Evaluation of anxiety and pain in eyelid surgery patients: a pilot study.

OBJECTIVE: A high level of preoperative anxiety may have negative consequences on the medical and psychological outcomes of a surgical intervention. The present study aims to identify the factors associated with high preoperative anxiety in eyelid surgery patients and to determine whether there is a relationship between preoperative anxiety and the pain felt during and after the procedure. DESIGN: Prospective single-centre pilot study between December 2017 and April 2018. PARTICIPANTS: Consecutive patients undergoing elective eyelid surgery. METHODS: The Amsterdam Preoperative Anxiety and Information Scale and a numeric rating scale were used to evaluate preoperative anxiety and need for information as well as peroperative and postoperative pain. RESULTS: Thirty-two patients were included. Mean age at surgery was 65.8 years. Most patients underwent lateral canthoplasty (44%) or ptosis surgery (25%), and all had local anaesthesia. Thirty-eight percent of the patients had a high level of preoperative anxiety (i.e., unsuited to the situation of the surgical stress). Factors associated with higher levels of preoperative anxiety were female sex, age under 65 years, no previous oculoplastic surgery, and unilateral surgery. Patients who felt pain during and after the procedure were found to have had higher levels of preoperative anxiety than the patients who felt no pain. CONCLUSIONS: A high level of preoperative anxiety may increase the pain felt by the patient during and after the surgical procedure. It is therefore important to implement anxiolytic measures before an eyelid surgery is performed, especially in patients who have a risk of elevated preoperative anxiety.

Management of Postblepharoplasty Lower Eyelid Retraction.

Postblepharoplasty lower eyelid retraction is challenging and multifactorial and may occur after transcutaneous lower eyelid surgery. Surgical correction is difficult and unpredictable. Patient psyche is often negatively affected. This combination of events can limit patient satisfaction, so significant preoperative counseling to educate patients and modulate expectations is critical. The combination of midface lifting, implantation of a posterior lamellar spacer graft, and canthal suspension (standard surgery) has led to variable degrees of functional and aesthetic improvement. This article reviews the typical presentation, outlines the steps of standard surgery, and touches on other modalities of treatment that may improve patient satisfaction.

Association between clinical characteristics, quality of life, and sleep quality in patients with periorbital hyperchromia.

INTRODUCTION: Periorbital hyperchromia (POH) is a multifactorial condition, precipitated or aggravated by sleep disorders, which negatively affects quality of life (QoL). The aim of this study was to evaluate the impact of POH on QoL, sleep quality, and dissatisfaction of affected patients. METHODS: In this cross-sectional study of male and female patients over 18 years, participants were examined, their demographic data were registered, and Dermatology Quality of Life Index (DLQI), Pittsburgh Sleep Quality Index (PSQI-BR), and Visual Analogue Scale (VAS) were used to assess dissatisfaction. RESULTS: Patients (n = 100) were mostly women (91%) with a mean age of 36.9 years and POH duration of 18.32 years. Phototypes II (24%) and III (60%) were predominant. A total of 33% reported 4-6 hours and 66% reported over 6 hours of sleep per night. POH was classified as mild (59%), moderate (37%), or severe (4%). Mean dissatisfaction with POH was 6.9, PSQI was 6.04, and DLQI was 4.92. There was a significant difference in the dissatisfaction scale (P < .005) between men and women. Women reported worse QoL (P < .001) and higher dissatisfaction (P < .0001). A correlation between DLQI and disease duration was found. CONCLUSION: Periorbital hyperchromia negatively impacts patients' QoL. Dissatisfaction is directly related to disease severity.

Surgical rehabilitation of paralytic lagophthalmus by platinum chain lid loading: focusing on patient benefit and health-related quality of life.

OBJECTIVE: To evaluate patient benefit and health-related quality of life after lid loading with platinum chains in adult patients with facial palsy. STUDY DESIGN: Retrospective data collection. SETTING: Germany's largest university clinic for otorhinolaryngology, head and neck surgery. SUBJECTS AND METHODS: Thirty-five patients received validated questionnaires determining the effects of the operation on the patients' health-related quality of life (Glasgow Benefit Inventory). Scores can range from -100 (maximal adverse effect), through 0 (no effect), to 100 (maximal positive effect). Furthermore, satisfaction, complaints, and complications regarding the platinum chain implant were inquired. RESULTS: Twenty-two patients (63 %) returned a valid questionnaire. The mean follow-up time was 31.5 months. A complete coverage of the cornea was achieved in 95% of the patients after the first operation and in the remaining patients after a revision with implantation of a heavier weight. Complete symmetry to the nonaffected eye was perceived by 64%. Recurrent conjunctivitis was complained preoperatively by 18% and postoperatively only by a single patient. In 2 patients, a mild pseudoptosis was found postoperatively, and a single patient complained about blurred vision. The median total Glasgow Benefit Inventory score was 27.8 (p < 0.001). The health-related quality of life was raised in 91% of the patients; 87% were fully satisfied with the functional result, and 91% with the aesthetical result. 100% would again decide in favor of platinum chain lid loading. CONCLUSION: Platinum chain lid loading in facial palsy patients can significantly increase patients' health-related quality of life and leads to a high rate of patient satisfaction.

Delusions of parasitosis of the eyelids.

The authors describe preseptal cellulitis and corneal ulceration due to secondary infection of self- inflicted wounds in a patient with delusions of parasitosis. A 42-year-old man presented with a 3-day history of progressive painful, purulent, periocular erythema. He reported that "little black bugs and whitish eggs" had infiltrated his body including the left eye and eyelids. On examination, he was agitated with superficial wounds covering the majority of his body. Ophthalmic evaluation was notable for markedly erythematous and mildly edematous eyelids resulting in complete blepharoptosis. Excoriations with yellow-brown serous crusting carpeted the periocular region. A 1-mm pericentral corneal ulcer was also noted. No objective evidence of parasites was found and his infection resolved with antibacterial therapy (intravenous ceftriaxone and vancomycin, and topical vancomycin and ceftazidime). Delusions of parasitosis may result in self-mutilation with secondary infection. Appropriate psychiatric care is needed to prevent ongoing destructive behavior.

Longitudinal study of trachomatous trichiasis in The Gambia: barriers to acceptance of surgery.

PURPOSE: Investigation of compliance with surgery for trachomatous trichiasis has become a priority of the World Health Organization. This study was conducted to investigate attitudes toward trichiasis and its treatment and to determine the rate of surgical uptake in The Gambia. METHODS: A 1-year longitudinal study was performed in 190 subjects with trichiasis. Persons with major trichiasis (involving five lashes or more) were referred for surgery, and those with minor trichiasis were advised to epilate. Outcome measures included attitudes toward trichiasis and its treatment, reported barriers to surgical uptake, acceptance rates for surgery, and factors affecting acceptance. RESULTS: Twenty-three percent (95% confidence interval [CI] 16.5%-30.6%) of subjects with major trichiasis attended for surgery during the year. Degree of ignorance about surgery, symptoms impeding work, and a multiple income source for the head of household predicted attendance. Reported lack of time predicted nonattendance. Sixty-eight percent of patients who had undergone surgery were trichiasis free at last follow-up. CONCLUSIONS: Poor attendance for surgery remains a problem in The Gambia. Barriers include ignorance and lack of time and money. Health education and surgical delivery strategies are needed to overcome these barriers. Regular audit of surgical results is necessary, with retraining where indicated.

Trichotillomania.

PURPOSE: Trichotillomania is characterized by an irresistible urge to pull one's hair, and may involve the eyelashes or eyebrows. The authors present four cases of trichotillomania, and review the management of this unusual disorder. METHODS: The cases of four patients with trichotillomania were reviewed retrospectively. RESULTS: All four patients had characteristic areas of broken lashes along the lid in the absence of other signs of disease. Three of the four knew they were plucking the hair, yet could not control it. In the fourth, it was only after a lengthy observation period that she was discovered plucking. CONCLUSIONS: Trichotillomania has been infrequently reported in the ophthalmic literature. Management can be difficult. Many of these patients are aware of their behavior, but are unable to curtail it. Others may conceal or deny their habit. Psychiatric counseling may be of some benefit if patients are willing to undergo it.

Trichotillomania: ophthalmic presentation.

PURPOSE: A case of trichotillomania, or compulsive hair-pulling, involving the eyelids is presented to alert ophthalmologists to this common, but frequently overlooked cause of eyelash and eyebrow alopecia. METHODS AND RESULTS: Clinical records of a 33-year-old woman suffering from trichotillomania were reviewed. Compulsive hair-pulling began in childhood and had become chronic. Psychiatric intervention was unsuccessful. CONCLUSIONS: The diagnosis of trichotillomania is made on history and slit-lamp examination findings. A skin biopsy may be necessary to exclude alopecia areata. Adults should be referred to a psychiatrist. Although childhood disease is usually benign, often reflecting a disturbed parent-child relationship, in adults hair-pulling is generally chronic and associated with psychiatric illness.

Nonsurgical aesthetic alteration of the eyelids in pathological conditions.

This study examines the potential value of camouflage and corrective make-up techniques in treating certain pathological eyelid conditions associated with cosmetic imperfections to determine whether surgery might be avoided. As well, these same techniques have been found to enhance postoperative results. The conclusions support the use of camouflage make-up and suggest the value of the combined expertise of the oculoplastic surgeon and clinical cosmetician.

Psychological aspects of essential blepharospasm.

Evaluation of 20 essential blepharospasm patients by using structured interview and psychological testing (MMPI, Rorschach) revealed characteristic pathological personality patterns in all cases. Recent losses or life change, marital conflict, and specific precipitating events were common. Test findings indicated unexpressed hostility, denial, and repression in a majority of women. Three of five men showed evidence of depression. This initial systematic investigation of psychological factors in blepharospasm supports the hypothesis that neurological and psychogenic factors may interact etiologically. The data suggest that personality, recent stress, and precipitating events warrant both clinical assessment and controlled research to determine the specificity and prevalence of these findings.