Auricular Cartilage Graft for Lengthening Levator Muscle Aponeurosis With Ectropion Correction for Paralytic Lagophthalmos.

BACKGROUND: Paralytic lagophthalmos can have devastating consequences for vision if left untreated. Several surgical techniques have been described, including the utilization of alloplastic and autologous materials. OBJECTIVES: The authors sought to evaluate the effectiveness of the surgical treatment of paralytic lagophthalmos with combined techniques employing autologous material and involving the upper and lower eyelids. METHODS: Patients with paralytic lagophthalmos underwent stretching of the levator aponeurosis with interposition of conchal cartilage in the upper eyelid associated with sectioning of the orbitomalar ligament and lateral canthoplasty in the lower eyelid. The effectiveness of the technique was evaluated employing subjective (symptomatology) and objective parameters (ophthalmologic evaluation and measurements of lagophthalmos and marginal reflex distances 1 and 2). RESULTS: Eight patients with paralytic lagophthalmos were subjected to the proposed technique. In the postoperative period, 85.7% reported complete improvement of symptoms and 62.5% presented a normal eye examination. The mean lagophthalmos measurement was reduced by 5.93 mm, the mean marginal reflex distance 2 was reduced by 2.61 mm, and the mean marginal reflex distance 1 was reduced by 0.69 mm. CONCLUSIONS: The technique presented herein, employing autologous material associated with sectioning of the orbitomalar ligament and lateral canthoplasty, was effective in the treatment of paralytic lagophthalmos and did not present significant complications, such as extrusion.

Intralesional Tetracycline Injection, Pinch Technique, and Canthopexy for the Treatment of Severe Festoons: Preliminary Results.

BACKGROUND: Many techniques have been presented for the treatment of lower eyelid festoons, but no singular technique has become dominant. OBJECTIVES: The authors describe the safety and efficacy of intralesional tetracycline injection, the pinch technique, and canthopexy for the treatment of severe festoons. METHODS: Institutional board review approval was obtained, and a retrospective chart review was performed on 15 consecutive patients who had received 2% tetracycline injections to treat lower eyelid large festoons between February 2017 and February 2020. Three months after the last injection, a series of patients underwent the surgical procedure: pinch technique and canthopexy bilaterally. RESULTS: Clinical and photographic records were reviewed, and 12 patients were included in the analysis. Three patients did not return for follow-up after the injection series. Of the 12 patients, there were 3 male patients and 9 female patients, with an average age of 66.6 years. The mean volume injected in each festoon was 0.43 mL, and the mean follow-up was 313 days. A series of injections with a 3-month time interval were performed for patients with a partial response to the initial injection. There was no evidence of complications at the site of the injection. Three months after the last injection, these 12 patients underwent complementary surgical treatment, which included pinch resection and canthopexy. CONCLUSIONS: These preliminary results suggest that intralesional injections of tetracycline 2% may offer a safe option to treat lower eyelid festoons. This noninvasive procedure represents adjunct benefits to complementary surgical therapy.

Lateral Canthal Clefts of the Eyelid.

PURPOSE: Facial clefts are congenital anomalies classified by Tessier based on their anatomical position. Tessier 8 craniofacial clefts extend from the lateral canthus to the temporal region, including bone cleft at the frontozygomatic suture, and it is characterized by the interposition of a strip of skin at the lateral canthus that disrupts the continuity of the orbicularis muscle, preventing its normal functioning. METHODS: This is a retrospective study of 6 patients with congenital eyelid coloboma, of whom 5 underwent surgery for the removal of dermolipoma and reconstruction of the lateral canthus. After surgery, the shape and symmetry of the lid fissure was restored, and motility was maintained. Vertical and horizontal measurements of the palpebral fissure were carried out before and after surgery. RESULTS: Five cases of lateral colobomas were evaluated after surgical treatment up to a year post operatively. The surgical correction with limited resection of the tumor was very effective, and the resulting small horizontal scar almost disappeared over time. In all cases, motility was maintained, and there were no cases of symblepharon. After surgery, there was improvement in the shape and symmetry of the eyelid fissures. CONCLUSIONS: Tessier' Number 8 facial cleft coloboma is characterized by the interposition of a skin strip, constituting a dermolipoma between the upper and lower eyelids that disrupts the continuity of the orbicularis muscle, and lateral bone alteration. The surgical correction of dermolipoma should be performed conservatively with limited resection of the tumor. A simple canthoplasty was very effective, and the small scar practically disappears over time. The absences of bone alteration in the cases presented suggest a unusual variation of lateral canthal cleft.

Adverse Events Following Immunization in Brazil: Age of Child and Vaccine-Associated Risk Analysis Using Logistic Regression.

Objective: Vaccines are effective in controlling and eradicating infectious diseases. However, adverse events following immunization (AEFI) can occur in susceptible individuals. The objective of this study was to analyze the Brazilian AEFI database and compare eight vaccines in order to profile risks of AEFIs related to the mandated pediatric schedule of immunization, considering the age and sex of the child, type of vaccine, and reported adverse events. Methods: We analyzed the Brazilian AEFI database integrating reports between 2005 and 2010 for children less than 10-years old immunized with eight mandated vaccines: diphtheria, pertussis, tetanus, Haemophilus influenzae type b (TETRA); diphtheria, tetanus, and pertussis (DTP); Bacillus Calmette⁻Guerin (BCG); oral poliovirus vaccine (OPV); measles, mumps, and rubella (MMR); oral rotavirus vaccine (ORV); hepatitis B (HB); and yellow fever (YF). We compared the children's age regarding types of AEFI, evaluated AEFI factors associated with the chance of hospitalization of the child, and estimated the chance of notification of an AEFI as a function of the type of vaccine. In total, 47,105 AEFIs were observed for the mandated vaccines. Results: The highest AEFI rate was for the TETRA vaccine and the lowest was for the OPV vaccine, with 60.1 and 2.3 events per 100,000 inoculations, respectively. The TETRA vaccine showed the highest rate of hypotonic hyporesponsive episode, followed by convulsion and fever. The MMR and YF vaccines were associated with generalized rash. BCG was associated with enlarged lymph glands but showed the largest negative (protective) association with hyporesponsive events and seizures. Compared with children aged 5⁻9-years old, young children (.

Tratamento cirúrgico do entrópio palpebral inferior involucional / Surgical treatment of involutional lower lid entropy

Introdução: O entrópio é definido como uma rotação interna da margem palpebral. O contato dos cílios e da pele palpebral com o globo ocular pode resultar em sintomas irritativos, abrasões e cicatrizes corneanas. Este trabalho tem o objetivo de apresentar a eficácia da técnica descrita por Lessa no tratamento do entrópio involucional. Métodos: Foram submetidos à correção do entrópio involucional 13 pálpebras inferiores de 11 pacientes. Utilizou-se a técnica de Lessa, em que é realizada uma incisão subciliar, descolamento subcutâneo, ressecção de faixa muscular e sutura pele-septo-pele, associada a um procedimento de suporte lateral. Resultados: Foram operados 11 pacientes (5 homens e 6 mulheres), com média de idade de 76,72 anos, (69 até 84 anos), totalizando 13 pálpebras, pois dois pacientes apresentavam a afecção bilateralmente. Em oito pacientes (9 pálpebras) usou-se a suspensão muscular. Em um paciente, a suspensão tarsal, e em dois (três pálpebras) o retalho tarsal. O tempo cirúrgico médio (por pálpebra) dos pacientes submetidos à suspensão muscular foi de 36,55 minutos, enquanto nos submetidos à cantoplastia foi de 56 minutos. Nenhum paciente apresentou recidiva e um paciente apresentou ectrópio. Conclusão: A técnica descrita por Lessa mostrou-se eficaz, pois não houve nenhum caso de recidiva.

Introduction: Entropion is defined as an internal rotation of the eyelid margin. The contact of the eyelid skin and eyelashes with the eye may result in irritating symptoms, corneal abrasions, and scars. The purpose of this study is to present the effectiveness of the technique described by Lessa in the treatment of involutional entropion. Methods: We underwent correction of involutional entropion on 13 lower eyelids. We used the Lessa technique, in which a subciliary incision was made, a skin flap was dissected from the orbicularis oculi, a muscle strip was resected, and a skinseptum- skin suture was made. The procedure was associated with lateral support. Results: There were 11 patients (5 men and 6 women) with a mean age of 76.72 years (69 to 84 years), totaling 13 eyelids, as two patients had bilateral pathology. Eight patients (9 eyelids) used muscular suspension technique. In one patient, the tarsal suspension was performed, and in two patients (three eyelids), we used the tarsal flap. The mean operative time (for eyelid) of patients undergoing muscle suspension was 36.55 min, while that in patient undergoing canthoplasty was 56 min. No patient had recurrence, and one patient developed ectropion. Conclusion: The technique described by Lessa proved to be effective since there was no recurrence.

[Individual versus collective protection: bioethical analysis of the national program of mass child vaccination]. / Proteção individual versus proteção coletiva: análise bioética do programa nacional de vacinação infantil em massa.

Vaccination is considered one of the most efficient and cost-effective public health policies most used in the control and prevention of disease. However, it is also one of the most polemic and controversial biomedical techniques, making it difficult to avoid an ethical dilemma, especially when vaccination is compulsory for the entire population. Indeed, since vaccines are not totally effective and safe, there is an ethical conflict between the individual and the collective interest, because children effectively carry the burden of vaccination for the benefit of public health when they are affected with serious adverse reactions and do not benefit from the care that should be offered by the government. The objective of this article was to demonstrate that the tools of bioethics are relevant in this discussion to understand and analyze these dilemmas critically by providing convincing arguments to underpin the development of biopolitics that consider prevention not only rigorously, but also the joint responsibility of all as fundamental for individual and collective protection.

Bilateral lid/brow elevation procedure for severe ptosis in Kearns-Sayre syndrome, a mitochondrial cytopathy.

BACKGROUND: The purpose of this work was to determine the effectiveness and possible complications encountered with bilateral fascia lata lid suspension used to correct blepharoptosis in patients with Kearns-Sayre syndrome. METHODS: This was a retrospective study of seven patients with Kearns-Sayre syndrome who had a minimum of 1 year of follow-up. A bilateral fascia lata sling was used to correct the ptosis. Preoperative and postoperative measurements of the vertical lid fissure width (VFW) and marginal reflex distance (MRD) were performed. The Student's t-test was used to analyze the results. RESULTS: The mean preoperative VFW and MRD measurements were 4±2.45 mm and 0.14±0.92 mm, respectively. The mean postoperative VFW and MRD measurements were 7.71±1.85 mm, and 2.86±1.69 mm, respectively. All preoperative and postoperative values were considered to be statistically significant (P<0.01). Adequate elevation of the lids was obtained in all patients, both functionally and aesthetically. All of the patients showed a mild symmetric postoperative inferior version lagophthalmos, and one patient developed corneal ulceration and scarring due to corneal exposure and a weak Bell's phenomenon. CONCLUSION: The surgical technique described to correct the blepharoptosis found in patients with Kearns-Sayre syndrome was found to be efficient and relatively safe. The correction should be conservative to decrease the risk of postoperative corneal damage that occurred in one patient.

Proteção individual versus proteção coletiva: análise bioética do programa nacional de vacinação infantil em massa / Individual versus collective protection: bioethical analysis of the national program of mass child vaccination

A vacinação é considerada como uma das políticas de saúde pública mais efetivas e de menor custo-benefício, utilizada no controle e na prevenção de doenças. Mas é também considerada uma das técnicas biomédicas mais polêmicas e controversas, o que torna difícil evitar uma abordagem ética, principalmente quando a vacinação é utilizada de forma compulsória em toda a população. Com efeito, visto que as vacinas não são totalmente seguras e eficazes, há um conflito ético entre o interesse individual e o coletivo, pois as crianças carregam de fato o ônus da vacinação em benefício da saúde pública quando são acometidas com reações adversas graves e que ficam alheias aos cuidados que deveriam ser oferecidos pelo Poder Público. O objetivo deste artigo foi demonstrar que as ferramentas da bioética são relevantes nesta discussão para analisar e compreender criticamente estes conflitos, fornecendo argumentos cogentes para orientar a elaboração de biopolíticas que considerem não apenas, com rigor, a prevenção, mas, também, a responsabilidade solidária de todos como fundamento para uma proteção que seja tanto individual como coletiva.

Vaccination is considered one of the most efficient and cost-effective public health policies most used in the control and prevention of disease. However, it is also one of the most polemic and controversial biomedical techniques, making it difficult to avoid an ethical dilemma, especially when vaccination is compulsory for the entire population. Indeed, since vaccines are not totally effective and safe, there is an ethical conflict between the individual and the collective interest, because children effectively carry the burden of vaccination for the benefit of public health when they are affected with serious adverse reactions and do not benefit from the care that should be offered by the government. The objective of this article was to demonstrate that the tools of bioethics are relevant in this discussion to understand and analyze these dilemmas critically by providing convincing arguments to underpin the development of biopolitics that consider prevention not only rigorously, but also the joint responsibility of all as fundamental for individual and collective protection.

Bioética e vacinação infantil em massa / Bioethics and mass childhood vaccination

As vacinas são consideradas como uma das maiores conquistas da humanidade no controle e erradicação de doenças infectocontagiosas e também uma das técnicas biomédicas mais polêmicas e de maior controvérsia considerando os riscos de efeitos adversos e a sua forma compulsória de utilização em milhões de crianças saudáveis. O atual paradigma preventivo de vacinação em massa tem sido desafiado nas últimas décadas por mudanças nas relações com a imunização, melhoria das condições sanitárias das populações e pelo surgimento de declarações universais de proteção do ser humano. Com isso, o presente artigo pretende analisar a vacinação infantil em massa sob a ótica da bioética no contexto individual e coletivo e criar um ambiente de discussão para reflexão ética sobre os programas de vacinação. Concluímos que a bioética em sua nova concepção conceitual propõe novos referenciais teóricos e metodológicos que podem ser utilizados para o debate ético das atuais políticas sanitárias.

Vaccines are considered one of the greatest achievements of mankind in the control and eradication of infectious diseases and also one of the most controversial biomedical techniques and greater controversy considering the risks of side effects and their compulsory use in millions of healthy children. The current paradigm ofpreventive mass vaccination has been challenged in recent decades by changes in relationships with immunization, improvement of sanitary condition of populations and the emergence of universal declarations forhuman protection. Thus, the present work aims to analyze the mass childhood vaccination from the perspective of bioethics in the individual and collective context and create an environment for discussion of ethicalreflection on vaccination programs. We conclude that de new bioethics’ approach proposes a new theoreticaland methodological framework that can be used for the ethical debate of current health policies.

Two-stage reconstruction for eyelid deformities in partial cryptophthalmos.

PURPOSE: Cryptophthalmos was first described in 1872 as a rare syndrome consisting of congenital upper eyelid and eyebrow coloboma and a rudimentary ocular bulb. Later, Fraser described it as being part of a complex syndrome with multiple anomalies. Many cases have been described since then, but very few surgical techniques have been proposed for its correction. In this paper, the authors present a surgical procedure for correction of the upper eyelid and ocular bulb anomalies in cryptophthalmos. METHODS: Five patients with Fraser syndrome were seen from 1993 to 2008. They were in the age group of 18 months to 24 years. Of these, 4 patients underwent reconstruction of the upper eyelid. RESULTS: The large upper eyelid coloboma and the cutaneous pterygium were treated with a 2-stage procedure, with good results obtained with the adoption of Mustardé's technique. CONCLUSIONS: The complexity of the surgical treatment increases when there is no possibility of rudimentary eye bulb preservation. In upper eyelid reconstruction, the authors adopted Mustardé's technique with fixation of the lower eyelid transposed flap to the levator muscle, leading this way to relatively good upper eyelid motility. The authors consider imperative that the upper fornix be reconstructed with adequate depth to allow perfect positioning of an aesthetic prosthesis, in this way improving the final aesthetic and functional results.

A one-stage correction of the blepharophimosis syndrome using a standard combination of surgical techniques.

BACKGROUND: The aim of this study was to evaluate the efficacy of a one-stage treatment for the blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) using a combination of standard surgical techniques. METHODS: This is a retrospective interventional case series study of 21 BPES patients with a 1-year minimum follow-up period. The one-stage intervention combined three different surgical procedures in the following order: Z-epicanthoplasty for the epicanthus, transnasal wiring of the medial canthal ligaments for the telecanthus, and a bilateral fascia lata sling for ptosis correction. Preoperative and postoperative measurements of the horizontal lid fissure length (HFL), vertical lid fissure width (VFW), nasal intercanthal distance (ICD), and the ratio between the intercanthal distance and the horizontal fissure length (ICD/HFL) were analyzed using Student's t test for paired variables. RESULTS: The mean preoperative measurements were 4.95 ± 1.13 mm for the VFW, 20.90 ± 2.14 mm for the HFL, 42.45 ± 2.19 mm for the ICD, and 2.04 ± 0.14 mm for the ICD/HFL ratio. The mean postoperative measurements were 7.93 ± 1.02 mm for the VFW, 26.36 ± 1.40 mm for the HFL, 32.07 ± 1.96 mm for the ICD, and 1.23 ± 0.09 mm for the ICD/HFL ratio. All these values and their differences were statistically significant (P < 0.0001). All of the patients developed symmetric postoperative inferior version lagophthalmus, a complication that tended to decrease over time. CONCLUSION: One-stage correction of BPES is safe and efficient with the surgical techniques described.

Simple canthopexy used in transconjunctival blepharoplasty.

PURPOSE: To describe a canthopexy technique without canthotomy that avoids release of the lateral canthal tendon for treatment of moderate lower eyelid laxity. METHODS: A total of 316 patients underwent canthoplasty-blepharoplasty between December 1996 and November 2007. None of the patients had previously undergone any aesthetic surgical procedure. All cases showed moderate laxity of the inferior eyelid, and in 22 cases (7%), there was antimongoloid obliquity of several degrees. The lateral canthal ligament was attached to the periosteum of the orbital rim with nonabsorbable suturing material through the upper blepharoplasty wound. This technique follows the principle of canthopexy without canthotomy, avoiding the dissection of a submuscular tunnel and the release of the lateral canthal tendon. RESULTS: Lower eyelid laxity was corrected in all cases. During the first 2 weeks, a greater tension of the lower eyelid and a slight upward slanting of the lateral canthus were observed. During this period, palpebral movement was slightly limited. In the third week after surgery, eyelid shape and canthal positioning had become completely normal. CONCLUSIONS: The technique described in this report greatly reduced surgical time and drastically lowered morbidity. It may be used in moderate lower eyelid laxity correction and in correction of moderate alterations of antimongoloid obliquity.

A utilização da anestesia peribulbar inferior nas blefaroplastias / The inferior peribulbar anesthesia for blepharoplasties

Introdução: A anestesia peribulbar para blefaroplastias inferiores foi utilizada com sucessoem pacientes selecionados nos últimos 9 anos. Esta técnica é amplamente utilizada nosprocedimentos oftalmológicos, porém ainda não havia sido especificamente indicada paraas blefaroplastias. Métodos: Foram submetidos a blefaroplastias com bloqueio peribulbarinferior 788 pacientes com idade variando entre 36 e 77 anos, 623 (79%) eram mulheres e165 (21%) homens. Resultados: Nenhum dos pacientes tratados queixou-se de dor ou desconfortodurante ou após a cirurgia. Quemose imediata (17 casos - 2,2%) após a anestesiaperibulbar inferior, hematoma orbital (3 casos - 0,4%) e diplopia foram as complicaçõesobservadas. Conclusões: A anestesia peribulbar inferior para as blefaroplastias ofereceresultados surpreendentes. As cirurgias são realizadas de forma indolor, permitindo aos pacientesum estado de relaxamento completo, proporcionando ao cirurgião um procedimentode realização mais simples e confortável.

Background: The peribulbar anesthesia for inferior blepharoplasties was employed successfullyin selected patients over the last 9 years. This technique is largely accepted forophthalmologic procedures but yet not specifically employed for blepharoplasties. Methods:788 patients with ages ranging from 36 to 77 years old were submitted to inferior peribulbaranesthesia for blepharoplasty procedures, 623 (79%) were female and 165 (21%) were male.Results: None of our treated patients complained of pain or discomfort during or after thesurgical procedure. Immediate chemosis after inferior peribulbar anesthesia was observed in17 (2.2%) cases, orbital hematoma was observed in 3 cases (0.4%) and diplopya or a slightimaging distortion may occur after inferior peribulbar anesthesia, lasting a few hours. Conclusions:The inferior peribulbar anesthesia for blepharoplasties offers surprising results.The surgical procedures are performed pain-free, leaving the patients completely relaxed,allowing an easier surgical procedure.

Treatment of paralytic lagophthalmos with gold weight implants covered by levator aponeurosis.

PURPOSE: To describe a technique to treat paralytic lagophthalmos and exposure keratitis with gold weight implants covered by levator aponeurosis. METHODS: The authors studied a case series of 29 patients who underwent surgical treatment for paralytic lagophthalmos using the technique of gold weight implantation covered by the aponeurosis of the levator palpebrae superioris muscle between June 1997 and December 2006. None had undergone previous surgical treatment. RESULTS: All patients sustained their implants; there were no cases of extrusion, dislocation, or infection. Patients had significant improvement of symptoms, especially exposure keratopathy, with lagophthalmos dimensions decreased from 4 to 5 mm preoperatively to 0.5 mm after surgery. CONCLUSIONS: Excellent results were obtained by recessing the levator palpebrae superioris muscle aponeurosis with relaxing incisions and advancing it to overly the gold weight implant completely. Visibility of the implant in the pretarsal upper eyelid surface was minimized, extrusion was avoided, and good eyelid position was obtained.

Tratamento do lagoftalmo paralítico com a utilização do implante de peso de ouro recoberto pela aponeurose do músculo levantador palpebral / Paralytic lagophthalmos treatment with gold weight implants covered by levator palpebrae muscle aponeurosis

OBJETIVO: Demonstrar a redução das complicações e melhora do resultado estético da correção do lagoftalmo paralítico com utilização de implantes de peso ouro através do recobrimento pela aponeurose do músculo levantador palpebral. MÉTODOS:Foram estudados vinte e nove pacientes portadores de paralisia facial idiopática com evolução clínica superior a 4 anos submetidos à correção cirúrgica do lagoftalmo paralítico com a utilização de uma modificação da técnica do implante de peso de ouro recoberto pela aponeurose do músculo levantador palpebral (Gladstone,1996) entre junho de 1997 e dezembro de 2006. Nenhum deles havia se submetido previamente a tratamentos cirúrgicos. RESULTADOS:Todos os pacientes apresentaram adaptação favorável dos implantes. Não houve casos de extrusão, deslocamento ou infecção, com melhora significativa da sintomatologia clínica e redução do lagoftalmo paralítico no período de acompanhamento pós-operatório que variou de 8 meses a 4 anos. CONCLUSÃO:Através da ampla dissecção da aponeurose do músculo levantador palpebral para recobrimento completo do implante do peso de ouro nós obtivemos excelentes resultados. O contorno da superfície cutânea pré-tarsal apresentou-se homogêneo, evitou-se a extrusão do implante e, comparativamente aos resultados apresentados pela técnica inicialmente descrita por Gladstone na qual realizava-se apenas a plicatura da aponeurose do músculo levantador palpebral sobre o implante de ouro, obtivemos um melhor controle do posicionamento final da pálpebra superior após o recobrimento do implante.

POURPOSE: To demonstrate an improvement in paralytic lagophthalmos surgical treatment complications and aesthetic results by covering the gold weight implants with the levator palpebrae muscle aponeurosis. METHODS:We studied a case series of twenty nine patients presenting idiopatic facial palsy with more than 4 years of clinical evolution, submitted to paralytic lagophthalmos surgical treatment using a modification of the technique of gold weight implantation covered by the aponeurosis of the levator palpebrae superioris muscle (Gladstone, 1996) between June 1997 and December 2006. None had undergone previous surgical treatment. RESULTS:All patients sustained their implants. There were no cases of extrusion, dislocation or infection, with clinical symptoms improvement and lagophthalmos reduction. CONCLUSION:By widely dissecting the levator palpebrae superioris muscle aponeurosis, exceeding it and recovering the implant completely, we obtained excellent results. The pretarsal upper eyelid surface became regular, extrusion was avoided and, comparatively to Gladstone's technique that performs an aponeurotic plication over the gold weight implant, we managed to obtain a better adjustment of the superior eyelid final positioning after implant coverage.

Utilização do implante de peso de ouro recoberto pela aponeurose do músculo levantador palpebral para tratamento do lagoftalmo paralítico / Gold weight implant covered by levator palpebrae muscle aponeurosis employment in the treatment of paralytic lagophthalmos

Introdução: O lagoftalmo e a ceratite por exposição são as complicações oftálmicas maiscomuns da paralisia facial. Tradicionalmente, as tarsorrafias mediais e laterais foram empregadasna correção do lagoftalmo paralítico, entretanto apresentando resultados desfavoráveis.Recentemente, a utilização dos implantes de peso de ouro tornou-se mais popular e ouso de materiais de revestimento para o implante para redução das complicações vem setornando crescente na literatura médica. Método: Foram estudados 29 pacientes submetidosa correção cirúrgica do lagoftalmo paralítico com a utilização da técnica do implante de pesode ouro recoberto pela aponeurose do músculo levantador palpebral. Resultados: Todos ospacientes apresentaram adaptação favorável dos implantes. Não houve casos de extrusão,deslocamento ou infecção. Os pacientes apresentaram melhora significativa dos sintomas,especialmente da ceratopatia por exposição, com redução das dimensões do lagoftalmo de4-5 mm para 0,5 mm após a cirurgia. Conclusões: Foram obtidos excelentes resultados; ocontorno da superfície cutânea pré-tarsal apresentou-se homogêneo, evitou-se a extrusão doimplante e um bom posicionamento palpebral foi obtido.

Introduction: Lagophthalmos and exposure keratitis are the most common complications offacial palsy. Inadequate eye protection may lead to corneal ulceration or even eye perforation.Recently, the use of gold weight implants has become popular and the use of implant wrappingto reduce complications has become increasingly present in medical publications. Methods: Westudied a case series of twenty nine patients submitted to paralytic lagophthalmos surgicaltreatment using the technique of gold weight implantation covered by the aponeurosis of thelevator palpebrae superioris muscle. Results: All patients sustained their implants; there wereno cases of extrusion, dislocation or infection. Patients presented significant improvement ofsymptoms, especially exposure kerathopathy, with lagophthalmos dimensions reducing from4-5 mm to 0.5 mm after surgery. Conclusions: We obtained excellent results; the pretarsal uppereyelid surface became regular, extrusion was avoided and good eyelid position was obtained.

Peribulbar anesthesia for blepharoplasty.

BACKGROUND: Peribulbar anesthesia for inferior blepharoplasty was used successfully in 788 selected cases over the past 9 years. This technique is largely accepted for ophthalmologic procedures, but is not yet specifically used for blepharoplasty. METHODS: In the past 9 years, 788 patients ages 36 to 77 years were submitted to inferior peribulbar anesthesia for blepharoplasty procedures. Of these patients, 623 (79%) were women and 165 (21%) were men. The anesthetic procedure is performed using a needle introduced at the junction of the medial two-thirds and the lateral third of the inferior orbital rim (point A). With the patient staring forward, the needle is introduced through the lid at point A. It enters the orbital cavity just above the orbital floor periosteum until the globe equator is minimally trespassed (depth, approximately 31 mm). There, 3 ml of the local anesthetic solution (2% lidocaine + 0.5% bupivacaine) is slowly injected. RESULTS: None of our treated patients reported pain or discomfort during or after the surgical procedure. Immediately after inferior peribulbar anesthesia, chemosis was observed in 17 cases (2.2%) and orbital hematoma in 3 cases (0.4%). Diplopia, or a slight imaging distortion lasting a few hours may occur after inferior peribulbar anesthesia. CONCLUSION: Inferior peribulbar anesthesia for blepharoplasty offers surprising results. The surgical procedures are performed pain free, leaving the patients completely relaxed and allowing an easier surgical procedure. This technique should be performed only by highly skilled anesthesiologists or surgeons with a perfect knowledge of the complex orbital anatomy.

A síndrome do blefarocalásio e sua diferenciação com o dermocalásio / The blepharochalasis syndrome and it´s comparison with dermochalasis

A síndrome do blefarocalásio é uma desordem incomum, que inicialmente pode se manifestar numa faixa etária mais jovem, especialmente na puberdade, sendo caracterizada por episódios recorrentes de edema peri-orbitário. Com o passar dos anos, estes episódios recorrentes levam a alterações das estruturas de suporte palpebral, determinando uma série de sinais característicos: redundância de pele palpebral, que se torna progressivamente mais fina e enrugada; pseudo-epicanto; desinserção do tendão cantal lateral; blefaroptose; atrofia de bolsas palpebrais e uma pigmentação cutânea peculiar, com tonalidade bronze. As alterações palpebrais podem ser divididas em duas fases: fase inicial (intumescente ou de edema), caracterizada por episódios recorrentes de edema palpebral e uma fase tardia (quiescente ou crônica), onde a atrofia cutânea se destaca. O tratamento cirúrgico se impõe com necessidade de reposicionamento e, muitas vezes, reconstrução palpebral. Diante dos inúmeros achados clínicos e alterações anatômicas da síndrome, torna-se imprescindível sua diferenciação com o dermocalásio – constituído por redundância cutânea palpebral que se desenvolve como parte do processo de envelhecimento facial, freqüentemente acompanhada de protusão de bolsas de gordura que resulta em pseudoptose – para o correto planejamento cirúrgico e tratamento adequado de condições distintas. A partir da avaliação de 34 pacientes, 28 dos quais submetidos ao tratamento cirúrgico, os autores caracterizam a síndrome, diferenciam-na adequadamente do dermocalásio e sugerem a conduta cirúrgica adequada para esta condição.

Estudo histológico das mudanças estruturais da pele fina palpebral após a fototermólise seletiva com laser de CO2 / Histological study of the structural changes in fine palpebral skin following selective photothermolysis with CO2 laser

O resurfacing com laser de CO2 é moderna e eficiente modalidade de tratamento das rugas faciais e envelhecimento. Baseia-se na vaporização das camadas mais superficiais da pele, com muita precisão. O objetivo era avaliar os efeitos histológicos da ação do laser de CO2 sobre a pele palpebral. Selecionados 26 pacientes, sendo 22 do sexo feminino e 4 do sexo masculino. A idade variou de 43 a 72 anos, sendo 19 deles classificados como tipo IIIe sete como tipo II, de Fitzpatrick. A pele palpebral superior foi examinada antes da operação e após a fototermólise seletiva, aos três meses, seis meses e um ano. Todas as avaliações pós-operatórias mostraram consistentes modificações histológicas epidérmicas e dérmicas, como a regeneração epidérmica evidenciando anatomia normalizada principalmente nas avaliações em torno de um ano. A derme apresenta dramática transformação de neo-colágeno na derme superficial e média, como também intensa modificação (reestruturação) do sistema de fibras elásticas e diminuição das glicominoglicans. As duas passagens do laser foram analisadas, assim como todo o processe de cicatrização. O resurfacing da pele fina palpebral, utilizando duas passagens de 300 mJ e 200mJ de energia, produz acentuada neo-formação de colágeno e correção da elastose dérmica, associada a um perfeito e rápido processo de cicatrização