Temporary Medial Upper Eyelid Lagophthalmos after External Dacryocystorhinostomy.

Background. Report of three cases of medial upper eyelid lagophthalmos as complication of external dacryocystorhinostomy. History and Signs. Shortly after dacryocystorhinostomy (skin incision on the side of the nose), three of ten consecutive patients (28 ± 4 years; mean ± standard deviation), presented with an ipsilateral lagophthalmos of 4 ± 1 mm in voluntary eyelid closure and 6 ± 1 mm in spontaneous blink. The lagophthalmos was due to a selective paresis of the medial part of the orbicularis oculi muscle of the upper eyelid. Patient 1 complained bitterly of dry eye symptoms and of her lagophthalmos. Patient 2 had mild symptoms but became very concerned after peers made her aware of her asymmetric blink. Patient 3 was asymptomatic and did not notice anything particular. Therapy and Outcome. Lagophthalmos resolved spontaneously within three months after surgery, first by improvement of voluntary eyelid closure and then of spontaneous blinking. Conclusions. Temporary lagophthalmos can occur as a complication of external dacryocystorhinostomy, most likely due to damage of the (only recently described) superficial buccal and/or zygomatic branches of the facial nerve that run upward to cross over the medial ligament and innervate the medial part of the orbicularis oculi muscle.

Excision and Redraping Skin and Orbicularis Oculi Muscle Separately during Transcutaneous Lower Eyelid Blepharoplasty.

BACKGROUND: The purpose of this study was to report a transcutaneous lower eyelid blepharoplasty procedure where different amounts of skin and orbicularis oculi muscle are excised and where skin and muscle are redraped (tightened) separately. PATIENTS AND METHODS: A retrospective non-consecutive small case-series of patients undergoing lower eyelid blepharoplasty is described. In a nutshell, during this procedure a skin flap was fashioned (caudal to the sub-ciliary pre-tarsal excess of skin to be excised), some pre-septal orbicularis oculi muscle fibers were excised (in regard of the skin flap), muscle and then skin were redraped, separately. In addition to these surgical steps conducted on each patient, when required, orbital fat prolapse was reduced, orbital retaining ligament was detached, and/or a canthopexie/plasty was performed. Assessment of surgical outcome was made by providing, for comparison, pictures taken before and after the procedure. RESULTS: No major intra- or postoperative complications were recorded and overall postoperative outcome was judged satisfactory by both surgeons and patients. CONCLUSIONS: In contrast to a conventional skin-muscle lower blepharoplasty approach where, in a block, pre-tarsal skin and muscle are excised and then pre-septal skin and muscle are redraped, the technique described in the present paper allows us to excise different amounts of skin and orbicularis muscle and to redrape them separately. Among several potential advantages, this approach preserves pre-tarsal orbicularis muscle function, allows us to apply more tension on the redraped muscle and less on the redraped skin, and avoids redraping of a relatively thick per-septal orbicularis oculi muscle over the tarsus (like it is in the case of a conventional skin-muscle technique).

Treatment of epiphora in connection with endolacrimal surgery using trephines: new and overview data.

BACKGROUND: To provide new and to summarize published data on endolacrimal surgery with Piffaretti's trephines, in particular in patients having patent lacrimal drainage system (syringing) and epiphora resistant to medical treatments. PATIENTS AND METHODS: From two tertiary referral centers (Basel/Switzerland; Belo Horizonte/Brazil), 126 patients undergoing endolacrimal surgery with Piffaretti's trephines, combined, when clinically indicated, with other procedures known to improve epiphora (canthoplasty/pexie and/or conjunctivochalasisplasty). RESULTS: I) A study (Basel) in 17 patients showed one-year after surgery marked epiphora symptoms' improvement in 88% (15/17) of patients, 65% (11/17) being symptom-free. II) Unpublished data (Belo Horizonte) in 42 patients found 81% (34/42) symptom-free six-months after surgery. Dacryoscintigraphy illustrated postoperative tears' clearance improvement. III) Unpublished data (Belo Horizonte) in 45 patients solely undergoing endolacrimal surgery for complete ductal obstruction found symptom-free, six-months after surgery, 27% (8/30) of patients with preoperatively enlarged lacrimal sac and 80% (12/15) with none-enlarged sac (p < 0.01, Fisher's test). IV) A study (Basel) in 22 epiphora patients reported no correlation (p = 0.62, rho -0.11, Spearman) between preoperative basal Schirmer's test II (oxybuprocain-HCL 0.4%) values and one-year surgical outcome. Patients with preoperative Schirmer's test's values ≤ or > 6 mm had similar mean postoperative symptoms' improvement (82 ± 30%, n = 11 vs. 76 ± 34%, n = 11, p = 0.97, Mann-Whitney). CONCLUSIONS: Endolacrimal surgery with Piffaretti's trephines, sometimes combined, when clinically indicated, with other procedures also known to ameliorate epiphora, can in particular improve (different conditions, surgeons, centers) epiphora's symptoms resistant to medical treatments in patients with patent lacrimal drainage system, and this apparently, even when pre-operative basal Schirmer-test values are low. By enlarged lacrimal sac, outcome is poor.