR) disinsertion and periosteal fixation (LRDAPF) and modified Nishida procedure (MNP) and discuss their outcome. In one patient, we combined this procedure with a contralateral LR recession. Anomalous head posture, exotropia, globe retraction, and palpebral fissure narrowing were reduced. Upshoot and downshoot were also reduced. Convergence improved in both patients.

Palpebral leishmaniasis.

Leishmaniasis can mimic many conditions, including hordeolum, basal cell carcinoma, and squamous cell carcinoma. The presence of kinetoplast in free-form or intramacrophage amastigotes, ensuring us to establish the microscopic diagnosis of leishmaniasis.

Stretching of Putative Mechanoreceptors in the Inferior Tarsal Muscle Regulates Tonic and Clonic Reflex Contractions of Slow-Twitch Fibers in the Palpebral Orbicularis Oculi Muscle Causing Apraxia of Eyelid Opening: A Case Series.

The levator palpebrae superioris muscle (LPSM) and facial muscles comprise both fast-twitch fibers (FTFs) and slow-twitch fibers (STFs). Still, they lack the muscle spindles to induce reflex contractions of STFs. Because reflex contractions of STFs in the LPSM and frontalis muscle, which are the major eyelid opening muscles, are induced by stretching of mechanoreceptors in the superior tarsal muscle, those in the palpebral orbicularis oculi muscle (POOM), which is the major eyelid closing muscle, should not be induced by stretching of the same proprioceptors but instead induced by the proprioceptors in the vicinity of the POOM. Apraxia of eyelid opening (AEO) after eyelid closure might be caused by prolonged POOM contraction. Most patients with AEO tend to stretch the upper and lower eyelids by applying contact lenses and eyedrops to disinsert the aponeurosis and retractor from the tarsi. They taught us that pulling down or raising the lower eyelid decreased or increased involuntary contraction of the POOM, which relieved or worsened AEO, respectively. Then, they asked us to have the lower eyelid lowered and the upper eyelid raised surgically. Whenever the upper eyelid is opened by contractions of the LPSM with the global layer of superior rectus muscle (GLSRM), the lower eyelid is concomitantly opened by contractions of the global layer of inferior rectus muscle (GLIRM), which counteracts the contraction of the GLSRM to maintain the visual axis. We hypothesized that patients with retractor disinsertion raise the lower eyelid by eyelid closure to stretch putative mechanoreceptors in the inferior tarsal muscle (ITM), which induces prolonged tonic and clonic reflex contractions of STFs in the POOM, resulting in AEO. To retrospectively verify the hypothesis, we report five cases with AEO. In the first case, AEO was induced by tight eyelid closure but was prevented by pulling down the lower eyelid during eyelid closure. Surgery to reinsert retractors into the tarsi cured AEO. In the second case, the patient sustained both severe aponeurosis-disinserted blepharoptosis and AEO. In this patient, the first surgery to reinsert aponeuroses to the the tarsi cured AEO, but a tight eyelid closure induced prolonged POOM contraction. The second surgery conducted to reinsert the retractors to the tarsi cured AEO. In the third case, with the entire eyelid AEO, surgery done to reinsert the retractors to the tarsi almost cured the entire eyelid AEO. In the fourth case, an increased clonic contraction of the POOM on the right eyelid after a tight eyelid closure was relieved by 4% lidocaine instillation to anesthetize the ITM. In the fifth case, downgaze induced clonic reflex contraction of the right POOM because of the right retractor disinsertion. Thus, prolonged tonic and clonic reflex contractions of STFs in the POOM appeared to be regulated by enhanced stretching of putative mechanoreceptors in the ITM in patients with retractor disinsertion due to increased contractions and microsaccades of FTFs in the GLIRM. Because reflex contractions of STFs in the POOM by stretching of putative mechanoreceptors in the ITM might essentially attach the upper and lower eyelids to the globe, AEO might simply be the increased reflex contraction of the POOM.

Schirmer tear test-1 with open or closed eyelids: An evaluation in brachycephalic and nonbrachycephalic dogs.

PURPOSE: Assess aqueous tear production when measured with the dogs' eyelids open or closed. METHODS: Thirty healthy dogs (15 Shih Tzus, 15 Labrador retrievers) were recruited. With the order of testing randomized for each dog, two sessions (separated by 30 min) of STT-1 testing were performed with the dogs' eyelids closed or open. Schirmer strip wetness (every 10 s for 60 s) and number of time(s) the strip dislodged during testing were recorded in each eye. Preferred STT-1 method was surveyed via a global Listserv of the veterinary ophthalmology community. RESULTS: STT-1 values were significantly higher in closed versus open eyes in Shih Tzus (18.6 ± 2.7 mm/min vs. 16.3 ± 2.5 mm/min; p = .002) and Labrador retrievers (21.6 ± 2.9 mm/min vs. 17.8 ± 3.2 mm/min, p < .001), findings that were also significant at times <60 s for either breed (p ≤ .004). Schirmer strips dislodged from six dogs with open eyelids and no dogs with closed eyelids. Maximal STT-1 difference with closed versus open eyelids was 13 mm/min in Labrador retrievers and 7 mm/min in Shih Tzus. Survey results from 275 veterinarians showed STT-1 performed with "closed eyelids" (38.5%), "open eyelids" (26.9%), or "never paid attention, sometimes closed, sometimes open" (34.6%). CONCLUSIONS: Eyelids status (closed or open) during STT-1 testing had a significant impact on aqueous tear secretion in brachycephalic and nonbrachycephalic dogs, highlighting the importance of consistency when repeating STT-1 in a canine patient. STT-1 differences are likely due to sustained reflex tearing throughout the test duration when the dogs' eyelids are closed.

Comparative analysis of ocular biometry, ocular protrusion, and palpebral fissure dimensions in brachycephalic and nonbrachycephalic dog breeds.

This study compared skull morphology and ocular parameters in brachycephalic (BC, n = 16) and nonbrachycephalic (NB, n = 16) dogs using head CT scans. The results of a Schirmer tear test I (STT I), intraocular pressure (IOP), ocular biometry, external structure, ocular protrusion, and palpebral fissure dimensions were evaluated and compared between BC and NB dogs. There were no statistically significant differences in the STT I results, IOP, globe dimensions, globe volume, internal structure, and external structure between BC and NB dogs (P > .05). Brachycephalic dogs exhibited significantly greater ocular protrusion and significantly larger palpebral fissure dimensions compared with NB dogs. For all dogs, we found a strong positive correlation between globe volume and body weight (r = 0.836, P = .0000). The globe volumes, external structure parameters, and ocular protrusion were normalized by body weight and were also significantly larger in BC dogs compared with NB dogs (P < .001). The ocular protrusion (r = 0.521, P < .0000) and horizontal palpebral fissure (r = 0.372, P = .0024) showed a moderate positive correlation with the cephalic index (CI). Additionally, normalized globe volume (r = 0.435, P = .0003), normalized orbital depth (r = 0.419, P = .0005), and normalized retrobulbar depth (r = 0.444, P = .0002) had a moderate positive correlation with the CI. The study emphasizes how the distinctive skull structure of BC dogs, with shortened facial bones and thickened retrobulbar soft tissue, influences their ocular appearance and raises the risk of eye problems.

Clinical Relevance of the Variability of the Infraorbital Arterial Anatomy Evaluated by Three-Dimensional Computed Tomography.

BACKGROUND: Knowledge of the anatomy of the infraorbital artery (IOA) is crucial for the rejuvenation of the anterior medial aspect of the midface; however, studies adequately describing the anatomy of the IOA branches are lacking, and their connection with the ophthalmic artery branches remains unclear. OBJECTIVES: This study aims to elucidate the anatomical characteristics of the IOA in its deployment within the lower eyelid using three-dimensional (3D) technology, thereby offering an anatomical foundation for clinical surgical procedures. METHODS: An analysis was conducted on computed tomography scans of 132 cadaveric head sides post-contrast injection, utilizing the Mimics software for reconstruction. The study focused on examining the anastomosis of the IOA, its principal branches, and the branches emanating from the ophthalmic artery. RESULTS: The prevalence of type I IOA was observed at 38.6% (51/132), while Type II IOA was found in 61.4% (81/132) of cases. A 7.6% incidence (10/132) of IOA directly anastomosing with the angular artery was noted. The presence of palpebral branches (PIOA) was identified in 57.6% (76/132) of instances. In the lower eyelid, four distinct distribution patterns of IOA were discerned: The likelihood of Type I PIOA was 5.3%, whereas for Types IIA, IIB, and IIC PIOA, the probabilities were 8.3%, 32.6%, and 11.4%, respectively. The occurrence of the orbital branch of IOA was recorded at 41.7% (55/132). CONCLUSIONS: 3D technology can map IOA variants and identify the deployment patterns of IOA branches in the lower eyelid vascular vesicles at high resolution as a guide in clinical practice. 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 .

Measurements of oculo-palpebral landmarks and evaluation of patient's head position.

PURPOSE: Keeping the head in a neutral position is requisite for glasses/lenses/head-up designs, the suitability of oculo-plastic surgery and for the grading the eye shift. Anatomically incompatible glasses are one of the common problems affecting accommodation, reducing comfort and disturbing by causing symptoms such as dizziness and nausea. The oculo-palpebral measurements act as a key determinant in symmetrical facial attractiveness. This study aims to investigate the most effective oculo-palpebral landmarks, head-neutral as the ideal position, taking into account of individual anatomical differences of these patients. METHODS: 100 females and 100 males aged between 18 and 20 years were photographed. Digital photogrammetric measurements were made with the ImageJ program. Interpupillary and interhelical distances, besides bilateral palpebral fissure length and height, and iris diameter were calculated on front-facing photographs. RESULTS: Mean interpupillary distance was measured wider in males than in females. The mean length of palpebral fissure was 31 mm; palpebral fissure height was 10 mm. These figures were valid in both eyes and gender. The interhelical distance was calculated as the mean and was measured longer in men. Since the measurement values were the same in both sexes and on both sides, they were determined as important landmarks for controlling the head-neutral position, evaluating whether there was a deviation in the eye, and measuring the numerical value when detected. CONCLUSION: It is essential to check the side-symmetry of the patient's palpebral fissure height, palpebral fissure length, diameter of iris and corneal depth during oculo-plastic invention and artificial design.

Lambda-double-fixation for medial epicanthoplasty in Blepharophimosis - Ptosis - Epicanthus Inversus Syndrome.

PURPOSE: This study aims to describe a novel approach to medial epicanthoplasty in patients with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) and evaluate the surgical outcome of this technique. METHODS: A retrospective, noncomparative, interventional case series involving 22 BPES patients who underwent medial epicanthoplasty using the Lambda-Double-Fixation technique (LDFT) performed by a single surgeon. Pre- and postoperative measurements of inner intercanthal distance (DIC) and horizontal palpebral fissure (HPFL) were recorded. Concurrent or staged ptosis surgery and lateral cantholysis, along with any complications, were documented. RESULTS: The mean age of the patients was 2.9 ± 2.2 years. Preoperatively, the mean DIC measured 34.0 ± 2.7 mm, significantly reducing to 23.7 ± 2.1 mm postoperatively (p < 0.001). A notable increase in mean HPFL was observed in both eyes postoperatively: right eye form 18.4 ± 2.4 mm to 23.7 ± 1.8 mm (p < 0.001) and left eye from 18.3 ± 2.4 mm to 23.8 ± 1.9 mm (p < 0.001). Postoperative scars were barely visible in all patients. CONCLUSION: LDFT is a simple and reproducible technique for medial epicanthoplasty in BPES. Our results affirm that LDFT induces a physiologically concave reshaping of the medial canthal region, optimizing access to the peritarsal zone and ensuring a secure fixation of the new canthus. These benefits lead to a reduction in ICD and an increase in HPFL, leading to a cosmetically appealing postoperative outcome.

Ophthalmic findings associated with Australian tick paralysis (holocyclotoxicity) in hospitalized domestic dogs and cats.

OBJECTIVE: To describe ophthalmic findings in hospitalized canine and feline patients with tick paralysis (TP) and investigate possible predisposing factors. ANIMALS STUDIED: Forty-seven dogs and 28 cats hospitalized with TP assessed with an ophthalmic examination performed by an ABVO resident. METHODS: Dogs and cats were hospitalized with TP from October 2021 to January 2022 and had an ophthalmic examination performed by an ABVO resident. Patient signalment data, information regarding tick number and location, hospitalization duration, medications used, and patient paralysis grades were recorded. Statistical analysis was performed to correlate findings. RESULTS: Corneal ulcers developed in up to 34.8% of dogs and up to 42.9% of cats hospitalized with TP. An absent palpebral reflex ipsilaterally increased the odds of a concurrent corneal ulcer being present by 14.7× in dogs and 20.1× in cats (p < .0001). Palpebral reflexes were absent in 38.3% of dogs and 35.7% of cats hospitalized with TP and were correlated with more severe gait paralysis (p = .01) and respiratory paralysis (p = .005) in dogs, and respiratory paralysis in cats (p = .041). STT-1 findings <10 mm/min were present in 27.7% of dogs and 57.1% of cats examined and were associated with increasing gait paralysis (p = .017) and respiratory paralysis (p = .007) in dogs, and increasing gait paralysis in cats (p = .017). CONCLUSIONS: Simple corneal ulcers, loss of a complete palpebral reflex, and reduced STT-1 scores frequently occurred in dogs and cats hospitalized for TP. The frequency of these findings increased as the degree of patient paralysis increased.

Selenium supplementation in inactive moderate to severe Graves' orbitopathy patients: a randomized controlled trial.

PURPOSE: This study was designed to evaluate the effect of selenium supplementation in inactive moderate-severe Graves' orbitopathy (GO) patients. METHODS: This study was a single-center, placebo-controlled, double-masked, randomized trial. Inactive moderate-severe GO participants were randomized to receive six months of 200 micrograms/day of selenium supplementation or placebo. Thorough eye exams, clinical activity score (CAS), Graves' Ophthalmopathy quality of life questionnaire (GO-QOL), and serum selenium level were evaluated at baseline and 6 months after the interventions. The chi-squared or Fisher's exact test was used to compare categorical variables. The t-test and the paired t-test were used to compare continuous variables between two independent samples and two dependent samples, respectively. RESULTS: A total of 25 participants were enrolled, 13 in the selenium group and 12 in the placebo group. Both groups had adequate baseline serum selenium levels at 98.96 ± 15.63 mcg/L and 102.55 ± 17.71 mcg/L, respectively. After 6 months of intervention, the selenium group showed a greater improvement in palpebral aperture (mean difference: -1.4 ± 1.7 mm, p = .04) compared to the placebo group (-0.3 ± 2.7 mm). Notably, 5(41.67%) people in the placebo group developed larger palpebral apertures. Proptosis, ocular motility, and soft tissue signs did not change significantly. GO-QOL and CAS score improvement showed no statistically significant difference between both groups. Minor adverse effects were observed. CONCLUSIONS: Selenium supplementation has a positive effect on eyelid aperture even in inactive moderate-to-severe GO patients with a sufficient baseline selenium level.

Line-field confocal optical coherence tomography of eyelid margin growths: A case series.

BACKGROUND: The clinical differential diagnosis of lesions arising on the eyelid margin may be challenging and an unneeded surgical approach may have serious functional and aesthetic consequences. Nonetheless, early recognition and treatment of malignant tumors of the eyelid margin is mandatory. Line-field confocal optical coherence tomography (LC-OCT) is a novel tool for the in vivo, real-time skin imaging. OBJECTIVES: The aim of the study was to identify and analyze the LC-OCT features of a series of eyelid margin growths and to correlate these features with the histopathological findings. METHODS: Patients with eyelid margin growths who were scheduled for lesion excision underwent LC-OCT examination. Inclusion criteria were a challenging clinical aspect of the lesions and a clinical history of recent onset (up to 12 months). In all cases, the histopathological examination of the excised lesions was performed for the final diagnosis. RESULTS: A total of 31 lesions located on the upper (13 cases) or lower (18 cases) eyelid margin from 28 consecutive patients (male = 15, female = 13; mean age: 64.7 years, range: 44-87 years) were evaluated and excised. The histopathologic diagnoses were nodular basal cell carcinoma (BCC) (nine cases), squamous cell carcinoma (SCC) (three cases), compound nevus (four cases), dermal nevus (two cases), seborrheic keratosis (four cases), pyogenic granuloma (one case), trichilemmal cyst (three cases), and hidrocystoma (five cases). LC-OCT allowed the in vivo recognition of the main microscopic features of the examined lesions. CONCLUSIONS: LC-OCT represents a promising tool for the evaluation of eyelid margin lesions. Advantages of non-invasive diagnosis particularly relevant in such a sensitive region include a more correct planning of the treatment and, in case of surgery, the most appropriate surgical approach and, importantly, a correct timing of intervention.

A technique for iris disk positioning on a custom ocular prosthesis.

Various techniques have been described for the rehabilitation of ocular defects with ocular prostheses to restore lost anatomical structures and correct cosmetic defects. This article describes a technique for optimizing the position of an iris disk over a custom-made ocular prosthesis, by using eyeglasses with customized graph paper pattern lenses. It presents a simplified method that will be useful for people with ocular defects in remote and distant service areas with limited resources.

Los desencadenantes reflejos en la epilepsia mioclónica juvenil / Reflex triggers in juvenile myoclonic epilepsy

Resumen Introducción : La epilepsia mioclónica juvenil (EMJ) es un síndrome epiléptico de inicio en la infancia y ado lescencia con mioclonías, convulsiones tónico-clónicas generalizadas y ausencias. Los estímulos reflejos como la sensibilidad a la luz o fotosensibilidad, la apertura y cierre palpebral y la inducción por praxias producen descargas epileptiformes y crisis. Estos desencadenan tes reflejos no son todos sistemáticamente estudiados. Objetivo : Examinar los rasgos reflejos en pacientes con EMJ. Métodos : Se evaluaron en forma consecutiva 100 adolescentes y adultos con EMJ que recibían diferentes tratamientos anticrisis. Se realizó un electroencefalogra ma standard con un protocolo de estimulación luminosa intermitente (ELI) y otro para la evaluación de las pra xias a través de una actividad neurocognitiva (ANC). El análisis estadístico fue descriptivo y de correlación. Se consideró significativa una p > 0.05. Resultados : La edad actual fue de 28+/-11 (14-67). Las crisis comenzaron a los 15 años +/-3 (Rango 8-25 años). EL 58% presentaron mioclonías y convulsiones tónico clónicas generalizadas. El 50% recibían ácido valproico y el 31% continuaban con crisis. Descargas epileptiformes en reposo 20%; hiperventilación 30%; apertura y cierre palpebral 12%; respuesta fotoparoxística en la ELI 40%; ANC 23%. Mayor porcentaje de descargas y demora en la realización de la ANC en los que presentaban crisis. El ácido valproico comparado con los otros fármacos no demostró superioridad en el control de las crisis. Conclusiones : Estos hallazgos confirman la importan cia del estudio de los rasgos reflejos para el diagnóstico, seguimiento y el control terapéutico.

Abstract Introduction : Juvenile myoclonic epilepsy (JME) is an epileptic syndrome with onset in childhood and adolescence with myoclonus, absences, and generalized tonic-clonic seizures. Reflex stimuli such as sensitivity to light or photosensitivity, eyelid opening and closing, and praxis induction produce epileptiform discharges and seizures. These reflex triggers are not all system atically studied. Objective : Examine reflex features in patients with JME. Methods : One hundred adolescents and adults with JME who received different anti-seizure treatments were evaluated consecutively. A standard electroen cephalogram was performed with an intermittent light stimulation (SLI) protocol and another for the evaluation of praxias through neurocognitive activity (CNA). The statistical analysis was descriptive and of correlation with a p > 0.05. Results : Current age was 28+/-11 (14-67). The seizure began at 15 years +/-3 (Range 8-25 years). They pre sented myoclonus and generalized tonic-clonic seizures in 58%. 50% received valproic acid and 31% continued with seizures. Epileptiform discharges at rest 20%; hy perventilation 30%; eyelid opening and closing 12%; photoparoxysmal response in SLI 40%; CNA 23%. Higher percentage of discharges and delay in performing CNA in those who presented seizures. Valproic acid com pared to other drugs did not demonstrate superiority in seizure control. Conclusions : These findings confirm the importance of studying reflex traits for diagnosis, follow-up, and therapeutic control.

Marcus Gunn Syndrome in Primary Care: A Case Report.

Marcus Gunn syndrome (MGS) is a rare craniofacial condition characterized by abnormal eyelid movements synchronized with jaw muscle activity. This case report describes a one-month-old girl with right eyelid ptosis and involuntary movements of the right eyelid during sucking. The diagnosis of MGS was made based on clinical observations. The etiology of MGS is not well-defined, and long-term follow-up is necessary to assess the progression of the condition. Early referral to ophthalmologists and neurologists/pediatricians is important to evaluate concomitant conditions and prevent secondary complications. Primary care physicians, who maintain continuous contact with patients, play a crucial role in detecting initial symptoms, initiating appropriate investigations, and coordinating multidisciplinary care. By raising awareness among primary care physicians about the signs, symptoms, and referral pathways for MGS, this case report aims to improve the recognition and management of this rare condition in primary care settings. Emphasizing the role of family doctors in the early identification and referral of MGS can lead to better outcomes for affected patients.

New insights into lacrimal gland anatomy using 7T MRI and electron microscopy: Relevance for lacrimal gland targeted therapies and bioengineering.

PURPOSE: To study the tissue architecture, isthmus (connection between two lobes) of the lacrimal gland using preclinical 7T MRI in combination with histology and electron microscopy. METHODS: Ten lacrimal glands from Caucasian body donors (mean age 78.7 years) were studied using 7T-MRI (N = 5; scanned at 75-µm intervals), histology, and electron microscopy (N = 5) and 3D cinematic rendering (CR) techniques. RESULTS: 3D CR images showed uniform-sized lobules (widest lobule diameter, 1.68 ± 0.19 mm in orbital lobe, 1.68 ± 0.17 mm in palpebral lobe) in both lobes, separated by septae (size, 0.29 ± 0.09 mm). The internal framework of the gland resembled a honeycoomb pattern. In CR and histology, the isthmus contained glandular acini, large blood vessels, nerves, and no more than two ducts having a tortuous course towards the conjunctival surface. On assigning a color display to the rendered lacrimal gland, all glands showed a blood vessel originating from the main lacrimal artery just 5 mm beyond the hilum and making it course to the palpebral lobe via isthmus. The distance between the conjunctiva and the central substance of the orbital and palpebral lobe was 9.4 ± 0.2 mm and 2.8 ± 0.7 mm, respectively. Electron microscopy of the palpebral lobe revealed compact subepithelial layer in the overlying conjunctiva, followed by loosely scattered collagen bundles that contained the gland lobules. CONCLUSION: 3D-CR can be used to study the lacrimal gland microstructure, help fabricate a 3D scaffold for lacrimal gland bioprinting, and serve as guide for transconjunctival lacrimal gland targeted therapies i.e., 2.9 & 9 mm long needle to reach the orbital and palpebral lobe center, respectively in normal-size glands.

Limited vertical tarsal resection in a case of basal cell carcinoma of the lower eyelid.

We present the clinical case of a 71-year-old woman with a history of multiple basal cell carcinomas (BCC) who presented a nodular lesion in practically the entire extension of the free edge of the lower eyelid. The lesion was approached by excision of the palpebral margin with limited vertical resection of the tarsus and Tripier flap with a correct aesthetic and functional result, free histological margins and no recurrence in a 12-month follow-up.

Normal palpebral anthropometric measurements in Uygur population： A cross-sectional study.

OBJECTIVE: To provide a normative palpebral database for the Uygur subjects to determine norms that may contribute to the diagnosis and prognosis of eyelid diseases. Methods: The cross-sectional study was conducted from March to May 2021 at the First People's Hospital of Kashi, China, and comprised Uygur subjects of either gender aged 18-70 years. The slant, height and width of the palpebral fissure, vertical brow-upper lid distance, intercanthal distance, pupillary distance, brow height, crease height and levator function were measured. Data was analysed using SPSS 22. RESULTS: Of the 335 subjects having mean age 41.41±14.53 years, 165(49.3%) were males with mean age 41.08±14.23 years and 170(50.7%) were females with mean age 41.74±14.85 years. There were 107(31.9%) subjects aged 18-30 years, 115(34.3%) aged 31-50 years and 113(33.7%) aged 51-70 years. Mean palpebral fissure width and margin reflex distance of the palpebrae were significantly different in terms of gender (p<0.05). Age was also a significant factor on several counts (p<0.05). Conclusion: Anthropometric measurements of eyelid in Uygur subjects indicated certain peculiarities.

Modified Nishida Procedure Combined with Lateral Rectus Disabling for Duane Retraction Syndrome.

Duane retraction syndrome (DRS) is a complex congenital cranial dysinnervation disorder. The choice of surgical procedure in esotropic-DRS depends upon several factors that include: the amount of esotropia in the primary position, the presence and severity of palpebral fissure narrowing, globe retraction, presence of medial rectus muscle (MR) contracture, the likelihood of improving abduction, age of the patient, and the presence of binocularity and stereopsis. In the presence of MR contracture, MR recession is performed either alone (unilaterally or bilaterally) or in conjunction with Y splitting plus recession of the lateral rectus muscle (LR) for reducing globe retraction. MR recession, with or without adjustable sutures, may be simultaneously combined with partial thickness vertical rectus muscle transposition (VRT) or with superior rectus muscle transposition (SRT). We describe a novel combination of surgical procedures in the management of esotropic-DRS in two patients. In our first patient, following an initial MR recession combined with LR disinsertion and periosteal fixation (LRDAPF), a modified Nishida procedure was performed. In our second patient following a prior simultaneous MR recession and LR Y splitting with recession, we combined periosteal fixation of the LR with a modified Nishida procedure of the vertical rectus muscles.