Quantitative Assessment of Lid Margin Vascularity Using Swept-Source Optical Coherence Tomography Angiography.

Purpose: To evaluate the ability of swept-source optical coherence tomography angiography (SS-OCTA) to assess lid margin vascularity. Methods: This prospective, cross-sectional trial enrolled 125 participants, including 15 control subjects and 110 meibomian gland dysfunction (MGD) patients. Lid margin blood flow density (LMBFD) was obtained using SS-OCTA. LMBFD was assessed for repeatability in 54 of 125 participants and for reproducibility in 23 of 125 participants. The efficacy of LMBFD was validated in the 125 participants, who were divided into mild (n = 46), moderate (n = 42), and severe groups (n = 37) according to the lid margin vascularity severity shown in the slit-lamp photographs. Correlations between LMBFD and MG-related parameters, such as ocular surface disease index (OSDI), fluorescein tear break-up time (FTBUT), cornea fluorescein staining (CFS), lid margin score (LMS), and meibomian gland expressibility (ME), were analyzed in all 125 participants. Results: Repeatability and reproducibility coefficients were satisfactorily high in the scan mode with a scan area of 6 mm × 6 mm (intraclass correlation coefficient [ICC] repeatability = 0.905; ICC reproducibility = 0.986) and a scan area of 9 mm × 9 mm (ICC repeatability = 0.888; ICC reproducibility = 0.988). The LMBFD gradually increased in the mild, moderate, and severe groups (P < 0.001). LMBFD was significant correlated with OSDI (r = 0.290, P = 0.001), FTBUT (r = -0.195, P = 0.030), CFS (r = 0.352, P < 0.001), ME (r = 0.191, P = 0.033), and LMS (r = 0.370, P < 0.001). Conclusions: LMBFD may be a noninvasive, repeatable, reproducible, and efficient index for the quantitative evaluation of eyelid margin vascularity in the future. Translational Relevance: We demonstrated that SS-OCTA has the potential to evaluate the eyelid margin vascularity in MGD patients and guide future treatment strategies in clinics.

Lower Eyelid Dark Circles (Tear Trough and Lid-Cheek Junction): A Stepwise Assessment Framework.

BACKGROUND: Despite increasing popularity, the use of hyaluronic acid (HA) fillers for the correction of dark under-eye shadows remains challenging. Specific guidance on patient assessment is limited. OBJECTIVES: The aim of this study was to develop a stepwise assessment framework for lower eyelid dark shadows to help practitioners classify patients based on their underlying problems and facilitate a more strategic approach to treatment. METHODS: Literature review and peer collaboration informed the current availability of educational material for use by experienced injectors when assessing patients presenting with dark circles. A practitioner survey provided insight into current practices. A focus group convened to review the survey results and discuss best practice approaches to patient assessment. RESULTS: Surveyed practitioners (n = 39) reported patient concern about under-eye hollows (91%), dark eye circles (80%), and looking tired (60%). All (100%) agreed that midcheek volume was critical when treating tear-trough depression, and only 26% reported use of a tear-trough classification system. The focus group developed a framework for assessing tear-trough depression and the lid-cheek junction in patients presenting with dark circles. Key factors within this framework included the importance of appropriate lighting when conducting a visual inspection, regional inspection of the cheek and tear trough, palpation of the orbital rim and soft tissues, determination of the orbital vector, and assessment of lower eyelid pigmentation and skin quality. CONCLUSIONS: Careful step-by-step assessment can reduce the challenges of treating dark circles by identifying patients in whom dark eye circles may be improved without the need to directly inject filler into the tear trough.

End-of-day assessment of asymptomatic versus highly symptomatic soft contact lens wearers.

PURPOSE: To investigate differences in key clinical parameters between asymptomatic and highly symptomatic soft contact lens (CL) wearers after 14 h of wear. METHODS: In this pilot investigation, Phase 1 identified asymptomatic (CLDEQ-8 score ≤ 7) and highly symptomatic (CLDEQ-8 score ≥ 20) subjects after fitting with nelfilcon A CLs. Phase 2 investigated the following over a single nelfilcon A CL-wearing day (14 ± 2 h): blinking characteristics, tear meniscus height (TMH), non-invasive tear break-up time (NIBUT), tear film osmolarity and eyelid margin staining. Parameters for the two groups were compared using linear mixed models and post-hoc testing. The relationship between comfort scores and the clinical parameters was also investigated. RESULTS: Overall, 161 and 42 subjects were enrolled into Phase 1 and 2, respectively. Twenty-five asymptomatic and 17 symptomatic subjects completed Phase 2. Lower eyelid TMH was decreased after 14 h in symptomatic compared with asymptomatic subjects (least square mean [LSM] difference -0.04 mm, 95% CI: -0.07, -0.01). Osmolarity was lower in symptomatic than in asymptomatic subjects at fitting (LSM difference -9.89, 95% CI: -18.91, -0.86). Upper eyelid margin staining was greater after 14 h in symptomatic than in asymptomatic subjects (LSM difference 0.53, 95% CI: 0.01, 1.05) and greater after 14 h than baseline in the symptomatic group (LSM difference 0.61, 95% CI: 0.16, 1.07). There was a significant relationship between comfort and upper eyelid margin staining (r = -0.40, 95% CI: -0.63, -0.11) and blink rate (r = -0.31, 95% CI: -0.57, -0.003). CONCLUSION: The potential parameters most effective in differentiating asymptomatic from symptomatic wearers were upper eyelid margin staining and lower TMH. The parameter with the strongest relationship to comfort was upper eyelid margin staining, where higher comfort scores were associated with lower levels of staining.

A Hue-Value method for semi-automated assessment of Lid Wiper Epitheliopathy.

BACKGROUND: Lid wiper epitheliopathy (LWE) is a marker of an abnormal lid/cornea interaction. This study proposes an automated Hue-Value grading algorithm of LWE staining following manual selection of the region of interest. METHODS: Images of LWE staining were processed using Hue and Value from HSV (Hue-Saturation-Value) color space with a custom MATLAB program. Thirty-one images were successfully analyzed. Examiners analyzed images in random order twice, separated by more than a week. Bland Altman and Intraclass Correlation Coefficients (ICC) were performed. RESULTS: There was no difference (p > 0.05) between upper (UL) and lower (LL) eyelids for LWE height (UL: 0.12 ± 0.12 mm, LL: 0.12 ± 0.07 mm), width (UL: 10.70 ± 3.84 mm, LL: 10.26 ± 3.49 mm), or area (UL: 2.85 ± 2.67 mm2, LL: 2.63 ± 1.71 mm2). There was no between examiner difference for all eyelid LWE height or area (p > 0.05), but a difference in LWE width (0.16 mm; p = 0.031). ICC for LWE height, width and area were 0.996 (95% CI: 0.993 to 0.998), 0.997 (95% CI: 0.992 to 0.998) and 0.999 (95% CI: 0.998 to 0.999). There was no between examiner difference for height or area (p > 0.05) for UL, but a difference in LWE width (0.28 mm; p = 0.026). ICC for height, width and area were 0.999 (95% CI: 0.996 to 1.00), 0.995 (95% CI: 0.982 to 0.999) and 1.00 (95% CI: 0.999 to 1.00). There was no difference in LWE height, width or area for LL (all p > 0.05). ICC were 0.991 (95% CI: 0.973 to 0.997) for height, 0.998 (95% CI: 0.995 to 0.999) for width and 0.997 (95% CI: 0.990 to 0.999) for area. CONCLUSIONS: This novel method results in highly repeatable interexaminer measures of LWE staining after general lid region delineation. Small differences in LWE width were observed between examiners.

The Efficacy of Magnesium Sulfate (MgSO4) Wet Dressing in Reducing Eyelid Swelling and Bruising after Blepharoplasty: A Randomized, Controlled, and Observer-Blinded Assessment Study.

The purpose of this study was to evaluate the effects of wet dressing with 50% magnesium sulfate (MgSO4) solution on decreasing eyelid swelling and bruising after blepharoplasty. Fifty-eight patients (23 male and 35 female) who underwent bilateral blepharoplasty were enrolled in our randomized clinical trial. One side of the periorbital area (upper and lower eyelids) per patient received a wet dressing with 50% MgSO4 solution randomly, and the other side was cooled with an ice pack from the first postoperative day for two consecutive days (30 minutes per time and twice a day). The eyelid edema and ecchymosis were evaluated and classified using respective graded scales. Degrees of eyelid edema were similar after surgery in both groups (p > 0.05) and were significantly decreased with time. Compared with the cooled ones, less swelling was observed in the eyelids treated by MgSO4 wet compress on postoperative day 5 (p < 0.01). Both the incidence and area of ecchymosis were lower in the MgSO4 group than those in the cooling group (p < 0.01 and p < 0.05, respectively). Moreover, the majority of patients (39/58, 67.2%) indicated a preference for MgSO4 wet dressing over ice cooling. MgSO4 wet dressing can be conveniently applied to alleviate eyelid swelling and reduce recovery time after blepharoplasty.

Eastern Mediterranean Health Journal [2023; Vol.29, Issue 11]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Retrospective review of eyelid coloboma in snow leopards (Panthera uncia) housed under managed care in North America: 49 cases (2000-2020).

OBJECTIVE: To determine incidence, trends in presentation, associated ocular lesions and other diseases, treatment modalities, and case outcomes of eyelid coloboma cases in snow leopards. ANIMALS: 49 snow leopards with eyelid coloboma living under managed care in North America. METHODS: Medical records were retrospectively searched to identify snow leopards in which eyelid coloboma was diagnosed between January 1, 2000, and December 31, 2020. Data recorded from each animal included signalment, ophthalmic examination information, clinical signs, concurrent health conditions, medical and/or surgical interventions, time to resolution of signs, recurrence of clinical signs, and direct relatives with a history of eyelid coloboma. RESULTS: Ocular clinical signs were present at diagnosis in most cases but not seen in all cases. Corrective procedures were undertaken in 39 cases. Clinical signs were resolved by the total combination of interventions in 84.6% of individuals; however, signs resolved in only 33.3% of cases after a single surgical reconstruction or cryoablation procedure per eye. CLINICAL RELEVANCE: Eyelid coloboma is widespread in the North American snow leopard population. A high percentage (73.5%) have an affected sibling, parent, or grandparent, suggesting a heritable component. Surgical correction resolves or improves clinical signs in most cases, but there is a high rate of postprocedural complications with all procedure types employed. Most complications are minor and manageable, but these can also impact case outcomes. Animals require long-term monitoring, as clinical signs may recur (in some cases, years after initial signs are reported to be resolved), and some animals may require long-term care to manage signs.

A Quantitative Three-Dimensional Tear Trough Deformity Assessment and Its Application in Orbital Septum Fat Transposition.

BACKGROUND: Existing evaluation tools of tear trough deformity are based on subjective impression of clinicians. More accurate quantitative assessment methods are needed. This study aimed to propose a quantitative three-dimensional assessment method for the tear trough deformity in comparison with the Barton's grading system and apply it to the efficacy evaluation of orbital septum fat transposition. METHODS: 117 healthy Chinese adults (234 eyes) were enrolled and divided into four groups according to the Barton's grading system. Three-dimensional facial images were captured using Vectra H1 handheld camera. 6 anthropometric landmarks were identified on each eye and 8 linear measurements were generated accordingly. Intra-observer reliability was determined and measurements were compared between groups. Pre- and post-operative three-dimensional measurements were compared in 19 patients who received lower blepharoplasty with orbital septum fat transposition. RESULTS: The severity of tear trough was positively correlated with age (P < 0.001) but not BMI (P = 0.145) or gender (P = 0.280). Intra-rater reliability of the 8 linear measurements was excellent except for the vertical distance between the palpebrale inferioris margin and the tear trough below the pupillary center. Intergroup comparison showed that the horizontal distance between the lateral end of tear trough (P < 0.001) and medial canthus and the sagittal vector from tear trough point toward eyelid bag point (P = 0.009) increased with grade, while the vertical distance from mid-pupil to palpebrale inferioris margin decreased gradually (P = 0.001). Orbital septum fat transposition significantly improved the tear trough deformity as assessed by these three-dimensional measurements. CONCLUSIONS: We demonstrated a novel quantitative evaluation method of the tear trough deformity using three-dimensional stereophotogrammetry and proved it to be valid and reliable. It showed good value of clinical application and might help with periorbital rejuvenation planning and outcome assessment. 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 .

Upper Blepharoplasty: An Evidence-Based Assessment of Preoperative Considerations and Surgical Techniques.

Upper blepharoplasty is one of the most common facial plastic surgical procedures performed. Due to its growing popularity, an abundance of articles is available describing variations in the surgical technique and outcomes. As a result, it has become increasingly difficult to identify appropriate surgical literature validated by a high level of evidence. The purpose of this review is to identify and describe specific evidence-based components of the preoperative evaluation and surgical approach in upper blepharoplasty surgery.

Clinical Assessment for Lower Eyelid Blepharoplasty with Attention on Negative Prognostic Indicators.

In the present report, a comprehensive approach on the assessment of the lower eyelid for blepharoplasty is provided. Important items such as anatomical key areas and surgical factors are discussed. Proper management of lower eyelid deformities requires an understanding of both intrinsic and extrinsic anatomical factors resulting in the unfavorable outcome.

ImageJ assessment of double-frequency YAG laser efficacy in treatment of mild lower eyelid ectropion with punctal eversion.

PURPOSE: To describe a simple and minimally invasive technique using double-frequency YAG laser for correction of mild medial lower eyelid ectropion with punctal eversion and assess the efficacy of the technique by measuring the tear film meniscus pre- and post-laser treatment using imageJ software. METHODS: This study included 23 eyes of 19 patients with lower eyelid ectropion with punctal eversion. All patients were treated by double-frequency YAG laser applied to lower medial conjunctiva. Tear film thickness was assessed using imageJ software pre- and post-argon laser treatment. RESULTS: There was a highly significant change detected after argon laser treatment as regarding the mean of the height of tear film which was found to be significantly lower after argon laser treatment compared to before it (81.1 pixels versus 193.1 pixels, respectively) (P < 0.001). CONCLUSION: Double-frequency YAG laser applied to lower medial palpebral conjunctiva is a simple, easy, safe, and effective procedure which can be used as a solo treatment in early cases of punctal eversion with no or mild medial canthal tendon laxity.

Slit lamp polarized dermoscopy: a cost-effective tool to assess eyelid lesions.

PURPOSE: Dermoscopy is a complementary examination of skin lesions, which allows the observation of anatomical features invisible to the naked eye. Its use increases the diagnostic accuracy of skin tumors. The development of polarized dermoscopy allowed the observation of deeper skin structures, without the need of skin contact. The purpose of this study was to present a low-cost prototype through the adaptation of polarized lenses on a slit lamp in order to assess anatomical aspects invisible to conventional biomicroscopy in eyelid lesions. METHODS: Twenty two eyelid lesions were documented using a prototype, compound of two polarizing filters, orthogonal to each other, adapted to a slit lamp with an integrated digital camera. Images of the eyelid lesions were also obtained with non-polarized biomicroscopy and with a portable dermatoscope, and were compared regarding anatomical aspects. RESULTS: Anatomical structures imperceptible to conventional ophthalmic examination were evidenced using the polarized lenses, demonstrating that this tool can be useful to the ophthalmologist when assessing eyelid lesions. We have obtained high-quality images of the lesions. The slit lamp provided higher magnification, better focus control and easier assessment of eyelid lesions than the portable dermatoscope. CONCLUSION: Ophthalmologists already use the slit lamp in their practice. The adaptation of polarized lenses to this device is a cost-effective, fast and non-invasive method that permits to improve the diagnostic accuracy of eyelid lesions, evidencing anatomical structures imperceptible to conventional ophthalmic examination.

Objective Assessment of the Effectiveness of the Transconjunctival Fat-Repositioning Technique Using Magnetic Resonance Imaging and Three-Dimensional Surface Imaging.

Background: To quantify the surgical outcomes of transconjunctival fat repositioning technique, we study the lower periorbital area with magnetic resonance imaging (MRI) and three-dimensional (3D) surface imaging. Methods: The preoperative and postoperative images were analyzed. The T1-weighted MR images in the quasi-sagittal plane parallel to the long axis of the orbit and passing through the globe center were used to measure the transposed fat, and 3D comparison was performed to calculate the tear trough depth. Changes throughout the surgery and their relationships with clinical characteristics were statistically analyzed. Results: A total of 11 patients who underwent surgery were included. The mean follow-up period was 10.1 months. MRI measurements showed that the fat area beneath the tear trough increased from 0 to 22.7 ± 6.7 mm2 after fat repositioning, whereas the fat area of the eyelid bag decreased from 46.3 ± 11.0 mm2 to 25.5 ± 14.0 mm2. The 3D results revealed an increase in thickness by 1.2 ± 0.4 mm in the tear tough areas. Conclusion: Both MRI and 3D imaging provide options to objectively assess the fat-repositioning technique.

Epidemiologic Differences and Management of Eyelid Lesions in the Pediatric Population.

PURPOSE: To report the relative incidence of excised pediatric eyelid lesions and describe the correlation between the clinical and pathology diagnosis. METHODS: This was a retrospective analysis of 137 consecutive pathology-confirmed eyelid lesions excised at a U.S. quaternary children's hospital system. Chalazion was excluded from this study. RESULTS: Benign non-cystic epithelial lesions comprised 48.2% of all excised lesions, followed by mesenchymal (14.6%) and cystic (10.2%) lesions. The most common lesions were molluscum contagiosum (21.9%) and verruca vulgaris (19.0%). Hispanic White race represented 62.0% of cases, followed by non-Hispanic White (23.3%) and Black (8.8%). There were no malignant lesions. A specific preoperative clinical diagnosis was attempted in 70.1% of cases. Of these, 60.4% had a matching histopathology. CONCLUSIONS: The authors report a higher proportion of molluscum contagiosum and verruca vulgaris when compared to the literature; these differences may suggest geographic variance, management preference, or a general increase in incidence. Correlation with pathology showed the clinical diagnosis of eyelid lesions can be challenging even for ophthalmologists. However, malignancy in pediatric eyelid lesions is rare and submission for histopathology may be safely omitted, except in cases with atypical features or suspicion for syndromic disease. The decision for surgery should be methodically approached and take into consideration the most likely diagnosis, natural history of the disease, sociopsychological impact, anesthesia risk, and resource burden. [J Pediatr Ophthalmol Strabismus. 2022;59(6):405-409.].

Objective assessment of eyelid position and tear meniscus in facial nerve palsy.

PURPOSE: To evaluate lower lid position and tear meniscus in peripheral idiopathic facial nerve palsy (FNP). METHODS: A prospective study enrolled patients with peripheral idiopathic FNP and epiphora. Data were collected on patient demographics, House-Brackmann (HB) scale, digital photographs of the face, and tear meniscus at the 1st, 30, and 90 day after onset of FNP. Marginal reflex distance to the upper (MRD1) and lower eyelid (MRD2) were evaluated using ImageJ software. Anterior segment optical coherence tomography (OCT) was performed to measure the tear menis- cus. P< .05 was considered statistically significant. RESULTS: Sixteen patients were evaluated. The HB scale at presentation was grade III in six patients (37.5%). At 90 day, nine patients (56.25%) were grade I-normal. Three (18.7%) had upper lid retraction, three (18.7%) upper eyelid asymmetry and 7 (43.75%), lower eyelid retraction. The difference between MRD2-FNP with MRD2-healthy side was 0.51 ± 1.9 mm at the 1st visit, decreasing to 0.09 ± 1.47 mm at 90 days (P= .877). Tear meniscus measurements were significantly higher in FNP at the 1st visit (P= .001). The decrease in MRD2 was statistically correlated with the reduction of the tear meniscus area (TMA) (r = 0.67; P= .007) at 90 days. No correlation was found between HB and TMA. There is a difference in TMA between age groups at the 1st day(p= .009). Eldest group had higher HB scales. CONCLUSION: Quantitative evaluation of eyelid position and tear meniscus are effective to document the evolution of FNP and can serve as a clue of orbicularis recovery.

Assessment of Patient Satisfaction With Appearance, Psychological Well-being, and Aging Appraisal After Upper Blepharoplasty: A Multicenter Prospective Cohort Study.

BACKGROUND: To determine the success of an upper blepharoplasty, a popular cosmetic procedure, it is essential to measure outcomes from the patient perspective because these often outweigh objective outcomes. OBJECTIVES: This study aimed to assess patient-reported satisfaction with facial appearance, psychological well-being, and aging appraisal after upper blepharoplasty with validated questionnaires. METHODS: This prospective cohort study included upper blepharoplasty patients from 8 outpatient clinics. Patient-reported satisfaction was assessed with the FACE-Q at intake, and 6 and 12 months postoperatively. RESULTS: In total, 2134 patients were included. High satisfaction with outcome and decision to undergo treatment were measured 6 months postoperatively. Large improvements in FACE-Q scores (range, 0-100) between intake and 6 months postoperatively were seen for satisfaction with appearance (mean, effect size: eyes +48, 2.6; upper eyelids +48, 3.1; facial appearance overall +26, 1.4), psychological well-being (+11, 0.56), and aging appraisal (+22, 1.0). Patients reported they appeared a mean [standard deviation] 3.3 [5.2] years younger postblepharoplasty. No clinically relevant changes were seen between 6 and 12 months. Additionally, improvements in appearance were not dependent on their intake scores, whereas improvements in psychological well-being and aging appraisal were smaller in patients with higher intake scores. Satisfaction with treatment outcome was strongly correlated with appearance satisfaction but not with aging appraisal. CONCLUSIONS: Significant improvements in patient satisfaction regarding appearance, psychological well-being, and aging appraisal can be seen 6 months after blepharoplasty, and outcomes remain stable up to 12 months postoperatively. These data may be used to inform patients and clinicians and improve the overall quality of care.

Avaliação da autoestima em pacientes submetidos à blefaroplastia / Assessment of self-esteem in patients undergoing blepharoplasty

INTRODUÇÃO: A forma subjetiva que o indivíduo se vê representa a autoestima, A blefaroplastia é um dos procedimentos mais realizados em cirurgia plástica e este estudo teve como objetivo correlacionar a realização da blefaroplastia com possíveis alterações na autoestima. MÉTODO: No período de março de 2021 a fevereiro de 2022, 17 pacientes de ambos os sexos foram selecionados e divididos em 3 grupos: somente blefaroplastia superior, somente blefaroplastia inferior e blefaroplastia superior em conjunto com inferior. Foram aplicados os questionários de autoestima de Rosenberg ­ EPM em consulta pré-operatória e após 3 meses da cirurgia realizada. A indicação dos diferentes procedimentos variou de acordo com a indicação clínica. A técnica de escolha para as blefaroplastias inferiores foi a incisão transcutânea com retalho miocutâneo e as bolsas gordurosas foram retiradas de acordo com indicação clínica. Foi realizada a análise de variâncias com medidas repetidas (ANOVA), complementada pelo método de Bonferroni. RESULTADOS: Houve uma melhora nos resultados dos questionários nos grupos de blefaroplastia superior e blefaroplastia superior + inferior, porém somente quando avaliados os procedimentos em sua totalidade, foi estatisticamente significante. O grupo de somente blefaroplastia inferior só teve uma representante, não havendo melhora no resultado do teste pré e pós operatório. CONCLUSÃO: Diversos fatores podem ter influenciado o resultado da pesquisa, porém houve uma melhora na maioria dos grupos, sendo estatisticamente significativo quando considerados os procedimentos em sua totalidade. Palavras-chave: Blefaroplastia. Autoestima. Pálpebras. Autoimagem.