Are the seizures under control or unnoticed? Electroclinical evaluation of epilepsy with eyelid myoclonia.

PURPOSE: In this study, patients with epilepsy with eyelid myoclonia (E-EM) were evaluated according to their EEG findings, seizure outcomes, and their consistency with the final ictal EEG findings. We also investigated the possible prognostic factors. METHODS: Patients with E-EM and at least two years of follow-up in our clinic were included in the study. We analyzed the presence of eyelid myoclonia, absence and myoclonic seizures, and generalized tonic-clonic seizures for the prior two years and then verified with the latest ictal EEG features. Video-EEGs were analyzed according to the background activity, the existence of generalized spike-wave discharge or polyspike-wave complexes, focal spike-wave discharge, photoparoxysmal responses, and fast activity. RESULTS: 21 patients were involved in this study. In six patients, the seizures were undetected on the first EEGs, whereas they were detected on subsequent ones. The seizures were captured on the first EEGs of six patients; however, they disappeared on subsequent ones. Only one patient had seizures detected on every EEG. The consistency of the seizures was variable in eight patients. At the final follow-up, seizures were reported as being under control for more than two years in 12 patients, according to patients and their parents' reports. However, ictal EEG findings were detected in six of these patients. No electroclinical feature was associated with seizure freedom. CONCLUSION: This study provides further evidence that seizure freedom in E-EM patients is overestimated. The patients and their parents may not be aware of the seizures. Therefore, video-EEG monitorization is essential during follow-up.

Eyelid retraction during smiling in a patient with monocular congenital ptosis: a case report.

BACKGROUND: Blepharoptosis is a common symptom in ophthalmology clinic, but eyelid retraction when smiling in a ptosis eye is a rare manifestation. Here we report a novel manifestation that eyelid retraction during smiling in a patient with monocular congenital ptosis. CASE DESCRIPTION: A 10-year-old girl with isolated and mild unilateral congenital ptosis showed eyelid retraction in ptotsis eye when smiling together with a lid lag on downgaze. She didn't have any systematic and ocular diseases other than myopia and astigmatism.Eyelid retraction during smiling is 5 mm, resulting in a significant difference in the height of bilateral palpebral fissures.As for ptosis, is mild.The margin to reflex distance 1 is 1.0 mm on the right eye(ptosis eye) and 3.0 mm on the left eye. A lid lag of 1.0 mm on downward gaze was noted on the right, she could close her eyes fully while sleeping.The ice pack test, laboratory test for thyroid function, whole-exome sequencing (WES) and magnetic resonance imaging(MRI) of the orbital and ocular motor nerves showed normal results.Her symptoms alleviated after 6 months, with the retraction of the right upper eyelid when smiling was approximately 3 mm, thus the difference in the palpebral fissure height when smiling was smaller than that at the initial presentation. CONCLUSION: Blepharoptosis may accompanied with abnormal innervation like eyelid retraction, this phenomenon can be alleviated with age.The results of the levator muscle function test should be carefully examined to determine whether it is ptosis in an impaired innervation eyelid.

Spontaneous Blinking Kinematics After Frontalis Muscle Flap Advancement.

PURPOSE: To measure the spontaneous blinking metrics after blepharoptosis correction with frontalis muscle flap advancement. METHODS: A video system was employed to measure the amplitude and velocity of spontaneous blinking of 24 eyelids after the frontalis muscle flap surgery for blepharoptosis correction. A control group with no eyelid disorders was also measured. The data of 13 eyelids who had frontalis slings with autogenous fascia, which were previously collected with the same method in another study, were used for comparison. Digital images were used to measure the superior margin reflex distance and the presence of lagophthalmos during a gentle closure of the palpebral fissure. Superficial keratitis was assessed by corneal biomicroscopy. RESULTS: The mean amplitude of spontaneous blinking was 6.3 mm in controls, 2.6 mm in the frontalis flap patients, and 2.1 mm in the fascia sling group. The mean blink velocity was 133.8 mm/second in controls, 39.0 mm/second (3.7 standard error) after the frontalis flap, and 36.3 mm/second in patients with frontalis sling with fascia. For these 2 parameters, there was no statistical difference between the surgical groups, but a significant reduction when compared with the control group. No significant association was found between lagophthalmos and keratitis and the surgical procedure. CONCLUSIONS: There is no difference between the blinking metrics of eyelids operated using the frontalis muscle flap advancement technique or frontalis sling with autogenous fascia. The presence of lagophthalmos and keratitis also does not differ between the 2 procedures.

Blink Lagophthalmos in Graves Orbitopathy.

PURPOSE: To investigate the relationship between the kinematics of spontaneous blinks and the anterior area of the levator palpebrae superioris muscle in patients with Graves orbitopathy (GO). METHODS: This is a case-control study. The authors measured the margin reflex distance of the upper eyelid (margin reflex distance 1), the kinematics of spontaneous blinks, and the anterior area of levator palpebrae superioris muscle in CT coronal scans of patients with Graves upper eyelid retraction (GO) and a control group. The eye with the greatest margin reflex distance 1 was selected for analysis in each group. RESULTS: A total of 68 participants were included, with 36 in the GO group and 32 in the control group. In the GO group, the mean margin reflex distance 1 measured 6.5 mm, while in the control group, it was 3.9 mm. Almost all parameters related to the closing phase of spontaneous blinking activity, including amplitude, velocity, blinking rate, and interblink time, did not differ between the two groups. However, the effectiveness of the blink's amplitude (ratio of blink amplitude to margin reflex distance 1) and the main sequence (relationship between amplitude and velocity) were significantly reduced in the GO group compared with the control group. The area of the levator palpebrae superioris muscle was significantly larger in GO than in controls, with 71.4% of patients' muscles outside of the maximum range of the controls. CONCLUSIONS: In patients with GO, there is a reduction in blinking effectiveness, also known as blink lagophthalmos, which is a factor in the common occurrence of ocular surface symptoms. The increase in velocity with amplitude is also reduced in GO.

[Laser Doppler flowmetry in the diagnosis of chronic mixed blepharitis]. / Lazernaya dopplerovskaya floumetriya v diagnostike khronicheskogo smeshannogo blefarita.

Chronic mixed blepharitis accounts for 51.7% of all ophthalmic diseases. The use of laser Doppler flowmetry (LDF) in the diagnosis of this disease can help establish the initial manifestations of the inflammatory process in the eyelids, which is important for the prevention of possible complications - dry eye disease. PURPOSE: This study was conducted to determine the sensitivity and specificity of the LDF method in the diagnosis of chronic mixed blepharitis based on the study of microcirculatory changes in the eyelid skin. MATERIAL AND METHODS: The study included 23 patients with chronic mixed blepharitis (mean age 67±5.8 years) and 18 healthy volunteers (mean age 63±1.1 years). LDF was performed using the LAZMA MC-1 device. ROC analysis was used to determine sensitivity and specificity. RESULTS: A typical disturbance of the eyelid skin microcirculation was revealed in chronic mixed blepharitis - ischemia - with inhibition of the intensity of the functioning of blood flow regulatory systems and moderate activation of the lymph flow. The sensitivity and specificity of the coefficient of variation (reflecting the vasomotor activity of microvessels) of blood flow was 71.43 and 71.43%, lymph flow - 65.71 and 80.00%; myogenic rhythms of blood flow - 83.33 and 85.71%, lymph flow - 66.67 and 71.43%; neurogenic rhythms of blood flow - 75.00 and 78.57%, lymph flow - 91.67 and 78.57%, respectively. CONCLUSION: Laser Doppler flowmetry of the eyelid skin in combination with clinical, functional and instrumental research methods helped reveal with high sensitivity and specificity the eyelid damage in chronic mixed blepharitis. This method allows assessment of the condition of the eyelids in individuals without diseases of the anterior segment of the eye.

The acts of opening and closing the eyes are of importance for congenital blindness: Evidence from resting-state fMRI.

Volitional eye closure is observed only in conscious and awake humans, and is rare in animals. It is believed that eye closure can focus one's attention inward and facilitate activities such as meditation and mental imagery. Congenital blind individuals are also required to close their eyes for these activities. Resting-state functional magnetic resonance imaging (RS-fMRI) studies have found robust differences between the eyes-closed (EC) and eyes-open (EO) conditions in some brain regions in the sighted. This study analyzed data from 21 congenital blind individuals and 21 sighted controls by using amplitude of low-frequency fluctuation (ALFF) of RS-fMRI. The blind group and the sighted group shared similar pattern of differences between the EC and EO condition: ALFF was higher in the EC condition than the EO condition in the bilateral primary sensorimotor cortex, bilateral supplementary motor area, and inferior occipital cortex, while ALFF was lower in the EC condition than the EO condition in the medial prefrontal cortex, highlighting the "nature" effect on the difference between the EC and EO conditions. The results of other matrices such as fractional ALFF (fALFF) and regional homogeneity (ReHo) showed similar patterns to that of ALFF. Moreover, no significant difference was observed between the EC-EO pattern of the two subgroups of congenital blind (i.e., with and without light perception), suggesting that the EC-EO difference is irrespective of residual light perception which reinforced the "nature" effect. We also found between-group differences, i.e., more probably "nurture effect", in the posterior insula and fusiform. Our results suggest that the acts of closing and opening the eyes are of importance for the congenital blind, and that these actions and their differences might be inherent in the nature of humans.

Apraxia of eyelid opening secondary to possible progressive supranuclear palsy: a case report.

Apraxia of eyelid opening (AEO) is a disabling syndrome characterized by inability to open the eyes at will, and patients occasionally attempt to open their eyes by contracting the frontalis muscles and touching their eye lids with their fingers. The exact pathophysiological mechanisms underlying this syndrome remain unknown. Previous reports suggest that AEO is often associated with blepharospasm and is occasionally seen in patients with Parkinson's disease or other movement disorders. These reports suggest that AEO may be caused by lesions at the basal ganglia. In this report, we show a video of typical AEO.

Assessing the validity of eyelid parameters to detect impairment due to benzodiazepines.

OBJECTIVE: Benzodiazepines impair driving ability and psychomotor function. Eyelid parameters accurately reflect drowsiness; however, the effects of benzodiazepines on these measures have not been extensively studied. The aim of this study was to investigate the effect of benzodiazepines on eyelid parameters and evaluate their accuracy for detecting psychomotor impairment. METHODS: Eyelid parameters were recorded during a psychomotor vigilance task (PVT) and driving simulation over 2 days, baseline, and after 20-mg oral temazepam. The utility of eyelid parameters for detecting PVT lapses was evaluated using receiver operating characteristic curves, and cut-off levels indicating impairment (≥1 and ≥2 PVT lapses per min) were identified. The accuracy of these cut-off levels for detecting driving simulator crashes was then examined. RESULTS: PVT and driving simulator performance was significantly impaired following benzodiazepine administration (p < .05). Average eyelid closure duration (inter-event duration) was a reliable indicator of PVT lapses (area under the curve [AUC] of 0.87-0.90). The cut-off value of eyelid closure duration derived from PVT AUC was able to predict driving simulator crashes with moderately high sensitivity and specificity (76.23% and 75.00%). CONCLUSIONS: Eyelid parameters were affected by benzodiazepines and accurately detected the psychomotor impairment. In particular, eyelid closure duration is a promising real-time indicator of benzodiazepine impairment.

Analysis of blink activity and anomalous eyelid movements in patients with hemifacial spasm.

To assess spontaneous blinking and anomalous eyelid movements in patients with hemifacial spasm with an emphasis on interocular differences. Spontaneous eyelid movements were registered bilaterally for 3 min using a high-speed video camera in 28 patients with hemifacial spasm (HFS) who had not been treated with botulinum toxin injections for at least 5 months. The degree of blink conjugacy, maximum velocity, and amplitude of the closing phase of the blinks were determined for the affected and non-affected sides. Out of the 28 subjects, 23 (82%) presented with abnormal nonconjugate spasms that were similar to blinks, and in 17 (61%), high-frequency eyelid twitches were detected between blinks on the affected eye. The rate of nonconjugate blink-like spasms ranged from 0.3 to 24.7 movements/min. With regard for conjugate blinks, there was no significant interocular difference in amplitudes or eyelid closure velocities. The amplitude and velocity were significantly lower for nonconjugate movements than for spontaneous blinks. HFS is a unique condition in which complex patterns of eyelid movements, including both conjugate and nonconjugate movements, are present. Conjugate movements correspond to spontaneous blinking, and the same metrics were observed in affected and non-affected eyes. Nonconjugate movements correspond to anomalous nonconjugate blink-like spasms and high-frequency eyelid twitches in the affected eye, both of which were characterized by lower amplitudes and velocities than were observed in conjugate movements.

Infrared thermography: different options of thermal eyelid warming.

PURPOSE: Current therapies of Meibomian gland dysfunction (MGD) include thermal eyelid warming. It was the aim of the study to investigate the temperature run after eyelid warming using 3 different techniques (hot compresses, Blephasteam® (Thea Pharma GmbH, France), and having a sauna) in patients with MGD compared with normal subjects by infrared thermography. METHODS: A prospective case-control study was done. Temperature profiles of the eyelids were investigated in 93 subjects (49 normals, 44 MGD patients) after warming of the eyelids by 3 methods: hot compresses, Blephasteam®, and having a sauna. Temperature runs of the eyelids were measured with an infrared thermal imaging camera (VarioCAM® HD research 675/30 mm, InfraTec GmbH) at baseline and after eyelid warming for 10 min. Statistical analysis were done by Wilcoxon test or t tests for unpaired samples. RESULTS: The initial eyelid temperature was significantly increased after the use of Blephasteam® compared with hot compresses in MGD and normal patients (p < 0.001). Having a sauna showed a similar warming effect of the eyelids than Blephasteam® in normals and MGD patients (p > 0.05). Additionally, the warming effect of the eyelids after having a sauna was significantly longer than after the use of Blephasteam® in MGD (p = 0.016) and normal patients (p = 0.01). CONCLUSION: Eyelid temperature after having a sauna was similar to commonly used warming devices; yet, the duration of the eyelid warming effect was longer. Thus, having a sauna might be an alternative option for warming of the eyelids.

Effect of Manual Upper Eyelid Elevation on Intraocular Pressure Measurement by Four Different Tonometers.

SIGNIFICANCE: This study is the first to show that the manual upper eyelid elevation (manual UEE) that is commonly used to prevent disruption of the IOP measurement due to blinking or upper eyelid contact with the tip of the tonometer does not affect the IOP values. PURPOSE: We investigated whether manual UEE affects the IOP readings using three rebound tonometers (Icare TA01i, Icare PRO, and Icare ic100) and Goldmann applanation tonometry (GAT). METHODS: One eye was measured for 101 patients (56 eyes of primary open-angle glaucoma patients and 45 healthy subjects). The IOPs were measured without and with manual UEE. Each IOP was measured twice; the measurement order using the tonometers was randomly selected. In addition, palpebral fissure height (distance between the upper and lower eyelids) was measured. RESULTS: The IOPs without manual UEE were 12.1 ± 2.9, 13.3 ± 2.7, 11.7 ± 2.9, and 16.0 ± 3.2 mmHg (Icare TA01i, Icare PRO, Icare ic100, and GAT), and those with manual UEE were 12.3 ± 3.0, 13.3 ± 2.8, 11.7 ± 2.9, and 16.0 ± 3.3, respectively. No significant difference was found between the IOP without and with manual UEE (IOP difference; all, P > .50; paired t test). Multiple linear regression analyses revealed that palpebral fissure height did not affect IOP difference for any of the tonometers. CONCLUSIONS: Simple manual UEE when measuring the IOP has little effect on the IOP obtained using all current rebound tonometers and GAT.

Changes in Refraction and Visual Acuity after Upper Eyelid Blepharoplasty versus Posterior Approach Ptosis Procedures.

PURPOSE: To evaluate surgically induced refractive changes (SIRC) and visual acuity (VA) changes after blepharoplasty combined with posterior approach ptosis surgery (Müller's muscle-conjunctival resection [MMCR]) versus upper eyelid blepharoplasty alone. METHODS: In this prospective, comparative, clinical study on patients undergoing MMCR and blepharoplasty, comprehensive ophthalmic examinations were performed preoperatively and 3 months postoperatively. SIRC were calculated with the 10-step Holladay method. RESULTS: Fifty-six patients participated in the study, 31 in the blepharoplasty group and 25 in the ptosis group. logMAR VA improved significantly after surgery in both groups (p < 0.001). In both groups, most patients showed significant changes in SIRC sphere and spherical equivalent of >0.5 D (blepharoplasty group: 61.29 and 67.74%; ptosis group: 72.72 and 72.72%, respectively). Patients undergoing combined blepharoplasty ptosis surgery showed the greatest SIRC cylinder. CONCLUSIONS: Upper eyelid blepharoplasty with or without MMCR is associated with significant SIRC 3 months postoperatively. This may affect decision-making for all patients, especially for those who intend to seek refractive correction in addition to the index upper eyelid surgery.

Orbicularis Oculi Morphological Alterations in Affected and Nonaffected Sides in Hemifacial Spasm.

BACKGROUND: Although the nonaffected side appears to be clinically normal in hemifacial spasm (HFS), it is not known whether this side can be considered normal regarding histopathological findings. The purpose of this study was to objectively evaluate and compare orbicularis oculi samples of patients with HFS (not previously treated with botulinum toxin) and control patients undergoing cosmetic upper eyelid blepharoplasty. METHODS: Orbicularis oculi samples from 22 eyelids were evaluated. There were 7 samples from the affected and 7 samples from the nonaffected sides of patients with HFS who had not been previously treated with botulinum toxin, and 8 samples from normal control patients. Muscle samples were prepared using hematoxylin and eosin staining, and a digital image analysis software was used for objective analyses. RESULTS: When compared with normal controls, endomysial and perimysial connective tissue areas were significantly increased (P = 0.015) on the affected side in HFS, suggesting that this disorder is associated with chronic alterations that lead to muscle degeneration. Cell density was significantly reduced on the affected (P = 0.028) and also on the nonaffected sides in HFS (P = 0.003) compared with normal controls. This was observed, although, clinically, there were no signs or symptoms of increased muscular contraction on the nonaffected sides in any of the patients with HFS studied. CONCLUSIONS: Significant morphological differences in the orbicularis oculi muscle in patients with HFS were observed on both the affected and nonaffected sides. Our findings suggest a potential role for muscle homeostasis disturbances on both sides for patients with HFS. Affected sides in patients with HFS did, however, demonstrate muscle degeneration that was not present on the nonaffected sides.

Inadvertent tissue adhesive tarsorrhaphy of the eyelid: a review and exploratory trial of removal methods of Histoacryl.

OBJECTIVE: The use of tissue adhesives has become a popular option for closure of wounds in the ED. There have been a growing number of reports of inadvertent tissue adhesive injuries including closure of the eyelids. We aim to identify and compare various removal methods of tissue adhesives described in the literature in an exploratory trial. METHODS: A review was first conducted to establish all published methods for the removal of medical-grade tissue adhesives as well as commercial cyanoacrylates. This search was conducted on PubMed, Google Scholar and Google. All articles that reported attempts at removal of cyanoacrylate glues were included. These methods were then tested on a porcine model in an exploratory trial. Incisions were made on pigskin and closed with Histoacryl, a tissue adhesive. Three removal methods were tested-gentle rubbing with test compound after 45 or 90 s, as well as soaking in test compound. Removal methods that were successful underwent repeat testing. RESULTS: A total of 37 sources were reviewed with 13 different removal methods suggested. Based on the information, we tested 24 different compounds. Soaking of Histoacryl-closed wounds in Polydexa ear/eye drops displayed consistent success in achieving complete separation of incision edges after 2 hours. Several other soapy substances and antibiotic ointments showed potential but were not as consistent. CONCLUSION: In conclusion, in our trial of removal methods of Histoacryl, soaking in Polydexa antibiotic drops consistently facilitated removal after 2 hours. This approach can be attempted after inadvertent Histoacryl injury.

A Modified Procedure for Blepharoplasty: Physiological Structure Reconstruction of Upper Eyelids.

BACKGROUND: Double eyelid operation has become the most popular cosmetic procedure in China, while how to make sure the acquired double eyelids the same as congenital ones is still a problem. OBJECTIVE: This study aimed to explore a design and operation procedure to obtain natural and dynamic double eyelids, which are accordant with the congenital double eyelids both in appearance and movement. METHODS: The authors conducted a retrospective review of 352 patients who underwent our operation from October 2012 to October 2018. The procedures were performed by one senior surgeon. First, design the incision line 7 to 8 mm distance parallel to the ciliary margin. Then, cut down the skin and orbicularis muscle, and dissect the orbicularis myocutaneous flap from the anterior surface of the tarsal plate. Next, expose the orbital septum transversely in the lowest site from lateral to medial direction, and dispose of the fat tissue herniated spontaneously. Subsequently, suture the upper margin of pretarsal orbicularis myocutaneous flap to the levator aponeurosis. Finally, the skin edge of incision was closed interruptedly. The patients were followed up from 6 to 30 months after surgery by 2 surgeons to evaluate the long-term results. RESULTS: A total of 352 patients with 704 eyes were operated on and followed up in our study. There were 29 patients (8.2%) that showed slight asymmetry, and 7 eyes (2.0%) showed shallow creases. Besides that, all the creases were symmetry, parallel and natural. Just as congenital double eyelids, when opening eyes there was no sausagelike appearance, and when closing eyes there were no depressed scars. CONCLUSIONS: By reconstructing the physiological structure of upper eyelids, our double eyelid operation creates dynamic double eyelids, which are accordant with the congenital ones both in appearance and movement.

Diagnostic dilemma of kimura disease of eyelids.

Kimura disease (KD) is a rare benign chronic inflammatory disease that presents as a nodule mostly involving deep subcutaneous tissue of the head and neck region with frequent regional lymphadenopathy and peripheral blood eosinophilia. KD shares some clinical and histopathological similarity with angiolymphoid hyperplasia with eosinophilia (ALHE). Consequently, KD and ALHE were once considered variants of the same disease spectrum. We present here rare cases of Kimura disease and ALHE involving the eyelid and lacrimal gland and discuss their differential features.

Efficacy of wheat hot pack (dry heat) and pottery hot pack (moist heat) on eyelid temperature and tissue blood flow in healthy eyes: a randomized control trial.

PURPOSE: To investigate the eyelid temperature (Temp) and tissue blood flow (TBF) changes in healthy eyes using wheat hot pack (WHP) and pottery hot pack (PHP). METHODS: A randomized, double-blind, within-subject crossover study design was conducted in a Thai tertiary care center. All healthy subjects received warm compress treatment with WHP and PHP. The subjects were randomized to receive the WHP or the PHP at the first sequence. Temp and TBF measurements were taken at baseline, and every 2 min during the 10-min application of the heated compresses, and every 2 min for a 10-min duration after the compresses were removed. RESULTS: There were 29 females (96.7%) and 1 male. The mean (SD) age of the subjects was 33.17 (5.21) years. Two warm compresses were able to increase the surface lid Temp significantly from the baseline Temp at every time point of measurement and location. For the WHP application, the maximum surface Temp (SD) of the outer upper lid, outer lower lid, and inner lower lid were 40.07 (0.80) °C, 38.44 (0.91) °C, and 35.83 (0.71) °C, respectively (all P value < 0.001) and under the PHP application, the highest surface Temp (SD) were 40.63 (0.97) °C, 38.32 (1.27) °C, and 35.82 (0.71) °C, respectively (all P value < 0.001). Both WHP and PHP were able to increase TBF significantly with no adverse events and these effects can be sustained until 20 min. CONCLUSIONS: The results of this study suggest the potential of using these warm compresses for meibomian gland dysfunction. Further clinical research is needed.

Recurrent bilateral eyelid and conjunctival granulomatosis in Churg-Strauss syndrome.

A 47-year-old woman with poorly controlled asthma and allergic rhinitis presented with recurrent episodes of bilateral upper eyelid swelling associated with forniceal conjunctival mass for the past 10 years. Routine blood investigations showed raised IgE levels and raised eosinophil counts. The diagnosis of Churg-Strauss syndrome (CSS) was made following biopsy of the conjunctival mass. The symptoms responded well to oral steroid treatment but recurred following cessation of the therapy. The patient was co-managed with a rheumatologist and the patient currently remains stable and is on oral Methotrexate and low dose oral steroids. Ocular involvement in CSS is unusual but this unique presentation of CSS was successfully managed, and the patient remains in remission.

Ophthalmic features and management outcomes of 30 children having Goldenhar syndrome.

PURPOSE: To study the ophthalmic clinical profile and the management outcomes of children having Goldenhar syndrome (GS). METHODS: Retrospective review of included children fulfilling the diagnostic criteria of GS was performed. The demography, ophthalmic features, systemic anomalies, and treatment outcomes were recorded manually from patient files. An ENT, pediatrics, cardiology, and orthopedics consultation was sought for all GS patients before taking up for any ophthalmic surgical procedure. The anatomical (ocular surface and eyelid) and functional {vision and extraocular movements (EOM)} factors were exclusively studied. We ensured a minimum postoperative follow-up of 12 months, and our data were compared with the major studies featuring 'ophthalmic features' of GS. RESULTS: Totally 30 children (females = 18, 60%) were included with a median presenting age of 48 months. Twenty-seven (90%) had unilateral ophthalmic involvement with major features being upper eyelid coloboma (n = 25, 75.76%), lipodermoid (n = 18, 54.55%), and limbal dermoid (n = 10, 30.3%). Diminution of visual acuity was recorded in 22 (73.3%), while five (16.7%) had limitation of EOM. Systemically, the prominent features included hemifacial hypotrophy (100%), auricular anomalies (80%), cardiac anomalies (10%), and scoliosis (6.67%). The eyelid colobomas were repaired with the direct closure ± cantholysis technique or using a Tenzel's flap. All children had satisfactory anatomical and functional outcomes after ophthalmic surgical interventions without any significant complications. CONCLUSION: The tailored ophthalmic surgical intervention(s) provides satisfactory restoration of anatomy and functionality of the eye. These children need specific multi-discipline consultations for the holistic management and complete care.

Topical Review: Effects of Contact Lens Wear on Corneal, Conjunctival, and Lid Margin Sensitivity.

SIGNIFICANCE: Contemporary soft contact lenses do not affect mechanical sensitivity of the cornea, whereas conjunctival sensitivity is increased compared with nonwearers. Orthokeratology lens wear, however, reduces corneal sensitivity. The effects of contact lenses on lid margin sensitivity are unclear, and the link between ocular surface sensitivity and discomfort requires further exploration.Although up to 50% of contact lens wearers experience discomfort with varying severity, impact, and frequency, the relationship between ocular surface sensitivity and ocular surface discomfort experienced during contact lens wear is unclear. The purpose of this review is to examine and summarize the current evidence for the impact of both historical and contemporary contact lens wear on ocular surface sensitivity, the etiology of changes in ocular surface sensitivity, contact lens wear-related factors associated with changes in ocular surface sensitivity, and the relationship between sensitivity and discomfort. Despite minimal effects on mechanical corneal sensitivity with contemporary soft contact lens wear, orthokeratology reduces corneal sensitivity through pressure-related effects. This review addresses the relevance of conjunctival and potentially lid margin sensitivity in tolerance and discomfort with contemporary lens wear and the impact of instrument and stimulus characteristics. Less invasive techniques particularly for lid margin sensitivity measurements are required. Given the potential interactions between a contact lens and the varied types of ocular surface nociceptors, instruments that allow for exploration of cold and chemical sensitivity particularly may better allow the effects of lens wear to be elucidated compared with those that explore high-threshold mechanical sensitivity alone. A better understanding of the relationships between lens wear and ocular surface sensitivity may result in improved management of contact lens discomfort.