摘要
Objective:To investigate the effect of folding and filling the orbicularis muscle flap of the inferiorcentral pedicle in correction of sunken upper eyelids.Methods:From August 2020 to April 2022, 39 female patients aged 36-63 (47.1±6.3) years with dermatochalasis and sunken upper eyelid were admitted to the Plastic Surgery Department of the First Affiliated Hospital of Air Force Medical University. During the surgery, the orbicularis oculi muscle in the skin resection area was preserved and a muscle flap was formed with the central part of the lower margin of the incision as the pedicle, which was folded deep and filled in the anterior orbital septal space. 6 months after surgery, the Park method was used to compare the effects before and after surgery, and the doctors and patients were scored on the Global Aesthetic Improvement Scale, respectively.Results:Unilateral upper eyelid hematoma appeared in 1 patient and healed after local acupuncture and aspiration, unilateral incision induration appeared in 2 patients, and gradually disappeared after 6 months of follow-up. The wounds of other patients healed in one stage. All the 39 patients were followed up for 6-12 months. The scores of the Global Aesthetic Improvement Scale at 6 months after surgery were (4.12±0.95) for doctors and (3.82±1.27) for patients. Park method showed that the degree of sunken upper eyelid after surgery was significantly better than that before surgery, and the difference was statistically significant ( Z=-7.721, P=0.000). Conclusions:The folding and filling of the orbicularis muscle flap of the eye with the inferior central pedicle can correct the laxity of the upper eyelid and improve the sunken upper eyelid. This operation can make full use of local tissue, and the effect is simple and lasting.
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Objective:To investigate the effect of backfilling on the deformity of lacrimal sulcus and blepharobuccal sulcus after special treatment of the fat from orbital septum of the pouch in the lower intra-palpebral approach.Methods:From November 2019 to September 2022, a total of 42 patients (13 males and 29 females) aged 16-47(23.8±6.9) years with orbital septal fat swelling were treated by the surgical department of Beijing Huangsi Medical Cosmetic Clinic after the removal of orbital fat mass by the intraocular pouch approach. With mild, moderate, and severe lacrimal sulci and blepharobuccal depression deformity, the lower eyelid skin was not relaxed. The naturally herniated orbital septal adipose mass was cut off through the lower eyelid conjunctival incision approach, and then granulated into a 1 ml syringe, which was accurately filled into the depressed area of lacrimal sulci and blepharobuccal sulci according to the depressions marked before surgery.Results:The incisions of all 42 patients healed in the first stage without hematoma and infection, and the subcutaneous ecchymosis of 2 cases was observed by local hot compress 48 h later and the ecchymosis subsided 1 week. Follow-up was performed at 1 month, 2 months and 3 months, respectively. Among them, 35 patients underwent the operation of removing the lower eyelid bag and orbital septum cellulite and backfilling to correct the malformation of lacrimal sulci, and the postoperative effect was satisfactory. The symptoms of puffed eye bags, blepharobuccal sulci and lacrimal sulci depression disappeared, and the wound healed in one stage. 7 patients with eye bags accompanied by lacrimal sulci and blepharobuccal sulci were told before surgery that they might need two fat fillings due to insufficient fat content in the orbital septa and slight indentations. One month later, granular fat was taken from the legs to fill the lacrimal sulci and blepharobuccal sulci with satisfactory results.Conclusions:The treatment after the removal of orbital septum cellulite and the correction of lacrimal sulcus and blepharobuccal sulcus deformity are simple and satisfactory, and worthy of clinical application.
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Objective:To explore the effect of different injection schemes on improving lower eyelid rejuvenation and avoiding complications such as ecchymosis around the orbit.Methods:From September 2021 to June 2022, 86 patients who underwent lower eyelid rejuvenation at the Plastic Surgery Department of Nanjing Medical University Friendship Hospital and Taizhou Medical Cosmetic Clinic of Nanjing Medical University Friendship Plastic Surgery Hospital were included in this study. There were 2 males and 84 females, aged 20-58 (34.27±7.27) years. The patients were divided into two groups: the Cannula Group (68 cases) received appropriate injections under the deep layer of muscle fat pad and superficial layer of subcutaneous tissue using a 25 G cannula at two entry points on the lateral orbital zygomatic groove and the extension line of tear trough buccal groove; the Needle Group (18 cases) received injections directly perpendicular to the skin top to the orbital arch border of the corresponding area of tear trough and eyelid commissure fossa and superficial layer of subcutaneous fat using a 30G needle. The therapeutic effects and complications such as periorbital ecchymosis and swelling were observed in both groups.Results:In the Cannula Group, all 68 patients showed significant improvement in tear trough groove and eyelid commissure groove, achieving eyelid rejuvenation. Four patients developed spotty ecchymosis, and one patient was dissatisfied with the treatment outcome. The other patients were satisfied with the results. In the Needle Group, all 18 patients showed improvement in tear trough groove and eyelid commissure groove, with 6 patients developing ecchymosis. Two patients with large range of ecchymosis expressed dissatisfaction, while the rest were satisfied with the treatment outcome.Conclusions:Tear trough groove depression and eyelid commissure groove depression have been improved to varying degrees in both the Cannula Group and the Needle Group, achieving periorbital rejuvenation. However, the Cannula Group has a lower probability of complications such as ecchymosis compared to the Needle Group in lower eyelid rejuvenation treatment.
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AIM: To investigate the acute clinical manifestations of cosmetology-related ocular damage(COD).METHODS:Retrospective study. A total of 53 cases(89 eyes)with ocular damage caused by cosmetology from April 2016 to October 2021 were collected. The clinical features were analyzed, including age, gender, affected eye(s), clinical manifestations, injury cause, treatment procedures, and prognosis.RESULTS: All 53 patients were female, aged 22-45 years, with an average age of 28.4±6.7 years. Monocular injuries were observed in 17 patients, and binocular injuries in 36 patients. The same eye could exhibit two or more ocular damage simultaneously. The primary cosmetology procedures causing COD were eyeliner tattooing(38 eyes; 43%), eyelash extensions(18 eyes; 20%), removal of false eyelashes(11 eyes; 12%), mascara application(8 eyes; 9%), double eyelid surgery(6 eyes; 7%), and others(8 eyes; 9%). Major ocular damages included corneal damage(56 eyes; 63%), eyelid contact dermatitis(26 eyes; 29%), conjunctivitis(19 eyes; 21%), reactive eyelid edema(13 eyes; 15%), ocular surface foreign bodies(12 eyes; 14%), bacterial infection of the palpebral margin(10 eyes; 11%), and others(5 eyes; 6%). These 5 eyes included 1 eye(1%)with central retinal artery occlusion caused by periocular injection of hyaluronic acid. The majority of patients(74 eyes)recovered within 1-2 wk with appropriate treatment, while filamentosa keratitis appeared in 3 eyes and the eye with central retinal artery occlusion had poor prognosis.CONCLUSIONS: COD predominantly occurs in young and middle-aged females with cosmetology experience. The most common cosmetology procedure leading to COD is eyeliner tattooing, and corneal damage is the most significant type of COD. COD can be effectively prevented and treated, resulting in a generally favorable prognosis.
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Objective To explore the efficacy and safety of perforator flap eyelid reconstruction surgery for eyelid repair and reconstruction in patients with eyelid tumors after surgery.Methods Totally 80 patients(80 eyes)who re-ceived eyelid tumor surgery and planned to undergo the perforator flap eyelid reconstruction surgery in our hospital from January 2012 to December 2022 were included.All of them have early-stage and mid-stage eyelid tumors with no orbital or systemic metastasis.A perforator flap eyelid reconstruction surgery was conducted to treat the eyelid defects.The differ-ence in height and length of the palpebral fissure,aesthetic function scores and levels of depression and anxiety of patients before and after repair were compared;the clinical efficacy,adverse reactions and prognosis of patients were evaluated.Results Among the 80 eyes,there were 35 eyes with significant effect,35 eyes with effective impact,and 10 eyes with no effect,with a total effective rate of 87.5％.The height and length of palpebral fissure of patients after repair were(1.49±0.47)mm and(1.43±0.55)mm,respectively,which were significantly lower than those before repair[(2.55± 0.35)mm and(2.38±0.49)mm](both P＜0.01).The aesthetic function score before repair was 0.91±0.23,and that after repair was 1.87±0.19,with a significant difference(P＜0.01).The scores of the Self-rating Anxiety Scale and Self-rating Depression Scale after repair were 40.14±6.54 and 39.45±7.65,respectively,which were significantly lower than those before repair(59.56±8.23 and 57.93±8.19)(both P＜0.01).Among the 80 patients,the total incidence of compli-cations was 27.5％(22/80).All patients were followed up for 6-36 months,with an average follow-up time of(12.39± 6.17)months.No tumor recurrence was found during the follow-up.All composite flaps survived without infection,necro-sis or displacement.Conclusion The perforator flap eyelid reconstruction surgery has a good and safe therapeutic effect on repairing full-layer eyelid defects in patients who underwent eyelid tumor surgery.
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ABSTRACT Purpose: To assess Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum and correlate with ocular surface changes. Methods: This cross-sectional study evaluated patients with xeroderma pigmentosum. All patients underwent a comprehensive and standardized interview. The best-corrected visual acuity of each eye was determined. Detailed ophthalmic examination was conducted, including biomicroscopy examination of the ocular surface, Schirmer test type I, and meibography, and fundus examination was also performed when possible. Meibomian gland dysfunction was assessed by non-contact meibography using Oculus Keratograph® 5M (OCULUS Inc., Arlington, WA, USA). Saliva samples were collected using the Oragene DNA Self-collection kit (DNA Genotek Inc., Ottawa, Canada), and DNA was extracted as recommended by the manufacturer. Factors associated with abnormal meiboscores were assessed using generalized estimating equation models. Results: A total of 42 participants were enrolled, and 27 patients underwent meibography. The meiboscore was abnormal in the upper eyelid in 8 (29.6%) patients and in the lower eyelid in 17 (62.9%). The likelihood of having abnormal meiboscores in the lower eyelid was 16.3 times greater than that in the upper eyelid. In the final multivariate model, age (p=0.001), mutation profile (p=0.006), and presence of ocular surface malignant tumor (OSMT) (p=0.014) remained significant for abnormal meiboscores. For a 1-year increase in age, the likelihood of abnormal meiboscores increased by 12%. Eyes with OSMT were 58.8 times more likely to have abnormal meiboscores than eyes without ocular surface malignant tumor. Conclusion: In the final model, age, xeroderma pigmentosum profile, previous cancer, and clinical alterations on the eyelid correlated with a meiboscore of ≥2. Meibomian gland dysfunction was common in patients with xeroderma pigmentosum, mainly in the lower eyelid. The severity of Meibomian gland dysfunction increases with age and is associated with severe eyelid changes.
摘要
Abstract Background Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. Objective To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. Methods A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded. Results One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. Study limitations Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. Conclusion The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.
摘要
RESUMO Objetivo: Avaliar o perfil clínico-epidemiológico dos pacientes com trauma palpebral com laceração de canalículo lacrimal associado, fatores relacionados ao trauma e à intervenção cirúrgica e o sucesso anatômico e funcional pós-cirúrgico. Métodos: Estudo retrospectivo e analítico longitudinal, no qual foi realizada análise de prontuário dos pacientes com trauma palpebral e lesão canalicular associada, operados no período de 1° de janeiro de 2015 a 31 de julho de 2022. Os pacientes foram selecionados e contatados para avaliação presencial e aplicação de testes para análise do sucesso anatômico e funcional pós-cirúrgico. Resultados: Foram selecionados 84 pacientes, 28 compareceram para avaliação presencial. O sucesso anatômico foi obtido em 64,3%, e o funcional em 60,71% dos casos. A idade esteve associada ao mecanismo do trauma. Conclusão: A complexidade da lesão está associada ao sucesso anatômico e funcional finais, e o resultado do teste de Zappia-Milder guarda relação com a queixa de epífora.
ABSTRACT Objective: To assess the clinical-epidemiological profile of patients with eyelid trauma associated with lacrimal canaliculus laceration, factors related to trauma and surgical intervention, and to evaluate post-surgical anatomical and functional success. Methods: A retrospective and longitudinal analytical study was conducted, in which chart analysis was performed for patients with eyelid trauma and associated canalicular injury, who were operated on from January 1, 2015, to July 31, 2022. Patients were selected and contacted for in-person evaluation and tests to analyze post-surgical anatomical and functional success. Results: We selected 84 patients, and 28 of them attended the in-person evaluation. Anatomical success was achieved in 64.3% of them, and functional success in 60.71% of the cases. Age was associated with trauma traumatic mechanism. Conclusion: Injury complexity is associated with final anatomical and functional success, and the result of the Zappia-Milder test is related to patients' complaints of epiphora.
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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.
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Algunos pacientes en la tercera edad desarrollan con frecuencia diversas enfermedades, entre ellas se encuentra el cáncer de piel y la predisposición a la aparición de tumores, tanto en los párpados como en la conjuntiva. Entre los tumores epiteliales malignos se destacan: el carcinoma basocelular y el carcinoma epidermoide; con menor frecuencia, el carcinoma de células de Meibomio y el melanoma palpebral, y raramente, el carcinoma de células de Merkel. Por esta causa, se realizó la presentación de un caso clínico que recibió tratamiento en el Servicio de Cirugía Plástica del Hospital Vladimir Ilich Lenin, de Holguín, al cual se le aplicó la técnica de Mustardé por presentar tumor del párpado inferior. El objetivo fue presentar un paciente con reconstrucción palpebral postumorectomía y mostrar su resultado funcional y estético postoperatorio. Este caso evolucionó satisfactoriamente, sin aparición de complicaciones transoperatorias o postoperatorias.
Some elderly patients frequently develop various diseases, including skin cancer as well as a predisposition to the appearance of tumours, both in the eyelids and conjunctiva. Basal cell carcinoma and epidermoid carcinoma stand out among the malignant epithelial lesions; meibomian cell carcinoma and palpebral melanoma which are less common, and Merkel cell carcinoma rarely known. We present a male patient who received treatment in the plastic surgery service at "Vladimir Ilich Lenin" Hospital, in Holguín, to which Mustardé technique was applied for a tumour of the lower eyelid. An eyelid reconstruction was performed after lumpectomy which allowed us to show a postoperative functional and aesthetic result. This case evolved satisfactorily, without the appearance of intraoperative or postoperative complications.
Subject(s)
Skin Neoplasms , Surgery, Plastic , Eyelid Neoplasms摘要
Objetivo: Describir los resultados de la técnica de entrecruzamiento del orbicular, descrita por profesores eméritos del Pando Ferrer, en el entropión senil. Métodos: Se realizó un estudio observacional descriptivo longitudinal retrospectivo con pacientes atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer entre enero del 2021 a junio de 2022. La muestra estuvo constituida por pacientes operados con entropión senil con la técnica de Martínez Rodríguez modificada. Se les realizó examen ocular completo con seguimiento a las 24 h, 7 y 15 días, al mes y a los tres meses posteriores a la cirugía. Las variables utilizadas fueron edad, sexo, lateralidad, tiempo de cirugía y complicaciones. Resultados: La edad media fue de 79,26 años, con predominio del sexo masculino (69,56 por ciento) en 23 pacientes y 26 párpados; siendo 20 casos unilaterales y 3 bilaterales. Se reportó una complicación de hipocorreción (3,84 por ciento) y un tiempo medio de 11,9 minutos. Conclusiones: La técnica descrita es un abordaje efectivo demostrado en la baja frecuencia de complicaciones, sencillo y poco invasivo para entropión senil sin laxitud horizontal grave(AU)
Objective: To describe the results of the orbicularis crosslinking technique, described by emeritus professors from Pando Ferrer institute, in senile entropion. Methods: A retrospective, longitudinal, descriptive and observational study was carried out with patients who received attention at Instituto Cubano de Oftalmología Ramón Pando Ferrer between January 2021 and June 2022. The sample consisted of patients with senile entropion operated on with the modified Martinez-Rodriguez technique. They underwent a complete ocular examination with follow-up at 24 hours, 7 and 15 days, one month and three months after surgery. The used variables were age, sex, laterality, surgery time and complications. Results: The mean age was 79.26 years, with a predominance of the male sex (69.56 percent) in 23 patients and 26 eyelids; there were 20 unilateral cases and 3 bilateral ones. One complication of hypocorrection (3.84 percent) and a mean time of 11.9 minutes were reported. Conclusions: The described technique is an effective approach for senile entropion, demonstrated according to the low frequency of complications, as well as simple and minimally invasive and without severe horizontal laxity(AU)
Subject(s)
Humans , Male , Aged , Eyelids/injuries , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies , Observational Studies as Topic摘要
Purpose: Daily cleansing of eyelids is very important to carry out a successful blepharitis treatment. However, there are no therapeutic guidelines for blepharitis. The aim was to compare the symptomatic relief of anterior blepharitis using Blephamed eye gel, a cosmetic product, versus standard treatment. Methods: The study was a prospective, interventional open label clinical trial at a university?based hospital. The test population was subjects aged 18–65 years who presented with mild to moderate anterior blepharitis. Eyelid hygiene was applied twice a day. At each visit, a detailed assessment of symptomatology was carried out. A two?way repeated measure mixed model ANOVA was used to compare two groups by time. Results: In total, 61 patients with mean age of 60.08 ± 16.69 years were enrolled in the study including 30 patients in standard group and 31 patients in Blephamed group. Two groups did not differ in terms of age (P = 0.31) and eye laterality (P = 0.50). The baseline scores of erythema, edema, debris, and symptoms as well as total score were similar between two groups (all P values >0.50). Two groups became different for all these parameters at day 45 (all P values <0.001). Significant interaction was detected between time and intervention groups for all severity parameters of blepharitis as well as total score (all P values <0.001). Conclusion: Eyelid hygiene with Blephamed more significantly decreased symptoms of anterior blepharitis compared to standard treatment.
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Aims: To report a case of a rare giant eyelid eccrine hidrocystoma confirmed on histopathological examination and successful surgical excision with no recurrence.Presentation of Case: A young male presented with a mass over his eyelid which was gradually increasing in size, leading to drooping of the upper eyelid with no other associated symptoms. The mass 20x15x10 mm was present over the upper lid, non-mobile, non-tender, and firm. On the CT scan, a well-defined round to oval hypodense cystic mass was seen to be originating from the left upper eyelid. The cyst was excised and sent for histopathological analysis. The histological appearance of cystic spaces lined by cuboidal epithelium and containing mucinous fluid was suggestive of eccrine hidrocystoma. There was no recurrence till 2 months of follow-up.Conclusion: Eccrine hidrocystomas are 1-6 mm in size, generally 4 mm, and cysts larger than 10 mm are rare. Larger cysts have been described as “giant eccrine hidrocystoma.” Giant eyelid eccrine hidrocystoma is an unusual condition of the eyelid that must be considered in the differential diagnosis of eyelid tumours. They can be managed by complete surgical excision although recurrences are found to be common.
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Purpose: In cases of eyelid malignancies requiring full thickness excisional biopsy followed by reconstruction of the created defect, the Meibomian glands are lost. Post?operative varying degrees of dry eye disease (DED) are expected in such patients. The aim was to evaluate the objective and subjective statuses of DED in cases of full thickness eyelid reconstruction following excisional biopsy because of malignancies. Methods: This was a cross?sectional pilot study. Objective and subjective dry eye parameters are assessed in cases of full thickness eyelid reconstruction following excisional biopsy because of malignancies in 37 eyes at 6 months post?operative follow?up. Analysis of variance and Chi square test were used for statistical analysis. Results: When compared with fellow eye, all the parameters were found to be statistically significant (P < 0.0). Subjective assessment of dry eye by ocular surface disease index (OSDI) scoring did not corroborate with the objective data (p 0.00). Lower eyelid reconstruction showed a minimum number of dry eye cases (P > 0.05). Conclusion: Prevalence of post?operative dry eye is more with increasing percentage of full thickness upper eyelid reconstruction. Disparity was found between objective and subjective parameters of dry eye in patients requiring varying percentages of upper eyelid reconstruction because of malignancies.
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ABSTRACT Purpose: To investigate ocular surface and meibomian glands in patients with treatment-naive acne vulgaris. Methods: The Ocular Surface Disease Index (OSDI) questionnaire, invasive tear film breakup time, fluorescein staining of the ocular surface, and Schirmer II test were performed for all subjects. Total eyelid and meibomian gland secretion scores were assessed. Non-contact meibography was performed with the Sirius corneal topographic device. Results: The right eyes of 35 patients with acne vulgaris and 35 healthy volunteers were included the study. While the OSDI and staining scores were significantly higher in the acne group than in the control group (p=0.01 and p=0.003, respectively), the invasive tear film breakup time and Schirmer measurements were significantly lower in the acne group (p=0.000 and p=0.003, respectively). The total eyelid and meibomian gland secretion scores were also higher in the acne group than in the control group (p=0.003 and p=0.000, respectively). On the morphological evaluation of the meibomian glands, the thickening, thinning, tortuosity, and presence of ghost areas were statistically significantly more common in the acne vulgaris group than in the control group (p=0.000, p=0.001, p=0.05, and p=0.006, respectively). The percentage of the meibomian gland loss area was significantly high in the acne vulgaris group on both upper and lower meibography. The meibomian gland loss area positively correlated with total eyelid and meibomian gland secretion scores. Conclusion: Acne vulgaris may have a predisposition to meibomian gland dysfunction and ocular surface damage. Early recognition of meibomian gland and ocular surface alterations seems important, especially in acne vulgaris cases for which oral isotretinoin treatment is planned.
RESUMO Objetivo: Todos os indivíduos responderam ao questionário Ocular Surface Disease Index (OSDI) e tiveram avaliados o tempo de ruptura do filme lacrimal pelo método invasivo, a coloração da superfície ocular com fluoresceína e o teste de Schirmer II. Foram ainda avaliados o escore palpebral total e o de secreção das glândulas meibomianas. Foi realizada meibografia sem contato com um dispositivo topográfico corneano Sirius. Métodos: Todos os indivíduos responderam ao questionário Ocular Surface Disease Index (OSDI) e tiveram avaliados o tempo de ruptura do filme lacrimal pelo método invasivo, a coloração da superfície ocular com fluoresceína e o teste de Schirmer II. Foram ainda avaliados o escore palpebral total e o de secreção das glândulas meibomianas. Foi realizada meibografia sem contato com um dispositivo topográfico corneano Sirius. Resultados: Foram incluídos no estudo os olhos direitos de 35 voluntários com acne vulgar e 35 saudáveis. Os escores do Ocular Surface Disease Index e da coloração foram significativamente maiores no grupo com acne em comparação com o grupo controle (p=0,01 e p=0,003, respectivamente), mas o tempo de ruptura do filme lacrimal pelo método invasivo e as medidas do teste de Schirmer II foram significativamente menores (p=0,000 e p=0,003, respectivamente). O escore palpebral total e o escore de secreção das glândulas meibomianas também foram maiores no grupo com acne que no grupo controle (p=0,003 e p=0,000). Na avaliação morfológica das glândulas meibomianas, o espessamento, o afinamento, a tortuosidade e a presença de áreas fantasmas nas glândulas foram mais comuns no grupo acne vulgar que no grupo controle, com significância estatística (p=0,000, p=0,001, p=0,05 e p=0,006 respectivamente). A porcentagem da área de perdas das glândulas meibomianas foi significativamente mais alta no grupo com acne vulgar, tanto na meibografia superior quanto na inferior. A área de perda das glândulas meibomianas demonstrou uma correlação positiva com o escore palpebral total e com o escore de secreção das glândulas meibomianas. Conclusão: A acne vulgar pode levar a uma predisposição para a disfunção das glândulas meibomianas e para danos na superfície ocular. Parece ser importante reconhecer precocemente as alterações das glândulas meibomianas e da superfície ocular, especialmente nos casos de acne vulgar para os quais se planeja o tratamento oral com isotretinoína.
摘要
We describe the case of a 72-year-old female diabetic who presented with epiphora and purulent discharge from the right eye for the past 2 years and multiple skin lesions over the right upper eyelid and right arm for 1 year. Computed tomography of the paranasal sinuses revealed mucosal thickening in the frontal and ethmoidal sinuses, with a polypoidal mass from the right side of the nasal septum and dacrocystitis. The histopathology of the skin lesion was suggestive of lupus vulgaris (LV). There was no evidence of pulmonary tuberculosis. This case was a rare coexistence of LV with sinonasal tuberculosis and dacrocystitis.
摘要
Introduction: Non-melanoma tumors frequently affect the lower palpebral region and constitute a challenge for reconstructing the surgical wound without causing functional or aesthetic changes. Primary closure is generally impossible, and flaps are preferred over grafts as they generate less eyelid retraction. This article aims to describe a new surgical reconstruction technique. Method: A modified McGregor flap technique is described for correcting a surgical defect greater than 50% of the anterior lamella of a recurrent basal cell carcinoma lesion in the lower eyelid. Results: The patient was evaluated on the 7th, 14th, 21st, and 45th postoperative days. She presented a good functional and aesthetic response to the technique used. Conclusion: Using the double transposition flap, we demonstrate a new technique for closing defects larger than two-thirds in the lower eyelid.
Introdução: Os tumores não melanomas acometem frequentemente a região palpebral inferior e consistem em um desafio para a reconstrução da ferida operatória sem ocasionar alteração funcional ou estética. O fechamento primário geralmente não é possível e os retalhos são preferenciais aos enxertos por gerarem menor retração palpebral. Este artigo tem como objetivo descrever uma nova técnica de reconstrução cirúrgica. Método: Descreve-se técnica modificada do retalho de McGregor para correção de defeito cirúrgico maior que 50% da lamela anterior, de lesão recidivada de carcinoma basocelular localizada em pálpebra inferior. Resultados: Paciente foi avaliada no 7º, 14º, 21º e 45º dia de pós-operatório. Apresentou boa resposta funcional e estética com a técnica utilizada. Conclusão: Demonstramos uma nova técnica de fechamento de defeitos maiores do que dois terços na pálpebra inferior através do retalho de dupla transposição.
摘要
Introducción: La incidencia de los tumores malignos palpebrales varía según las diferentes razas. Su frecuencia aumenta con la edad y su aparición está relacionada con factores genéticos, virales y ambientales. Objetivo: Presentar un caso con una lesión tumoral en el párpado inferior al que se le realizó la reconstrucción palpebral luego de una resección parcial por cáncer con técnica combinada que incluyó Mustardé e injerto de mucosa. Presentación de caso: Paciente masculino de 76 años de edad con antecedentes de salud. Hace un año atrás comenzó a presentar una lesión endurada en el párpado inferior izquierdo hacia el canto interno del ojo, que fue aumentando de volumen, con una ulceración posterior. En el examen físico se observó una lesión ulcerada y sucia de aproximadamente 2 ( 2,5 cm, que comprometía los 2/3 mediales del parpado inferior, incluyendo la vía conducto lagrimal. Tras la intervención quirúrgica la extirpación creó un defecto correspondiente a la ausencia en todos los planos anatómicos en casi la totalidad del párpado inferior izquierdo, por lo que se planeó un colgajo de avance de la mejilla. El estudio histopatológico confirmó un carcinoma epidermoide completamente resecado. Conclusiones: Esta cirugía combinada permitió una exéresis amplia del tumor con el margen oncológico requerido y la sustitución aproximada de las estructuras del párpado. Se lograron una funcionabilidad adecuada y una cubierta del globo ocular óptima en su porción inferior, además de armónico con el contralateral(AU)
Introduction: The incidence of palpebral malignant tumors varies according to different races. Its frequency increases with age and its occurrence is related to genetic, viral and environmental factors. Objective: To present a case with a tumor lesion in the lower eyelid, who underwent palpebral reconstruction after a partial resection due to cancer with a combined technique including Mustardé and mucosal graft and its clinical evolution. Case presentation: 76-year-old male patient with a medical history. One year ago he began to present an indurated lesion on the left lower eyelid towards the inner canthus of the eye that was increasing in volume, with subsequent ulceration. Physical examination revealed an ulcerated and dirty lesion of approximately 2 ( 2.5 cm involving the medial 2/3 of the lower eyelid, including the lacrimal duct. After surgery the excision created a defect corresponding to the absence in all anatomic planes in almost the entire left lower eyelid, so a cheek advancement flap was planned. Histopathologic study confirmed a completely resected epidermoid carcinoma. Conclusions: This combined surgery allowed wide excision of the tumor with the required oncologic margin and approximate replacement of the eyelid structures. Adequate functionality and optimal eyeball cover was achieved in its lower portion, as well as harmonic with the contralateral one(AU)
Subject(s)
Humans , Male , Aged , Surgical Procedures, Operative/methods , Eyelid Neoplasms/epidemiology摘要
ABSTRACT Purpose: To evaluate the variables possibly related to actinic keratosis and malignant skin lesions on the eyelid. Methods: A prospective study of patients with suspected eyelid malignancy was conducted. The participants underwent a 2-mm punch biopsy at two opposite sites of the lesion for diagnosis, and the results were compared with those of the histopathological study of the surgical excised specimen. The patients with an actinic keratosis component were divided into two groups (actinic keratosis-associated malignancy and actinic keratosis alone), which were compared for the following variables: age, disease duration, largest diameter, tumor area, Fitzpatrick classification, sex, tumor site and margin involvement. A cluster analysis was also performed. Results: We analyzed 174 lesions, of which 50 had an actinic keratosis component. Actinic keratosis was associated with squamous cell carcinoma in 22% of the cases and to basal cell carcinoma in 38%, which shows that both neoplasms may have contiguous actinic keratosis. Statistical analysis revealed no significant difference among the variables. In a cluster analysis, four groups were identified with malignant lesions in the medial canthus with the largest mean diameter and area. All margin involvements on the lower eyelid were related to malignancy, which means that all cases with margin involvement had an almost 100% risk of malignancy. Conclusions: Larger actinic keratosis lesions in the medial canthus and lesions with margin involvement on the lower eyelid have a greater probability of malignant association.
RESUMO Objetivo: Avaliar as possíveis variáveis relacionadas à ceratose actínica e lesões malignas cutâneas nas pálpebras. Métodos: Estudo prospectivo de pacientes com lesões palpebrais suspeitas de malignidade. Os participantes foram submetidos à biopsia por trépano (punch) de 2-mm em dois pontos opostos da lesão como método diagnóstico e os resultados foram comparados com o estudo histopatológico da peça excisada cirurgicamente. Aqueles que apresentaram ceratose actínica como resultado foram divididos em dois grupos (ceratose actínica associada com malignidade e ceratose actínica isolada) e foram comparados de acordo com as variáveis: idade, tempo de doença, maior diâmetro, área do tumor, classificação de Fitzpatrick, gênero, localização e acometimento da margem palpebral. A análise de cluster também foi realizada. Resultados: Foram analisadas 174 lesões e 50 delas tinham ceratose actínica como componente do tumor. Ceratose actínica esteve associada ao Carcinoma Espinocelular em 22% dos casos e ao Carcinoma Basocelular em 38%, mostrando que ambos podem ter ceratose actínica adjacente. A análise estatística não encontrou diferença entre as variáveis. A análise de cluster identificou quatro grupos e mostrou que lesões malignas no canto medial tinham maiores diâmetro e área. Acometimento da margem na pálpebra inferior relacionou-se em 100% com malignidade, enquanto a ausência de acometimento da margem mostrou menor chance de malignidade. Conclusões: Lesões maiores de ceratose actínica no canto medial e lesões com acometimento da margem palpebral inferior têm maiores chances de associação com malignidade.
Subject(s)
Humans , Eyelid Diseases , Keratosis, Actinic , Neoplasms , Prospective Studies , Eyelid Diseases/pathology , Keratosis, Actinic/pathology , Neoplasms/pathology摘要
OBJECTIVE@#To investigate effectiveness of transconjunctival lower eyelid blepharoplasty with "super released" orbital fat in correction of lower eyelid pouch protrusion and tear trough and palpebromalar groove depression.@*METHODS@#A clinical data of 82 patients (164 sides) with lower eyelid pouch protrusion and tear trough and palpebromalar groove depression, who met the selection criteria between September 2021 and May 2022, was retrospectively analyzed. Of the included patients, 3 were males and 79 were females, with an average age of 34.5 years (range, 22-46 years). All patients had varying degrees of eyelid pouch protrusion and tear trough and palpebromalar groove depression. The deformities were graded by the Barton grading system as gradeⅠ in 64 sides, grade Ⅱ in 72 sides, and grade Ⅲ in 28 sides. The orbital fat transpositions were performed through the lower eyelid conjunctival approach. The membrane surrounding the orbital fat was completely released, allowing the orbital fat to fully herniate until the herniated orbital fat did not retract significantly in a resting and relaxed state, which is regarded as the "super released" standard. The released fat strip was spread into the anterior zygomatic space and the anterior maxillary space, and percutaneous fixed to the middle face. The suture that penetrates the skin was externally fixed by adhesive tape pasting without knotted.@*RESULTS@#There were 3 sides with chemosis after operation, 1 side with facial skin numbness, 1 side with mild lower eyelid retraction at the early stage after operation, and 5 sides with slight pouch residue. No hematoma, infection, or diplopia occurred. All patients were followed up 4-8 months, with an average of 6.2 months. The eyelid pouch protrusion, tear trough, and palpebromalar groove depression were significantly corrected. At last follow-up, the deformity was graded by Barton grading system as grade 0 in 158 sides and grade Ⅰ in 6 sides, with a significant difference compared to the preoperative score ( P<0.001). Patient's self-evaluation satisfaction reached very satisfied in 67 cases (81.7%), satisfied in 10 cases (12.2%), generally satisfied in 4 cases (4.8%), and dissatisfied in 1 case (1.2%).@*CONCLUSION@#The "super released" orbital fat can effectively prevent the retraction of orbital fat, reduce the probability of residual or recurrence of eyelid pouches, and improve the correction effect.