Eyelash Ptosis in Unilateral Myogenic and Aponeurotic Blepharoptosis: A Prospective, Controlled, Before- and After-Study.

PURPOSES: The purposes of this study were to compare lash ptosis (LP) with contralateral eyelid in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis before and after the ptosis repair and to assess the correlation between postoperative eyelid height and LP symmetry. METHODS: Patients older than 5 years were included from June 2015 to April 2017. Eyelid examination, LP grading (0-3), and photography were performed before and at least 6 months after ptosis repair. Success of ptosis repair (levator resection) was defined as margin reflex distance 1 within 0.5 mm of the contralateral eyelid; LP improvement, as at least 1 grade improvement at the last follow-up; and LP symmetry, as 2 eyelids being within 1 grade. RESULTS: There were 58 patients with MP and 20 with AP, with mean age of 19.2 and 49.5 years and median follow-up of 10 months. Lash ptosis was observed in 89.5% of ptotic and 33.3% of control eyelids. Mean LP grade was significantly higher in the MP (1.5) than in the AP (1.1), which significantly improved to 0.6 and 0.4, respectively. However, it persisted in 50.9% of MP and 31.2% of AP postoperatively. Lash ptosis symmetry was observed in 97.4% of patients, which was not correlated with margin reflex distance 1 symmetry. Lower levator function was the only significant factor correlated with LP. CONCLUSION: Lash ptosis was significantly worse in MP than in AP. Lower LF was correlated with more severe LP. Ptosis repair resulted in significant improvement of LP and its symmetry with the contralateral eyelid. Lash ptosis symmetry did not correlate with eyelid height symmetry postoperatively.

Renal anomalies and lymphedema distichiasis syndrome. A rare association?

Lymphedema distichiasis syndrome (LDS) is a rare, autosomal dominant genetic condition, characterized by lower limb lymphedema and distichiasis. Other associated features that have been reported include varicose veins, cleft palate, congenital heart defects, and ptosis. We update a previously reported family with a pathogenic variant in FOXC2 (c.412-413insT) where five affected individuals from the youngest generation had congenital renal anomalies detected on prenatal ultrasound scan. These included four fetuses with hydronephrosis and one with bilateral renal agenesis. A further child with LDS had prominence of the left renal pelvis on postnatal renal ultrasound. We also describe a second family in whom the proband and his affected son had congenital renal anomalies; left ectopic kidney, right duplex kidney, and bilateral duplex collecting systems with partial duplex kidney with mild degree of malrotation, respectively. Foxc2 is expressed in the developing kidney and therefore congenital renal anomalies may well be associated, potentially as a low penetrance feature. We propose that all individuals diagnosed with LDS should have a baseline renal ultrasound scan at diagnosis. It would also be important to consider the possibility of renal anomalies during prenatal ultrasound of at risk pregnancies, and that the presence of hydronephrosis may be an indication that the baby is affected with LDS.

Rare Variants in LAMA5 Gene associated with FLT4 and FOXC2 Mutations in Primary Lymphedema May Contribute to Severity.

Mutations in the Fms-related tyrosine kinase 4 (FLT4) and forkhead box protein C2 (FOXC2) genes cause Milroy disease (MD) and lymphedema-distichiasis syndrome (LDS), respectively, but the mechanism underlying disease pathology remains unclear. Applying whole-exome sequencing to two families with MD, one LDS family, and one sporadic LDS case, we identified four rare variants in the laminin subunit alpha-5 gene (LAMA5) in subjects carrying novel and known missense FLT4 mutations and a 7-bp duplication and 1-bp insertion in FOXC2. Phenotyping was expanded in some individuals using magnetic resonance lymphangiography, indiocyanine green fluorescence lymphography, and immunofluorescent lymphatic staining of skin tissue. Skin lymphatic staining showed the existence of dermal lymphatic vasculature in the MD case. Significant lymphatic dysfunction was observed in both MD and LDS patients. In the MD patient, tortuous lymphatics in the dorsum of the foot were slowly enhanced on indocyanine green fluorescent lymphography (ICG) imaging. Dilated lymph collectors with disruption and lymph leakage were observed in the familial LDS case on magnetic resonance lymphangiography (MRL). Numerous tortuous lymph collectors were visualized along the entire length of affected lower limbs on MRL imaging, and retrograde lymph flow was observed in the lymph collectors during ICG lymphography in the isolated LDS case. The finding of rare LAMA5 variants together with FLT4 and FOXC2 mutations suggests that these mutations may be co-responsible for these disorders and most likely interfere with the function of lymphatics. Further, larger studies are needed to confirm these results.

Madarosis, milphosis, eyelash trichomegaly, and dermatochalasis.

Eyebrows, eyelashes, and eyelids are cosmetically and functionally important periocular landmarks that offer insights into a patient's emotional state. Several pathologies exist with respect to the eyebrows, eyelashes, and eyelids. Madarosis refers to loss of the eyebrows or eyelashes; milphosis refers specifically to eyelash loss. Excess growth of eyelash hair is termed trichomegaly. Excess skin in the upper or lower eyelids is called dermatochalasis. Pathology of these important structures can be reflective of important local and systemic disease processes.

Use of adhesive tape for temporary management of inturned upper eyelid eyelashes.

OBJECTIVE: To evaluate the efficacy of adhesive tape for temporary management of inturned upper eyelid eyelashes. METHODS: In a prospective, consecutive, comparative, nonrandomized, interventional case series, 50 patients (100 eyes) had inturned eyelashes with at least 1 of 3 symptoms: foreign body sensation, itchiness, and tearing. Transpore tape was applied to the right upper eyelid of each patient; the left eye was used as a control. A questionnaire was used to assess relief or persistence of the symptoms before, during, and after tape adhesion. RESULTS: Analysis of variance showed a significant difference between the study and control groups (P = .002). Tukey honestly significant difference analysis revealed a significant difference in symptoms before and during tape adhesion and a significant difference during and after tape adhesion. Symptoms in the control eye remained unchanged. CONCLUSION: Use of adhesive tape can be an effective temporary measure for relief of symptoms of inturned upper eyelid eyelashes.

Anterior lamellar repositioning with complete lid split: a modified method for treating upper eyelids trichiasis in Asian patients.

Anatomically, the upper eyelids of an Asian are considerably unique, and nearly half of the East Asians have single eyelids. This study presents a new, modified, Asian-specialised procedure to simultaneously treat trichiasis and dermatochalasis. It combines anterior lamellar repositioning with lid split surgery and blepharoplasty, and creates a completely penetrating anterior lamellar flap so as to fully shift the anterior lid margin upwards. Between May 2004 and May 2006, 114 cases (144 eyelids) were operated and followed-up for at least 12 months. Lid margin and eyelash position, improvement of symptoms, recurrence rate, overcorrection and aesthetic appearance were assessed at each visit. Of the 144 eyelids operated, the recurrence rate was 0% at 3 months, 2.8% at 6 months and 5.6% at 12 months. There was no case of secondary lid ectropion or retraction, and the aesthetic alterations were accepted by all the patients. In conclusion, the modified operation - anterior lamellar repositioning with complete lid split - is an effective, personalized method for the treatment of upper eyelids trichiasis in Asian patients.

Ensortijamiento adquirido del cabello. Descripción de dos casos, uno de ellos asociado con triquiasis / Acquired kinking of the scalp hair. A report of two cases, one of them associated with trichiasis

El ensortijamiento adquirido del cabello es un trastorno raro del crecimiento del pelo del cuero cabelludo en el que los pelos afectados se vuelven oscuros y crespos, asemejándose al vello pubiano. Presentamos dos varones adolescentes afectados con esta enfermedad. En uno de ellos el trastorno se asociaba a triquiasis, en la que algunas pestañas crecen en mala dirección hacia la córnea. En ambos casos los estudios con microscopia óptica y electrónica de barrido mostraron idénticos resultados, con pelos de grosor variable que mostraban secciones más gruesas que alternaban con otras adelgazadas, formaciones canaliculares parciales y rotaciones de 180° sobre su eje longitudinal. Se sugiere que quizá algunos traumatismos mínimos puedan posiblemente actuar en algunos pelos predispuestos, originando el ensortijamiento del cabello en forma similar a la observada en algunos casos de pili torti secundario localizado adquirido (AU)

Tratamento de fitiríase palpebral com ivermectina / Treatment of palpebral phthiriasis with invermectin

Os autores descrevem um caso de paciente de 16 anos portadora de fitiríase palpebral tratada com ivermectina por via oral. Embora esta droga já esteja em uso há vários anos para terapêutica de outras parasitoses, ela também é reconhecidamente eficaz contra o Phthirus pubis. A maior vantagem de seu emprego na enfermidade aqui descrita pode residir na comodidade posológica.

Alteraciones oculares en pacientes pediátricos infectados con VIH / Ocular features in HIV infected pediatric subjects

Algunos autores señalan que las alteraciones oculares en pacientes infectados con Virus Inmunodeficiencia Humana (VIH) están relacionadas con el conteo linfocitario CD4. Debido a las características de dicha infección en la población pediátrica son muy diferentes a las de los adultos; se exploraron a 16 niños infectados, registrando la morbilidad ocular y relación con el conteo linfocitario.Se encontró una morbilidad elevada; con disfunción lagrimal, tricomegalia y retinopatía por VIH como las alteraciones más frecuentes; sin detectar una relación de éstas con un nivel específico de linfocitos CD4.

Conjunctival cilia entrapment: an unrecognized cause of ocular irritation.

Conjunctival entrapment of cilia is form of ocular irritation that to our knowledge has not yet been described. Scarring predisposes the conjunctiva to this phenomenon by creating blind recesses in which loose cilia can become entrapped. Once caught, the rigid cilia can act as a mechanical irritant or act as a nidus for microbial growth. We present herein three patients with entrapped cilia and discuss their pathophysiology and management. The symptoms in all three patients resolved with conjunctivoplasty and removal of the cilia.

Acquired eyelash trichomegaly and alopecia areata in a human immunodeficiency virus-infected patient.

We describe a human immunodeficiency virus (HIV) seropositive man with acquired eyelash trichomegaly and alopecia areata. This combination of clinical manifestations is intriguing since the new onset of elongated eyelashes in patients with acquired immunodeficiency syndrome has usually been associated with severe immunosuppression and alopecia areata has a presumed autoimmune etiology that requires T cell activation. The occurrence of these dichotomous conditions illustrates the potential selective pathogenesis of progressive HIV infection.

Relative roles of upper and lower lacrimal canaliculi in normal tear drainage.

A total of 88 cases of impaction of the eyelash into the lacrimal punctum were collected from 34,256 outpatients, and 39 cases of lash impaction into the Meibomian gland duct were found among 30,456 outpatients. Observations of these patients were analyzed to find the relative roles of the upper and lower lacrimal canaliculi in the normal tear drainage. In the cases of the Meibomian gland duct, the impaction occurred at a similar incidence in the upper and lower eyelids. However, in the cases of the punctum, the upper punctum was affected about three times more frequently than the lower punctum. The impaction of the eyelashes probably occurred at about the same rate in both puncta, but the present results suggested that the lashes in the lower punctum disappeared more easily into the drainage system than the lashes in the upper punctum. The lower canaliculus should, therefore, play the major role in normal tear drainage.

Epiblepharon. An important and often missed diagnosis.

Epiblepharon is a common, often unrecognized cause of epiphora and ocular irritation in the child. Epiblepharon consists of an extra fold of eyelid skin and orbicularis muscle overlying an eyelid margin. Occasionally an epiblepharon can push the lashes against the sensitive corneas, especially in downgaze. This paper illustrates epiblepharon and stresses the need for eyelid margin examination in downgaze in the child with epiphora or conjunctivitis.