Eye injuries caused by high intensity macro and micro focused ultrasound treatment: a case report.

BACKGROUND: High Intensity Macro and Micro Focused Ultrasound ( HIFU) is a safe and effective method for the treatment of skin laxity. However, the application of high-intensity focused ultrasound energy on eyelids has been associated with potential ocular complications including traumatic cataract, iridocyclitis, and conjunctival hemorrhage, among others. CASE PRESENTATION: A 40-year-old female developed blurred vision in her left eye after receiving HIFU treatment on binocular eyelids, and her left far vision was 20/66. The examination revealed left eye iris depigmentation and conjunctival hemorrhage. Both eyes exhibited multiple white streaking or tadpole-shaped opacities in the lenses. CONCLUSION: Excessive ultrasonic energy generated by HIFU can cause protein denaturation, leading to conditions such as traumatic cataract, visual impairment, injuries to the iris and conjunctiva when applied to the eyes. We recommend that individuals undergoing cosmetic treatment in the periorbital region should be highly aware of the possible ocular side effects.

A stepwise approach to chainsaw kickback injury of the nasoorbital complex: a case-based meta-narrative review.

PURPOSE: This article outlines the management of a rare and severe nasoorbital injury resulting from a chainsaw kickback accident in a 60-year-old male. A meta-narrative review of English, French, and German literature indexed in PubMed, Embase, and the Cochrane Library up to January 8, 2024, accompanies the case report. METHODS: This was a case report combined with a comprehensive review based on the 2011 Oxford Centre for Evidence-Based Medicine's highest and most recent level of evidence (LoE) and highest recommendation grade (RG). Rigorous selection criteria were applied. RESULTS: The patient had an open nasal fracture, complex lacerations, and avulsion of the left eyelid, lateral orbital wall and lateral rectus muscle. Staged surgical interventions comprised repositioning and fixation of the fractured nose, buccal mucosal grafting for nasal mucosa and conjunctiva repair, titanium mesh and polydioxanone sheet for lateral orbital wall reconstruction, and subsequent muscle and eyelid repair. The second intervention 3 months postsurgery addressed lateral ectropion, nasal dorsal hump, and nasolacrimal system issues. Despite the rarity of such injuries, evidence-based discussions were conducted. CONCLUSIONS: Complex nasoorbital trauma resulting from chainsaw kickback necessitates a meticulous, staged surgical approach. The inside-out technique proved effective in addressing various challenges. This article concludes with evidence-based recommendations, highlighting the importance of adapting established principles to unique nature of these injuries.

Burn-Induced Cicatricial Eyelid Retraction: A Challenging Case and Review of Management Principles.

Thermal and chemical burns can result in cicatricial eyelid retraction, characterized by an abnormal resting position of the eyelid margin and increased palpebral fissure height. Eyelid retraction often leads to exposure keratopathy, which can cause complications ranging from mild dry eye to globe-threatening ulceration and perforation. Prompt intervention includes aggressive lubrication, moisture chambers, eyelid tarsorrhaphy, and retraction repair surgery. Discussed here is a burn patient that developed severe cicatricial eyelid retraction and ectropion, leading to severe exposure keratopathy and infectious corneal ulceration with perforation. The patient required aggressive medical intervention, as well as 2 surgeries to restore the normal eyelid anatomy to protect the globe.

Oculoplastic Management of an Eyelid Zipper Injury.

We present a case of a zipper injury to an upper eyelid in a pediatric patient. The zipper was successfully removed in the operating room by using a double-action bone cutter to cut the median footplate of the zipper and release the entrapped tissue. Zipper injuries are well-described in urology literature, however, limited case reports exist in ophthalmology literature. We review several methods for zipper removal and present special considerations for eyelid injuries.

Dog Bite Injury: Rusk Became a Risk - A Case Report.

BACKGROUND: Dog bites are a worldwide problem that disproportionately affects children. It might be difficult to keep in mind that even a man's closest buddy can be dangerous to people. In light of the significant morbidity and mortality associated with dog bites, we report, herein, an intriguing case in which a two-year-old boy appeared with eyelid facial lacerations as a result of a dog bite. CASE PRESENTATION: A two-year-old boy presented with bleeding around the right and left eyes. Local examination of the eyes revealed laceration and disfiguration of the left orbit and abrasion around the right eye. Preoperatively, parenteral antibiotics were started and continued postoperatively. Dressing was done for the right eye. Lid reconstruction surgery for the left eye was scheduled and it was carried out under general anaesthesia. The child was monitored for a month and showed satisfactory wound healing with no visible scars or complications. DISCUSSION: The standard treatment for bites is direct suture, grafting, or local flaps, depending on the type of wound and the surgeon's preference, regardless of the time since the attack. Crush wounds are difficult to treat because the damage to the tissues is often so profound that amputation is unavoidable. CONCLUSION: The global injuries caused by dog bites are the consequence of uncommon illnesses and often manifest as peri-orbital and ocular lesions. Most rabies cases occur in underserved rural and urban areas, with a high frequency of stray dogs without immunisation.

Entrecruzamiento del orbicular para el entropión senil mediante técnica de Martínez-Rodríguez modificada / Orbicularis Crosslinking for Senile Entropion Using the Modified Martinez-Rodríguez Technique

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)

Ocular Complications of Facial Burns in the Pediatric Population.

Pediatric ocular burns carry a risk of permanent vision impairment. This study identifies risk factors that place these patients at high risk of permanent visual complications. A retrospective review was conducted in our academic urban pediatric burn center. All 300 patients under 18 years of age admitted from January 2010 to December 2020 with periorbital or ocular thermal injuries were included. Variables analyzed included patient demographics, burn characteristics, ophthalmology consultation, ocular exam findings, follow up time period, and early and late ocular complications. Etiologies of burn injuries were as follows: 112 (37.5%) scald, 80 (26.8%) flame, 35 (11.7%) contact, 31 (10.4%) chemical, 28 (9.4%) grease, and 13 (4.3%) friction. Overall, 207 (70.9%) patients with ocular burns received an ophthalmology consult. Of these patients, 61.5% had periorbital cutaneous burns and 39.8% had corneal injuries, and only 61 (29.5%) presented for a follow-up visit. Ultimately, six had serious ocular sequelae, including ectropion, entropion, symblepharon, and corneal decompensation. While thermal burns involving the ocular surface and eyelid margins are relatively infrequent overall, they carry a small risk of serious to long-term sequelae. Recognizing those at greatest risk, and initiating appropriate early intervention is critical.

Bicanalicular-nasal silicone stent for deep canalicular laceration management.

We evaluated the efficacy and clinical outcomes of bicanalicular-nasal silicone stents for deep canalicular lacerations and their anatomical restoration advantages. This retrospective case series study included patients with deep canalicular lacerations who underwent bicanalicular-nasal silicone stent intubation between January 2010 and June 2021 at a Chinese tertiary hospital and two primary hospitals. Intra- and post-operative complications were recorded. Anatomical, functional, and cosmetic outcomes were evaluated as anatomical restoration assessments at the last follow-up. We defined anatomical success as a free passage with no reflux during irrigation. Functional success was evaluated using the Munk epiphora scale and fluorescein dye disappearance test. Cosmetic outcomes were evaluated by examining the eyelid, lacrimal punctum, and medial canthus for any structural abnormalities and recorded objectively using a grading scale. We evaluated 92 eyes of 92 patients (63 men and 29 women); the mean distance from the lateral lacerated end to the punctum was 7.74 mm (range 7-10 mm). Bicanalicular-nasal silicone stents were successfully used in all 92 eyes with no severe intra- or post-operative complications noted. The stent placement duration ranged from 12 to 16 weeks (mean, 13.18 weeks). The follow-up period after stent removal ranged from 3 to 12 months (mean, 6.04 months). The anatomical and functional restoration success rates were 96.74% (89/92) and 100% (92/92), respectively. Satisfactory eyelid position realignment was achieved in all patients. Bicanalicular-nasal silicone stent placement sufficiently relieved orbicularis muscle tension during deep canalicular laceration repair, providing good functional results and excellent cosmetic realignment and anatomical restoration of the eyelid.

The Orbital Bones Protect the Globe From Sharp Periorbital Trauma Injuries.

BACKGROUND: The bones of the orbit hold the globe and periocular structures and protect it and other periocular contents. This has been shown in blowout orbital fractures, as well as in high-energy injuries to the periorbital region. However, there is little information regarding how the orbital bones protect the globe after periorbital trauma from sharp objects. OBJECTIVES: This study reports 4 cases of traumatic injury from sharp objects to the periorbital area and eyelids to demonstrate the protective features of the orbital bones. RESULTS: The anatomy of the periorbital bones clearly protected the globe from direct trauma in all the 4 cases. CONCLUSIONS: There was no harm to the orbit or visual impairment after the successful treatment with definitive surgery.

Long-term outcomes of a new anatomy-based method for finding the medial cut end during late canalicular repair.

BACKGROUND: Locating the medial cut end during late repair of canalicular lacerations can be challenging. OBJECTIVE: The aim of this study was to evaluate the effectiveness and long-term outcomes of a new anatomy-based method for solving the problem of locating the medial cut end. METHODS: This retrospective interventional study included 85 eyes of 85 consecutive adult patients with unilateral inferior canalicular lacerations who underwent late primary (≥2 days after injury) or secondary (≥6 months after initial treatment) surgery. Before surgery, the lacerations were classified as lateral, central, or medial according to the 'distance from the punctum to the distal end' of the lacerated inferior canaliculus. The time spent to locate the proximal lacerated end (TSL) was recorded. All patients were followed up for ≥1 year to evaluate the lacrimal passage patency and the distance between the superior and inferior punctum (DBSIP, to assess cosmesis). RESULTS: There were 16 (18.82%) lateral-type, 55 (64.71%) central-type, and 14 (16.47%) medial-type canalicular lacerations. The TSL was 3.48 ± 1.05 (range 0.9-6.8) min for all patients and differed significantly among the three types of canalicular lacerations (P < 0.001). Lacrimal irrigation showed patent lacrimal passages in 69 patients (81.18%) at 3 months and a further 4 patients (4.71%) at 6 months, residual stenosis without obstruction in 5 patients (5.88%), and obstruction in 7 patients (8.24%). The postoperative DBSIP on the affected side was shorter than the preoperative DBSIP (2.66 ± 0.66 vs. 3.09 ± 1.72 mm, P = 0.006) and comparable to that on the unaffected side (2.78 ± 0.40 mm). CONCLUSION: Our new anatomy-based method is efficient and achieves good long-term outcomes for all types of late canalicular repair.

Canalicular laceration repair with a novel bicanalicular silicone tube.

PURPOSE: This study aimed to investigate the efficacy and safety of canalicular laceration repair using a novel bicanalicular silicone tube. METHODS: Retrospective and consecutive patients who underwent canalicular laceration repair using novel Runshi-RS bicanalicular silicone stents from January 2020 to February 2021 were included. The stent was placed for 3 months, and patients were followed up for more than 3 months after extubation. Demographics, causes of eyelid injuries, placement time and position of stent, and surgical outcomes at follow-up were recorded. Anatomical success was evaluated by diagnostic probing and irrigation of lacrimal passage, while functional success was evaluated by the patient's subjective symptoms of epiphora. RESULTS: This study included 43 patients with canalicular laceration. The median age was 43 years (3-75 years). The average duration of stent implantation was 12.9 weeks, and the follow-up time was 8.8 months. No complications were observed in any patients during operation and follow-up. After extubation, irrigation of the lacrimal passage in 43 eyes showed no obstruction, and the anatomical success rate was 100%. Overall, 39 patients (90.7%) had no subjective symptoms of epiphora. All patients got good cosmetic results. Furthermore, subgroup classification showed deep laceration group (distance from laceration to punctum>5 mm) accounted for 51.2%, and the functional success rate of the deep laceration group was lower than that of the shallow laceration group. CONCLUSION: Runshi-RS bicanalicular silicone stent achieved good anatomical (100%) as well as functional (90.7%) success and good cosmetic results (100%) in patients with canalicular laceration repair.

Clinical Efficacy, Healing Efficacy, and Safety Analysis of Skin Orbicularis Oculi Muscle Combined with Tissue Flap for Eyelid Trauma.

This study investigates the efficacy, healing efficiency, and safety of skin orbicularis oculi muscle combined with tissue flap repair for eyelid trauma patients. According to the different methods of surgical intervention, this study chooses 78 cases of eyelid injury patients. This study sets up the joint intervention group and the routine repair group, including the joint intervention group adopting the orbicularis oculi muscle skin of composite tissue flap to repair surgery. The routine repair group is treated by conventional repair skin flap transfer operation. Spearman correlation coefficient is used to analyze the correlation between postoperative healing of eyelid trauma patients and quality of life (SF-36) and self-image satisfaction (BIS) scale scores. The surgical intervention of skin orbicularis oculi muscle combined with tissue flap for patients with eyelid trauma has a better plastic repair effect in clinical practice. It can also effectively reduce the risk of postoperative complications, which is conducive to improve the postoperative quality of life and self-image satisfaction of patients.

Blefaroplastia realizada con láser de CO2 versus radiocirugía en pacientes con dermatochalasis / Blepharoplasty performed with CO2 laser versus radiosurgery in patients with dermatochalasis

Objetivo: Describir los resultados de las blefaroplastias con láser de CO2 y radiocirugía realizada a pacientes con dermatochalasis del párpado superior en el Hospital "Hermanos Ameijeiras". Métodos: Se realizó un estudio descriptivo longitudinal en pacientes del servicio de Oftalmología. Después de aplicar los criterios de selección la muestra quedó conformada por los primeros 100 pacientes que asistieron de forma consecutiva y se dividieron al azar en dos grupos de 50 casos cada uno, al grupo A se le realizó blefaroplastia superior transcutánea con radiofrecuencia y al grupo B se le realizó blefaroplastia superior transcutánea con láser de CO2. Resultados: En ambos predominaron los pacientes entre los 60 a 79 años, el sexo femenino y los de color de piel blanca (p>0,05); se logró una reducción completa de la piel redundante en más de un 50 pr ciento. El tiempo quirúrgico promedio con el láser de CO2 fue de 31.5 min y con radiofrecuencia de 35,9 min. El sangrado intraoperatorio fue menor en operados con el láser de CO2. La satisfacción de los pacientes fue buena en ambos grupos. Complicaciones posoperatorias: el 16 del grupo A y el 11% del B, presentaron alguna complicación. Conclusiones: Se observó que con el uso del láser de CO2 el tiempo quirúrgico, el sangrado intraoperatorio y las complicaciones disminuyeron; con lo cual mejoró el aprovechamiento del salón. Ambas técnicas mostraron un elevado grado de satisfacción y mejoría de la estética palpebral por lo que son efectivas y seguras(AU)

Objective: To describe the results of CO2 laser blepharoplasty and radiosurgery performed in patients with upper eyelid dermatochalasis. Methods: A descriptive longitudinal study was carried out in patients of the Ophthalmology Service of the Clinical Surgical Hospital "Hermanos Ameijeiras". After applying the selection criteria, the sample consisted of the first 100 patients who attended consecutively and were randomly divided into two groups of 50 cases each. Group A underwent transcutaneous upper blepharoplasty with radiofrequency and group B underwent transcutaneous upper blepharoplasty with CO2 laser. Results: In both groups, patients between 60 and 79 years of age, female gender and white skin color predominated (p>0.05); a complete reduction of redundant skin was achieved in more than 50 percnt. The average surgical time with CO2 laser was 31.5 min and with radiofrequency 35.9 min. Intraoperative bleeding was lower in those operated with the CO2 laser. Patient satisfaction was good in both groups. Postoperative complications: 16 por ciento of group A and 11 percent of group B presented some complication. Conclusions: It was observed that with the use of CO2 laser the surgical time, intraoperative bleeding and complications decreased; thus improving room utilization. Both techniques showed a high degree of satisfaction and improvement of palpebral aesthetics, so they are effective and safe(AU)

Fishhook Injury to the Upper Eyelid: A Novel Surgical Approach.

BACKGROUND: Fishhook injuries are an uncommon trauma, and removing a penetrating fishhook is a complicated maneuver, especially if the wound involves delicate anatomical structures like the ocular region. DISCUSSION: Several techniques that have been discussed in literature are reviewed and the authors present a novel approach that has been successfully performed on a patient with a fishhook penetrating his upper eyelid after a fishing accident. CONCLUSION: Emergency physicians should be aware of all the possible approaches to fishhook penetrating injuries. If the fishhook does not involve the globe and an ophthalmologist is not available, the injury may be managed in the emergency department.

Treatment of upper eyelid third-degree burns by dispersed implantation of very small autologous columnar skin grafts: A pilot study of a new method.

OBJECTIVE: This retrospective study compared the effectiveness of dispersed implantation of very small autologous columnar skin (SCS) grafts and full-thickness skin grafts (FTSGs) for treating upper eyelid third-degree burns. METHODS: Fourteen patients and 26 eyes with granulation tissue formed by third-degree upper eyelid burns were enrolled in the study from August 2017 to June 2020. The experimental group of 6 patients with 11 eyes was treated with SCS grafts. The control group of 8 patients with 15 eyes was treated with FTSGs. The survival rate of the grafts, healing time, SCS diameter, upper eyelid movement distance (ULMD), visual analogue scale (VAS) score for patient satisfaction, and Vancouver Scar Scale (VSS) score were evaluated. RESULTS: The difference in the survival rate between the two groups was not statistically significant (P = 0.06). The ULMD and VAS scores in the experimental group were higher than those in the control group (P < 0.05). The healing time was longer in the experimental group than in the control group (P < 0.05). The VSS scores of the donor site and the skin grafting site in the experimental group were lower than those in the control group (P < 0.05). CONCLUSION: Unlike classical skin grafts, SCS implantation surgery can restore the appearance of the upper eyelid, and there is no obvious scar at the donor site. This can be a viable alternative to traditional FTSGs with potential benefits.

Tratamiento no quirúrgico, quirúrgico y reconstructivo del carcinoma basal de párpados / Non-surgical, surgical and reconstructive treatment of basal cell eyelid carcinoma

Se realizó una búsqueda sobre carcinoma basal de párpado, con el objetivo de describir el contexto actual del tratamiento quirúrgico, no quirúrgico y reconstructivo. Con el fin de eliminar el tumor con las menores secuelas funcionales y estéticas posibles, son aceptadas muchas opciones de tratamiento en el manejo actual de esta patología, que incluyen: tratamientos tópicos (imiquimod, interferones, vismodegib, sonidegib), procedimientos mínimamente invasivos (terapia fotodinámica), modalidades ablativas (curetaje, electrocauterización, criocirugía) y procedimientos altamente especializados (resección quirúrgica convencional, radioterapia o cirugía de Mohs). El tratamiento previo, el subtipo histológico, el sitio y el tamaño de la lesión deben considerarse en la planificación quirúrgica, porque se ha demostrado que afectan las tasas de curación. A partir de estos elementos, se desarrolló un algoritmo para el tratamiento del carcinoma basocelular que podría ayudar a elegir la técnica quirúrgica y los márgenes de seguridad, especialmente en lugares donde la cirugía micrográfica no está ampliamente disponible(AU)

A bibliographic search was conducted about basal eyelid carcinoma with the purpose of describing the current context of surgical, non-surgical and reconstructive treatment. Current management of this condition includes many treatment options aimed at removing the tumor with the least possible functional and esthetic sequels. Among them are the following: topical medication (imiquimod, interferons, vismodegib, sonidegib), minimally invasive procedures (photodynamic therapy), ablative therapy (curettage, electrocauterization, cryosurgery) and highly specialized procedures (conventional surgical resection, radiotherapy or Mohs surgery). Surgical planning should consider the previous treatment, the histological subtype, and the site and size of the lesion. These factors have been shown to affect cure rates. Based on these elements, an algorithm was developed for the treatment of basal cell carcinoma which may be useful in selecting the surgical technique and safety margins, particularly in settings where micrographic surgery is not widely available(AU)

Diseases of the Eyelids and Orbit.

The eyelids and orbit encompass intricate bony and soft tissue structures that work harmoniously in concert to protect, support, and nourish the eye in order to facilitate and maintain its function. Insult to periorbital and orbital anatomy can compromise orbital and ocular homeostasis. This article provides a foundational overview of eyelid and orbital anatomy, as well as common and key disorders that may confront internists and medical subspecialists.

Periorbital Soft Tissue Trauma.

Eyelid trauma occurs across a broad spectrum of pathology, ranging from simple periorbital lacerations to severe, vision-threatening injuries requiring expert oculoplastic consultation. Any injury, no matter how benign, is also inherently cosmetically sensitive, further adding to the reconstructive challenge. In this review, we discuss the anatomy of the eyelid and develop an understanding of evaluating for signs of more serious, potentially occult, trauma. A framework is developed for approaching the patient with periorbital trauma to assess for injury and triage necessary treatments. Damage to the lacrimal drainage system, which can be particularly difficult to detect and repair, is specifically emphasized and explored.

Accuracy of periocular lesion assessment using telemedicine.

OBJECTIVES: To assess the agreement in diagnosis and management plans reached between clinicians reviewing eyelid lesions remotely and in face-to-face clinics. METHODS: In this single-centre observational case series, data were prospectively collected on 50 consecutive adults referred with eyelid lesions suitable to be seen by a nurse. A proforma was completed to gather salient information. A nurse specialist saw patients in face-to-face clinics and collected information using the proforma, devising a diagnosis and management plan. Photographs of the eyelid lesions were taken by a medical photographer. A subsequent remote review was completed by an oculoplastic consultant using the proforma information and photographs in the absence of the patient. The diagnosis and management plan constructed by the nurse specialist were compared with those reached by the consultant. RESULTS: Complete data were available for 44 consecutive cases. There was an overall 91% agreement (40 cases out of 44) between the diagnoses reached by the nurse specialist, and the remote reviewer; kappa coefficient 0.88 (95% CI 0.76 to 0.99). There was an overall 82% agreement (36 out of 44 cases) in the management plans devised by the nurse-led clinic and remote reviewer; kappa coefficient 0.74 (95% CI 0.58 to 0.90). The average time taken for a remote reviewer to reach a diagnosis and management plan was 1 min and 20 s. CONCLUSIONS: This study evaluated the feasibility of assessing eyelid lesions using asynchronous telemedicine. There was overall a high rate of concordance in the diagnosis reached, and management devised between the clinic and remote review.