Primary lacrimal gland sebaceous carcinoma - case presentation and literature review.

Primary sebaceous carcinoma of the lacrimal gland (PSCLG) is the rarest lacrimal gland (LG) tumor, often belatedly diagnosed, worsening the prognosis. We present a 68-year-old man with a large, indurated mass in the left orbital outer quadrant, visible at the conjunctival upper temporal fornix, extending to the lower fornix, with left gaze restriction. The lesion was not related to the eyelid or other periocular tissues. Excisional biopsy revealed the PSCLG diagnosis. There are only eight others previous PSCLGs. Males are the most affected. Indurated mass in the lacrimal fossa, with eyelid in "S" shape is the most common presentation. Image exams are suggestive, but histological and immunohistochemical evaluations showing a single tumor cell line within LG are mandatory for definitive diagnosis. Larger and more extensive lesions can have a poor prognosis, but early detection can favor the outcome.

Isolated bilateral orbital and paranasal Rosai-Dorfman disease affecting two brothers: a case report and a systematic literature review.

A systematic literature review revealed 88 Rosai-Dorfman Disease (RDD) cases affecting the orbit. We present a review of the literature on orbital RDD in addition to two brothers with isolated bilateral extra-nodal orbital RDD cases associated with G-6PD deficiency. The disease manifested as asymmetric extensive orbital and paranasal sinus infiltration, with orbital bone destruction. Orbital mass debulking and steroids improved the condition in both patients. This is the most extensive case series of orbital RDD reported, including clinical manifestation, imaging, pathologic results, management, and outcome. Vigilant follow-up is essential to monitor for potential malignant transformation, systemic manifestations, potential vision loss, or life-threatening recurrences.

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.

Outcomes of the use of orbital hydrogel expanders in the management of congenital anophthalmia: CT-based orbital parameter analysis.

PURPOSE: To evaluate the outcomes of orbital hydrogel expanders in the management of congenital anophthalmia. METHODS: In this retrospective one-armed cohort study, a chart review was performed of eight children with congenital anophthalmia who underwent orbital expansion using orbital hydrogel tissue expander from January 2006 to July 2018. Computed tomography (CT) of orbital parameters was evaluated before and after surgery. Changes in the orbital parameters were correlated with clinical factors. RESULTS: The study sample comprised 11 anophthalmic orbits of eight children (seven males, one female; median age = 12 months), with a median postoperative follow-up of 3.8 years. The anophthalmic orbital parameters after hydrogel expander implantation improved significantly compared to preoperative assessment as follows: mean orbital height improved from 21.7 mm to 25.4 mm (P < .001); width from 19.2 mm to 23.8 mm (P < .001); depth from 27.5 mm to 32.6 mm (P = .008); and volume from 3.7 cm3 to 5.3 cm3 (P = .001). Despite enlargement in all dimensions, the anophthalmic orbits with hydrogel expander had a significantly lower development than the normal orbits, mainly in height and volume. At the last postoperative visit, four (36.4%) cases had fornices deep enough to maintain the conformer. Migration and extrusion occurred in two (18.2%) cases. CONCLUSIONS: Orbital hydrogel expander can improve the orbital development in congenital anophthalmia. However, the enlargement is not as extensive as that observed in the normal orbit. Orbital expanders associated with external conformers were not sufficient to induce normal growth of lids and fornix.

Use of Soft Contact Lens for Esthetic and Functional Rehabilitation.

OBJECTIVE: To report the outcomes and complications of colored soft contact lenses (SCLs) to improve esthetic or eye function in visually impaired (VI) or blind patients. METHODS: This retrospective study enrolled consecutive patients with unilateral or bilateral VI or blindness who had received colored SCLs to improve appearance or ocular function. Data were collected on demographics, complaints, complete ophthalmological examinations, types of SCL, follow-ups, and complications. RESULTS: The study sample was comprised of 109 patients (ages 4-80 years). Eighty-six patients (78.89%) had unilateral blindness, and 14 patients (12.84%) had functional disorder. Most of the patients presenting for improved esthetic had anterior segment pathology (74/67.88%), mainly secondary to trauma (55/50.5%) resulting in leukoma (73/66.97%). Patients with functional VI (19/17.43%) received filtered SCLs for color blindness (7/6.42%), diplopia (7/6.42%), or photophobia (5/4.58%). No serious complications were observed in any cases, and 94.49% of patients were satisfied with the SCLs. CONCLUSION: Colored SCLs can cover ocular surface imperfections in VI or blind eyes of patients who are seeking better cosmesis or improvement functional VI. Soft contact lenses with only one filter can cover imperfections of the ocular surface and improve vision in functional VI. Appropriate follow-up of these patients can reduce complication rates, resulting in good cosmesis and patient satisfaction with a positive impact on the lives of patients suffering from functional VI or blindness.

Clinical and histological features and outcomes of upper eyelid colobomas in the Saudi population.

PURPOSE: To study the clinical features, histopathology, and management of congenital upper eyelid coloboma (CEC) in the Saudi population. METHODS: A retrospective review of health records evaluated the demographics, histopathology, and surgical outcomes of patients with CEC. RESULTS: Thirty-nine eyelids of 27 patients were included in this study. CEC was bilateral in 12 (44.4%) patients, isolated in 17 (62.9%), and as part of a syndrome in 10 (37.1%) patients. CEC was commonly located in the medial upper lid (22 lids, 56.4%) and mostly involved the full thickness of the lid (27 lids, 69.2%). Corneal adhesion (18 eyes, 46.1%) and poorly formed eyebrows (21 eyebrows, 53.8%) were the most common ocular/adnexa associations. Histopathology was similar in all cases and the main features were scarred dermis, atrophic orbicularis oculi, and atrophic or absent tarsus. Visual acuity at the final follow-up was 20/50 or better in 13 (33.3%) eyes. Complete lid closure without lagophthalmos after one or more surgical procedures was achieved in 11 (40.7%) cases. CONCLUSIONS: CEC features in Saudi patients are similar to those described in the literature. Dermal scarring and defective orbicularis muscles are common. Achieving cosmetic and functional success after management remains challenging.

Characteristics and Success Rates of Same Day or Asynchronous Bilateral External Dacryocystorhinostomy.

PURPOSE: To evaluate the characteristics of bilateral nasolacrimal duct obstruction (NLDO) carriers and success rates of same day (simultaneous) or asynchronous (different day) bilateral dacryocystorhinostomy (DCR). METHODS: This retrospective study included patients with bilateral NLDO who underwent bilateral external DCR between January 2010 to August 2015 at the King Khaled Eye Specialist Hospital, Saudi Arabia. Postoperative success rate was considered as subjective perception of no tearing bilaterally or failure if unilateral or bilateral tearing persists after surgery. Data were statistically analyzed with P <0.05 indicating significance. RESULTS: Of 57 patients undergoing bilateral DCR, 32 (56%) had same-day surgeries and 25 underwent asynchronous surgery. The median duration of follow up was 7 months. The success rates were similar for the same day group [61.3%-95% CI 49.4-73.2)] and for the asynchronous group [54.2% (95% CI 40.4-68.0)]. Success rate was not correlated to the age, gender, or use of stents. CONCLUSIONS: The authors strongly recommend bilateral same-day external DCR to treat bilateral NLDO since the success rate of the procedure is similar to the asynchronous surgery, allowing a full treatment in just 1 operative visit.

Nanoskin® Subcutaneous Implant in Guinea Pigs.

PURPOSE: To evaluate the suitability of Nanoskin, a biomaterial derived from bacterial cellulose, as an alternate material for repairing the posterior lamellae of the eyelids. METHODS: Forty guinea pigs received a fragment of Nanoskin subcutaneously in the dorsal region. The animals received Nanoskin (group 1) or Nanoskin coated with a gelatin layer (group 2). The animals were observed daily for over 7, 30, 90, or 180 days with the subcutaneous implants in place. The animals were euthanized at a designated time and the Nanoskin was removed for histologic, morphometric, and transmission electron microscopy evaluation. RESULTS: The results were similar for both groups. The subcutaneously implanted Nanoskin resulted in good tissue integration, induced mild inflammation, and was surrounded by a delicate pseudocapsule. CONCLUSION: The good tissue integration of Nanoskin in study indicates that it may be a potential material for application as a substitute of posterior eyelid lamellar tissue. Further clinical studies are required to confirm the preliminary outcomes of this experimental study.

Split-Skin-Graft Wrapped Conformer to Treat Severe Contracted Sockets.

This case series present the surgical management of cases with severe contracted sockets using a split-skin-graft wrapped conformer. Eight patients with severely contracted anophthalmic sockets underwent surgery. The surgical technique is described and a chart review was performed to collect patient data pre- and postoperatively. Preoperatively, all patients had grade 3 or 4 contracted sockets with shallow or obliterated fornices and patients were unable to retain an external prosthesis in place. Donor material was harvested from the supraclavicular area. The split-skin-graft was successfully performed in all cases without fornix-deepening sutures. All patients underwent a significant improvement of socket contracture enabling retention of the prosthesis and were satisfied with the outcomes. The split-skin-graft wrapped conformer is a rapid and less surgically challenging option to correct severe contracted anophthalmic sockets.

Cohesive silicone gel implants with smooth, textured or polyurethane-coated surface to restore volume in eviscerated sockets.

The purpose of this article is to evaluate the three different surface coating on cohesive silicone gel implants in eviscerated rabbit eye sockets. Forty-five albino rabbits underwent right eye evisceration and received hemisphere-shaped cohesive silicone gel implants with smooth (Group 1), textured (Group 2), or polyurethane-coated surface (Group 3) in the socket. The animals were euthanized at 7, 30, and 90 days postoperatively. Computed tomography of the orbits was performed prior to euthanasia. Subsequently, the orbital contents were removed and underwent histologic and morphometric examination. Data were statistically analyzed. There were no adverse effects throughout the study. The majority of implants in the Group 1 exhibited 180° rotation. The Group 3 experienced an intense inflammatory reaction around the implant and implant deformation probably due to pseudocapsule contraction. Cohesive silicone gel implants had good integration into the scleral socket. Optimal results were obtained with cohesive silicone gel textured implants (Group 2). Smooth implants (Group 1) rotated significantly, whereas polyurethane (Group 3) coated implants precipitated an intense inflammatory reaction and were deformed postoperatively.

Outcomes of two surgical techniques for major trichiasis treatment.

The purpose of this article is to analyze the outcomes of two surgical techniques to treat major trichiasis. A retrospective chart review of 67 patients (89 eyelids) with major trichiasis was performed who underwent surgical treatment using one of two techniques: intermarginal split lamella with graft (ISLG group) or lid lamella resection (LLR group). There were 30 lids in the ISLG group with mean patient age of 71.8 years and 63.3% were females. There were 59 lids in the LLR group with mean patient age of 72.5 years and 52.5% were female. The minimum postoperative follow up was six months. Statistical analysis included descriptive measures, Goodman association test for contrasts between and within multinomial populations and nonparametric Mann-Whitney test for comparison between groups. P < 0.05 was considered statistically significant. The underlying causes of trichiasis were blepharitis (37.07%), chronic meibomitis (21.3%), multiple causes (20.2%), ectropion (11.2%), actinic keratosis (6.7%), or prior ocular surgery (3.3%). Postoperatively, in the ISLG group, there were 20% lids with complete success, 50% underwent laser or electrolysis, 16.7% required further surgery, and 13.3% were unsuccessful. Postoperatively, in the LLR group, there were 47.5% eyelids with complete success, 46.7% underwent laser or electrolysis, 6.8% required further surgery, and 5.1% were unsuccessful. There was a higher statistical chance of complete success with LLR (P < 0.05). LLR is superior to ISLG surgery for the treatment of major trichiasis. There is a greater chance of success with LLR and it is technically simpler.

Dacryocystectomy as a treatment of chronic dacryocystitis in the elderly.

To evaluate the dacryocystectomy (DCT) outcomes for chronic dacryocystitis in an elderly population over 70 years old. A retrospective chart review was performed for patients over 70 years old who were diagnosed with chronic dacryocystitis and underwent DCT at the Botucatu School of Medicine, UNESP, Brazil, from 2007 to July 2014. Data were collected about patient demographics, age, gender, previous nasal, or ophthalmic diseases, symptoms related to the lacrimal drainage system preoperatively and postoperatively, signs of enlargement of the lacrimal sac (regurgitation of secretion), and histopathologic evaluation. The study sample was comprised of 17 patients with an average age of 76.5 ± 8.5 years. The major complaint for all patients was tearing and 17.6% patients had an additional complaint of discharge. Regurgitation of secretion with lacrimal sac expression was present in 76.5% of patients. Postoperatively, 76.5% of the patients reported improvement of the initial complaint, likely due to the total excision of the lacrimal sac which removed the focal site of chronic infection. Epiphora persisted in 23.5% of patients, of whom 11.7% underwent successful lacrimal stent intubation. DCT for chronic dacryocystitis should be considered a primary procedure in individuals over 70 years old. This procedure has a much lower risk to these patients who often have associated comorbidities.

Refractive errors in a Brazilian population: age and sex distribution.

PURPOSE: To determine the prevalence of refractive errors and their distribution according to age and sex in a Brazilian population. METHODS: This population-based cross-sectional study involved 7654 Brazilian inhabitants of nine municipalities of Sao Paulo State, Brazil, between March 2004 and July 2005. Participants aged >1 year were selected using a random, stratified, household cluster sampling technique, excluding individuals with previous refractive or cataract surgery. Myopia was defined as spherical equivalent (SE) ≤-0.5D, high myopia as SE ≤-3.0D, hyperopia as SE ≥+0.5D, high hyperopia as SE ≥+3D, astigmatism as ≤-0.5DC and anisometropia as ≥1.0D difference between eyes. Age, sex, complaints and a comprehensive eye examination including cycloplegic refraction test were collected and analysed using descriptive analysis, univariate and multivariate methods. RESULTS: The prevalence of astigmatism was 59.7%, hyperopia 33.8% and myopia was 25.3%. Astigmatism had a progressive increase with age. With-the-rule (WTR) axes of astigmatism were more frequently observed in the young participants and the against-the-rule (ATR) axes were more frequent in the older subjects. The onset of myopia occurred more frequently between the 2nd and 3rd decades of life. Anisometropia showed a prevalence of 13.2% (95% CI 12.4-13.9; p < 0.001). There was an association between age and all types of refractive error and hyperopia was also associated with sex. Hyperopia was associated with WTR axes (odds ratio 0.73; 95% CI: 0.6-0.8; p < 0.001) and myopia with ATR axes (odds ratio 0.66; 95% CI: 0.6-0.8; p < 0.001). CONCLUSIONS: Astigmatism was the most prevalent refractive error in a Brazilian population. There was a strong relationship between age and all refractive errors and between hyperopia and sex. WTR astigmatism was more frequently associated with hyperopia and ATR astigmatism with myopia. The vast majority of participants had low-grade refractive error, which favours planning aimed at correction of refractive error in the population.

Influence of uncorrected refractive error and unmet refractive error on visual impairment in a Brazilian population.

BACKGROUND: The World Health Organization (WHO) definitions of blindness and visual impairment are widely based on best-corrected visual acuity excluding uncorrected refractive errors (URE) as a visual impairment cause. Recently, URE was included as a cause of visual impairment, thus emphasizing the burden of visual impairment due to refractive error (RE) worldwide is substantially higher. The purpose of the present study is to determine the reversal of visual impairment and blindness in the population correcting RE and possible associations between RE and individual characteristics. METHODS: A cross-sectional study was conducted in nine counties of the western region of state of São Paulo, using systematic and random sampling of households between March 2004 and July 2005. Individuals aged more than 1 year old were included and were evaluated for demographic data, eye complaints, history, and eye exam, including no corrected visual acuity (NCVA), best corrected vision acuity (BCVA), automatic and manual refractive examination. The definition adopted for URE was applied to individuals with NCVA > 0.15 logMAR and BCVA ≤ 0.15 logMAR after refractive correction and unmet refractive error (UREN), individuals who had visual impairment or blindness (NCVA > 0.5 logMAR) and BCVA ≤ 0.5 logMAR after optical correction. RESULTS: A total of 70.2% of subjects had normal NCVA. URE was detected in 13.8%. Prevalence of 4.6% of optically reversible low vision and 1.8% of blindness reversible by optical correction were found. UREN was detected in 6.5% of individuals, more frequently observed in women over the age of 50 and in higher RE carriers. Visual impairment related to eye diseases is not reversible with spectacles. Using multivariate analysis, associations between URE and UREN with regard to sex, age and RE was observed. CONCLUSION: RE is an important cause of reversible blindness and low vision in the Brazilian population.

Superior rectus/levator complex in acquired anophthalmic socket repaired with spheric implant-a computed tomography scan and topographic study.

AIM: To determine whether the levator palpebrae superioris (LPS)/superior rectus (SR) muscle complex, can influence the position of the upper lid and fornix in acquired anophthalmic sockets. METHODS: This comparative non-randomized and non-interventional study included retrospective data of 21 patients with unilateral acquired anophthalmic sockets repaired with spheric implants. High-resolution computed tomography (CT) measurements of the LPM/SR muscle complex and clinical topographic position of the upper lid, superior and inferior fornix depth in primary gaze position were evaluated. Demographic data were presented as frequency and percentage proportions and quantitative variables comparing the socket measurements with the normal contralateral orbit was statistically analyzed using non-parametric tests considering P<0.05. RESULTS: The anophthalmic orbits had a significantly shorter LPS length (P=0.01) and significantly thicker SR (P=0.02) than the normal orbit. Lagophthalmos was present in anophthalmic sockets but not in normal orbits (P=0.002), while levator function was normal in both (P>0.05, all comparisons). The superior fornix depth was similar in the anophthalmic socket and the contralateral normal orbit (P=0.192) as well the inferior fornix depth (P=0.351). CONCLUSION: Acquired anophthalmic sockets repaired with spheric implants have shorter LPS, thicker SR, and more lagophthalmos than normal orbits. The relationship of the LPS and SR with other orbital structures, associated with passive or active forces acting in the final position of the lids and external ocular prosthesis should be further investigated.

Management of congenital nasolacrimal duct obstruction--latin american study.

PURPOSE: To survey the management of congenital nasolacrimal duct obstruction, in particular, the timing of intervention and the use of massage, probing, nasolacrimal intubation, nasal endoscopy, and dacryocystorhinostomy. METHODS: This was an exploratory study that used an electronic questionnaire, which was sent via Internet to the members of Ojoplast, a social network composed of ophthalmologists from several Latin American countries. The responses were analyzed using adherence and the chi-square test. RESULTS: Seventy-two completed questionnaires were received. Approximately 64% of survey participants indicated that they use massage as the initial treatment for congenital nasolacrimal duct obstruction until 1 year of age and lacrimal probing (70.8%) for patients >1 year of age. Early probing used by 58.3% of the patients for a dilated lacrimal sac, and 66.7% reported that lacrimal system probing in conjunction with irrigation is effective. If the probing is not effective, 65.3% indicated that they repeat the procedure a second time. If the patient does not respond to massage or probing, 69.4% perform lacrimal system intubation. Sixty-two percent of the respondents indicated that they perform dacryocystorhinostomy for cases in which probing or intubation is not effective. CONCLUSIONS: The members of Ojoplast adopt massage as the initial treatment for congenital nasolacrimal duct obstruction for patients <1 year of age. Probing is performed on patients >1 year of age, and early probing is used only for cases of dilated lacrimal sac. When massage and probing are not effective, intubation is performed, and if intubation is unsuccessful, dacryocystorhinostomy is performed, in which the external approach to dacryocystorhinostomy is used most often.

Short-term qualitative and quantitative analyses of preseptal injection of hyaluronic acid on the treatment of acquired lower eyelid cicatricial ectropion.

PURPOSE: Recently, hyaluronic acid (HA) was proposed as a promising option for the treatment of acquired lower eyelid cicatricial ectropion. However, this effect was not confirmed by quantitative assessments. This study aimed to assess the effect of hyaluronic acid on the treatment of acquired lower eyelid cicatricial ectropion. METHODS: Eight patients with acquired lower eyelid cicatricial ectropion (13 eyelids) were treated with a single 1 mL injection of hyaluronic acid in the preseptal area of the lower eyelid. Evaluation of symptoms and biomicroscopic exam was performed before and 30 days after hyaluronic acid injection. Quantitative analysis of the lower eyelid position (with and without lid traction) was determined before and 30 days after hyaluronic acid injection through standard photographs analyzed using the ImageJ. RESULTS: All patients experienced partial improvement of symptoms. The lower eyelid position was significantly lifted after hyaluronic acid injection with a significant reduction of medial and lateral angles, reduction of the margin reflex distance, and total and medial ocular fissure area. However, signs of lid margin inflammation and corneal punctate keratitis persisted. CONCLUSIONS: Hyaluronic acid injected in the pre-septal area of the lower eyelid improved acquired lower eyelid cicatricial ectropion symptoms and significantly lifted the position of the lower eyelid. Further studies, with a large number of participants and a long-term follow-up period, are needed to better determine the permanency of the effects of hyaluronic acid injections on the treatment of acquired lower eyelid cicatricial ectropion.

Anterior versus posterior retractor reinsertion with a lateral tarsal strip for involutional entropion repair: A multicentric experience.

PURPOSE: The aim was the comparison of two different approaches to re-insert the inferior eyelid retractors within addition to lateral tarsal strip at lower eyelid involutional entropion (LEIE) surgical correction. METHOD: This multicentric retrospective case series involved 233 consecutive patients (195 eyelids) who underwent LEIE repair. All the lids had a lateral tarsal strip (LTS) in addition to the reinsertion of retractors onto the tarsal plate via the anterior approach (group 1) or the posterior approach (group 2). The desired normal position of the eyelids at 6-month follow-up was considered 'surgical successes, while entropion recurrence and overcorrection (ectropion) were considered 'surgical failures'. RESULTS: One-hundred ninety-one (82%) surgeries were included in group 1 and 42 (18%) in group 2. The success rate was 92.1% (176 lids) in group 1 and 85.7% (36 lids) in group 2 (p = 0.188). The recurrence rate was statistically higher for group 2 (14.3%) than for group 1 (3.7%) (p = 0.016). Overcorrection only described in group 1 (3.1%). Both groups had a similar complication rate (p = 0.268), with trichiasis being the most frequent (14, 6%). Ten eyelids (47.6%) from the 21 overall failures were satisfactorily reoperated, and the remaining ones were treated conservatively. CONCLUSION: The anterior or posterior approach to reinsert lower eyelid retractors to tarsal plate in addition to LTS to correct LEIE can provide a similar outcome. However, the anterior approach achieves a slightly higher success rate with fewer recurrences but with a higher overcorrection rate.

Vegetal polymer in repair of defects of the orbital floor: an experimental study in rabbits.

BACKGROUND: An experimental study was done to assess the ability of the vegetal polymer miniplates and screws to repair defects of the orbital floor. METHODS: An artificial standard-sized defect was created in the bony floor of right orbit of 45 albino rabbits. The animals were divided into three experimental groups: control group (G1) involving animals with orbital floor defect and no treatment; titanium group (G2) containing animals with orbital floor defect repaired by titanium miniplates and screws; vegetal polymer group (G3) composed of animals with similar orbital floor defects repaired by vegetal polymer miniplates and screws. Throughout the course of the experiment, the animals were clinically evaluated. At 15, 30 and 60 days after surgery, the animals were killed. They were X-rayed immediately after the floor defect and at the moment of sacrifice. Histological and morphometric evaluation of inflammatory reaction and bone healing was done. Data were statistically evaluated. RESULTS: No implants were extruded. Bone consolidation was similar in G2 and G3 and better than in G1 group animals. Inflammatory reaction was most pronounced in animals of G3 15 days after surgery, and it subsided over time. CONCLUSION: Vegetal polymer miniplates and screws induces small inflammatory reaction and had the ability to stimulate bone growth with good integration in the orbital floor defect allowing to consider the vegetal polymer adequate option to treat orbital floor defects. Future studies involving long-term follow-up and biomechanical tests to evaluate material resistance to traction are needed.

Assessment of eyebrow position before and after upper eyelid blepharoplasty.

OBJECTIVE: Assess the occurrence of secondary brow ptosis after upper lid blepharoplasty. METHODS: Forty-five individuals (n = 90 brows) submitted to upper lid blepharoplasty, were assessed by means of a comparative analysis using pre- and post-operatively digital photographs, in the primary position of the eye. The images were processed using ImageJ "software", transferred to a computer, to an electronic Microsoft Excel 2002(®) worksheet. Angular measurements were used, taking the lateral canthal angle of the brow, the most medial point of the brow, the medial canthal angle and the lateral canthal angle of the lid as anatomical reference points. When the outer angles were reduced or the inner angles increased after surgery this was considered a brow ptosis. Individuals who had undergone lid surgery associated with the eyebrow, previous eyebrow surgery and those with eyelid ptosis were excluded. The difference between the pre-operative and post-operative measurements were analyzed statistically using the Student's t-test for paired samples and the angular variation was compared with their corresponding contralateral sample using Wilcoxon's non-parametric test. RESULTS: The measurements obtained after the blepharoplasty show significant variations from those before the surgery, indicating that the correction of redundant tissues in the brow accentuates the tendency of the eyebrow to move down. The alterations are more important in the lateral portion of the eyebrow and they occur bilaterally. CONCLUSION: The assessment of angular measurements obtained pre- and post-operatively showed that there are secondary changes in the position of the eyebrow as a result of upper eyelid blepharoplasty.