Morphological and functional characteristics of the meibomian gland in pediatric patients with epiblepharon.

BACKGROUND: To observe morphologic and functional changes in meibomian glands in pediatric patients with and without lower eyelid epiblepharon. METHODS: In this prospective observation study, 55 eyes of 55 patients( 24 males, 31 females; mean age ± SD,9.82 ± 2.59 years; range 6-14 years) and 60 eyes of 60 controls ( 32 males, 28 females; mean age ± SD,10.57 ± 2.75 years; range 6-14 years) were included. The following tests were performed: eyelid margin abnormality by slit-lamp examination, measurement of noninvasive keratographic break-up time (NIKBUT), grading of absence of meibomian gland (meibography score) assessed with noncontact meibography, morphologic changes of meibomian glands (thinning, dilatation and distortion), tear production by the Schirmer 1 test, and grading of meibum quality and meibomian gland expressibility. RESULTS: The morphologic changes in meibomian glands were more common in the epiblepharon group (56.36%) than in the control group (28.33%) (p = 0.002). The meibum quality was worse in the epiblepharon group than in the control group (p = 0.009), and the NIKBUT was significantly shorter in the epiblepharon group than in the control group (p = 0.012). There was no significant difference in the Schirmer 1 test, meibomian gland expressibility, eyelid margin abnormality score or total meibography score between the two groups. Morphologic changes in the meibomian glands in the upper eyelids (38.18%) were more common than those in the lower eyelids (20%) (p = 0.036) in the epiblepharon group, and the meibography score was higher in the upper eyelids than in the lower eyelids (p = 0.001). CONCLUSION: There are morphological and functional changes in meibomian glands in pediatric patients with lower eyelid epiblepharon. Although the inverted eyelashes were located in the lower eyelid, morphological changes in the meibomian glands were more common in the upper eyelid.

Application of allogeneic sclera combined with tarso-conjunctival flap in total excision of divided eyelid nevus.

OBJECTIVE: To explore the clinical effect of allogeneic sclera transplantation combined with tarso-conjunctival flap in total excision of divided eyelid nevus. METHODS: Eleven patients (three male and eight female patients) who experienced divided nevus of the eyelids between January 2014 and April 2020 were recruited to this retrospective study. All lesions were thick, darkly pigmented, presented with a wart-like appearance, and invaded the eyelid margin and tarsal conjunctiva. The surgical method involved a full-thickness lesion excision; then, the posterior defect was reconstructed by sliding the residual tarso-conjunctival flap forward and allogeneic sclera transplantation, and the anterior defect was reconstructed with sliding flaps, rotating flaps, and free skin grafts. RESULTS: Neither malignant transformations nor recurrences were observed after a follow-up of more than one year. The eyelid shape was normal, the rim of the eyelid was smooth, there was no dissolution or rejection of the allogeneic sclera, and the eyelid had good mobility. All the flaps used were viable, soft, and thin. The most frequent complication was the loss of eyelashes in the reconstructed area. CONCLUSION: For divided nevus of the eyelids invaded the eyelid margin and tarsal conjunctiva, total excision is a better decision, regardless of tumor recurrence or aesthetic considerations. The posterior defect reconstruction through sliding residual tarso-conjunctival flaps combined with allogeneic sclera transplantation is simple and effective.