[Lower lid blepharoplasty]. / Blépharoplasties inférieures.

Baggy lower eyelids result from herniated orbital fat, excess skin, hypertrophic or lax orbicularis sometimes associated with lower lid laxity resulting from degeneration of the lateral canthal tendon with age. Two main approaches are used: skin-muscle flap or the transconjunctival approach in younger patients who have herniated orbital fat with minimal or not excessive lower eyelid skin. Preoperative evaluation of the patient is extremely important in lower lid blepharoplasty before any surgical procedure: excessive skin, herniated orbital fat, retraction and laxity must be evaluated. In our practice, a lateral canthoplasty is often performed in case of horizontal lower laxity in order to avoid round eye, scleral show or lower lid ectropion. In some patients, subperiosteal elevation of malar soft tissue is associated with lower blepharoplasty via subciliary incision.

[Internal transient palpebral inclusion following dacryocystorhinostomy]. / Inocclusion palpébrale interne transitoire après dacryocystorhinostomie.

The authors report two cases of postoperative lagophthalmos immediately following ab externo dacrycystorhinostomy (DCR). Two female patients, aged 67 and 62 years, underwent under general analgesia for chronic dacryocystitis with mucocele. An inferior surgical approach, sparing the inner canthal ligament was chosen in both cases. Lagophthalmos was observed on the operated side on the first postoperative day. Normal lid occlusion was present on the contralateral side. Impairement of palpebral occlusion was predominant in the nasal portion of the lid fissure. Upon voluntary and reflex blinking, a reduction in the downward movement of the superior lid was observed. This reduction was not as apparent when the patients were asked to produce a forced blink. Lagophthalmos disappeared progressively over 3 postoperative months in both cases. Neither epiphora nor any corneal complications were observed. Lagophthalmos following DCR via an inferior approach is a previously unreported complication and may be related to the disinsertion of the nasal portion of the orbicularis muscle and periosteum at the time of periosteal cleavage. Recovery of normal lid function may be due to reattachment of the periosteum.

[Transient internal palpebral inocclusion after dacryocystorhinostomy]. / Inocclusion palpébrale interne transitoire après dacryocystorhinostomie.

The authors report two cases of postoperative lagophthalmos immediately following ab externo dacryocystorhinostomy (DCR). Two female patients, aged 67 and 62 years, underwent under general analgesia for chronic dacryocystitis with mucocele. An inferior surgical approach, sparing the inner canthal ligament was chosen in both cases.

[Suppurative pseudo-lithiasic canaliculitis]. / Canaliculites suppurées pseudo-lithiasiques.

The affection is often undiagnosed at the first stage. The second stage is characterized by a chronic suppurative canaliculitis with intra-canalicular concretions involving in many cases the lower canaliculus. Our 6 cases have been treated by a posterior canaliculotomy, a microsurgical evacuation of the concretions and a lacrimal tubing. It is not a fungal infection but a bacterial disease due to Actinomyces. Surgical treatment is very effective.