Epiblepharon correction in Korean children based on the epicanthal pathology.

PURPOSE: This study aims to investigate the surgical outcomes of a novel epiblepharon correction method based on the pathologic features of epicanthal tissue. The correlation between the pathology and clinical presentations was also studied. METHODS: This retrospective study included 72 eyelids of 36 children with epiblepharon and epicanthal folds. From July 2013 to March 2016, epicanthal tension-releasing procedure of subdermal fibrinolysis with orbicularis oculi ring myotomy were performed in 36 children. Photographs before and after operation were analyzed with Image J program. A clinical severity of the epiblepharon was scored based on the lower eyelid skin fold height (mild to severe). Subdermal fibrosis index was defined as the portion of fibrosis in low power field (× 40) and eyelid contour was assessed with custom software (MATLAB). Eighty eyelids without eyelid pathology were analyzed to establish the normal eyelid contour. The epicanthal tissues were classified into three categories: mild, moderate, and severe fibrosis. RESULTS: The mean age of the patients was 5.5 years. Intercanthal distance (ICD) ratio was defined as Inner ICD (IICD)/outer ICD (OICD). The IICD/OICD was 0.41 in the severe epiblepharon group that is significantly longer compared to that of the mild epiblepharon group (0.38). Subdermal fibrosis index was higher in severe epiblepharon group. Eyelid contour was normalized and the cilia touch was resolved after the epicanthal tension-releasing procedure. CONCLUSION: Epicanthal tension-releasing procedure with orbicularis oculi ring myotomy achieved favorable surgical outcomes. Clinical correlations with pathologic findings and satisfactory results of the procedure suggest that medial epicanthal fibrosis is the main pathologic feature causing epiblepharon and epicanthal folds.

Accounting for Ethnicity-Related Differences in Ocular Surface Integrity as a Step Toward Understanding Contact Lens Discomfort.

Contact lens discomfort is a common problem that can lead to unsuccessful or limited contact lens wear. Although many factors may contribute to contact lens discomfort, limited research has explored the influence of ethnicity-related differences in the anatomy and physiology of the ocular surface. Therefore, we performed a search of the literature in PubMed using key words related to "ocular surface" paired with the terms "race" and "ethnicity." The goal of this review was to determine potential areas of research regarding ethnicity differences, particularly between Asian and non-Asian eyes, in ocular surface integrity to advance our understanding of contact lens discomfort.

Management of epiblepharon: state of the art.

PURPOSE OF REVIEW: Epiblepharon is prevalent in East-Asian children. As the population in Asia is increasing, so is the demand for epiblepharon surgery. Surgeons should be familiar with the standards of beauty and needs of Asian people for epiblepharon management. This review provides a comprehensive summary of the published studies on the clinical manifestations, pathophysiology, and management of epiblepharon. RECENT FINDINGS: Astigmatism is prevalent in epiblepharon patients, which can contribute to amblyopia. Early surgery and visual rehabilitation is important for epiblepharon patients with a high degree of astigmatism and amblyopia. Various etiologic factors play a role in the pathophysiology of epiblepharon. Surgical procedures focusing on creation of a lower eyelid crease have been popular for treating epiblepharon in Western textbooks; however, this is not appropriate for Asian patients in whom, a crease may be undesirable. In selecting surgical methods, it is important to resect a minimal amount of skin-muscle to avoid the adverse effects of ectropion and eyelid retraction. SUMMARY: Although epiblepharon may resolve with facial growth, surgical correction is needed for cases in which there is significant corneal injury from the lash touch. Surgical management should focus on techniques that are effective, with little chance of complication, and do not create a lower eyelid crease.

Comparison of surgical techniques and results of upper blepharoplasty between Asian males and females.

The purpose of this study was to describe surgical techniques and results of upper blepharoplasty for dermatochalasis to optimize cosmetic outcome in males, compared with females. We conducted a retrospective, interventional study on 156 eyes (78 patients) that had been diagnosed with dermatochalasis and had undergone upper lid blepharoplasty at the Korea University Hospital between August 2008 and October 2008 by a single surgeon. Twenty-eight male patients and 50 female patients were enrolled. Patient age, sex, follow-up duration, complications, and treatment were analyzed. We evaluated intraoperative (1) lid crease height, (2) skin-muscle excision amount, and (3) whether or not fat was removed. In total, 78 patients (28 men and 50 women: 156 procedures) who underwent upper eyelid blepharoplasty for dermatochalasis were identified. The mean age was 59.6 years in male patients, and 62 years in female patients (P = 0.165). No significant difference was observed between mean lid crease height and the distance between eyebrow lower margin to lid crease in males and females. The amount of skin-muscle excision in the female group was significantly greater than that in males. The frequency of fat removal was significantly lower in males than in females. For a good cosmetic outcome, we recommend (1) lower lid crease, (2) less skin-muscle excision using a scalpel shape design, (3) lateral orbicularis oculi muscle preservation, and (4) minimizing fat removal to avoid feminization in older male upper blepharoplasty.

Fat repositioning via supraperiosteal dissection with internal fixation for tear trough deformity in an Asian population.

BACKGROUND: To investigate the efficacy and complications of fat repositioning via supraperiosteal dissection with internal fat-flap fixation for tear trough deformity in an Asian population. METHODS: This study is a retrospective chart review. From June 2005 to May 2010, 212 patients with lower eyelid fat prolapse and tear trough deformity underwent fat repositioning via supraperiosteal dissection with internal fat-flap fixation. Postoperative complications were recorded, and the degree of outcome satisfaction was obtained at the 6-month postoperative follow-up. RESULTS: In total, 142 patients underwent transconjunctival fat repositioning, and 70 received the transcutaneous approach for redundant lower lid skin and tear trough deformity. The level of satisfaction 6 months after the operation was high: 152 patients rated their experience as very satisfied (71.7%), 54 as satisfied (25.5%) and six as acceptable (2.8%). None reported being dissatisfied or unhappy. No diplopia or evidence of granuloma formation in the lower eyelid or check area was noted. Four patients who suffered from significant ecchymosis and conjunctival chemosis with corneal exposure were managed with lubricants and resolved spontaneously. Three patients who underwent the transcutaneous approach and excess skin excision had the complication of lower lid ectropion; they received lateral tarsal strip procedures with good results. Three patients required revision to remove the residual lateral fat pad because of inadequate lateral orbital fat excision during the initial procedure. CONCLUSIONS: Fat repositioning via supraperiosteal dissection with internal fat-flap fixation is a safe and effective method to create a youthful midface appearance for Asians with tear trough deformity.

Management of the aging upper eyelid in the asian patient.

Successful management of the aging upper eyelid region in the Asian patient requires a unique skill set and clinical experience. The surgeon must exhibit a thorough understanding of the unique anatomy of the Asian eyelid and its variations and of the cultural expectations of the patient and must possess a unique set of surgical skills such as de novo creation of the supratarsal crease as well as complementary procedures such as fat transfer used for volume augmentation of the periorbital region. The modern approach outlined here summarizes the key elements necessary to restore the youthful appearance of the upper eyelid region in a natural and ethnically consistent fashion.

Kimura disease of the eyelid in an Indian man.

Kimura disease is a rare idiopathic chronic inflammatory disease, characterized by subcutaneous nodular lesions in the head and neck area. Ophthalmic manifestation of Kimura disease involves orbital and eyelid lesions mostly in Asian patients, but it has been described in White patients and Black Caribbean patients. Kimura disease is usually associated with eosinophilia and occasionally with renal disease. Here, we report a case of Kimura disease of the eyelid in a 50-year-old Indian man with eosinophilia. The main differential diagnosis was angiolymphoid hyperplasia with eosinophilia. Histology is crucial to separate these two entities, and our case was shown to be Kimura disease by histology. To our knowledge, this is the first report of a person of Indian origin to develop Kimura disease involving the eyelid.

[Meibomian glands dysfunction and ocular surface in black people]. / Dysfonctionnement des glandes de Meibomius et surface oculaire du sujet âgé mélanoderme.

Meibomian gland dysfunction is the leading cause of evaporative-type dry eye syndrome. Our goal was to determine the epidemiological and clinical features of meibomian gland dysfunction as well as its impact on the ocular surface in elderly black patients in Cameroon. PATIENTS AND METHODS: We performed a cross-sectional analysis from January 2 through May 31, 2017 in the ophthalmology department of Laquintinie Hospital in Douala, including blacks aged 50 years and older. The examination focused on the Meibomian glands, Tear film Break Up Time and Schirmer I test for qualitative and quantitative assessment of tears. The relationship between the quantitative and qualitative variables and meibomian gland dysfunction was determined by linear regression tests. RESULTS: We enrolled 340 elderly black patients. The mean age was 62±9 years. The prevalence of meibomian gland dysfunction was 71.8 % and did not increase with age. The hypoproductive clinical form was the most frequent (47.9 %). The prevalence of asymptomatic Meibomian gland dysfunction was 19.7 %. Evaporative dry eye disease was the most frequent (34.7 %). Aside from advanced age, Meibomian gland dysfunction was associated with high blood pressure (P=0.020), cataract surgery (P=0.034), long-term glaucoma medication (P=0.041) and alcohol consumption (P=0.043). CONCLUSION: Meibomian gland dysfunction is very common in elderly black patients in Cameroon.

Epiblepharon in Chinese children: relationships with body mass index and surgical treatment.

PURPOSE: To evaluate the relationship between the incidence of lower eyelid epiblepharon and body mass index in Chinese children and report the outcomes of a rotating suture technique or the L-plasty procedure aimed at correcting the structural anomalies. METHODS: The medical records of patients treated surgically, with either rotating suture procedure or L-plasty, for lower eyelid epiblepharon were reviewed retrospectively and compared with an age-matched control group of children without epiblepharon. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters. RESULTS: A total of 67 patients (mean age, 5.7 ± 2.6 years) and 178 controls were included. All patients had coexistent epicanthus. In 62 patients, rotating suture procedures were used; in 5, L-plasty. The BMI in 4- to 6-year-old boys with epiblepharon was significantly higher than that in children without epiblepharon (P = 0 .042). All patients showed successful surgical outcomes according to improvement of symptoms and lack of cilia-cornea contact. There were no cases of recurrence or other complications. CONCLUSIONS: Obesity may be an aggravating factor in cases of lower eyelid epiblepharon, which may be corrected effectively with the rotating suture procedure and the L-plasty procedure. The L-plasty procedure is recommended for patients with coexistent severe epicanthus.

Association between symptoms and signs of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study.

PURPOSE: To analyze the association between dry-eye symptoms and signs in an elderly Chinese population in Taipei, Taiwan. METHODS: The participants were those of the Shihpai Eye Study, a population-based survey of eye diseases in the elderly (> or =65 years) in Shihpai, Taipei, Taiwan. Of 2045 randomly selected noninstitutionalized residents, 1361 (66.6%) participated in the study. Dry-eye symptoms were evaluated with an interviewer-administered questionnaire. Dry-eye signs, including tear-film breakup time, Schirmer test result, score for fluorescein staining of the cornea, and meibomian gland dysfunction, were assessed. Correlations between symptoms and signs were analyzed. RESULTS: Of the participants, 33.7% (459/1361) were symptomatic, defined as reporting one or more symptoms often or all the time. A Schirmer result of < or =5 mm was the only sign associated with frequent symptoms (P = 0.028). Its sensitivity and specificity in detecting symptomatic subjects were 62.5% and 43.7%, respectively. The agreement between each sign was statistically significant, although weak, except that no correlation was found between the Schirmer result and meibomian gland anomalies. Of the symptomatic subjects, 85.4% (392/459) had either a low Schirmer result or a meibomian gland anomaly; 38.8% (178/459) of them were abnormal on both tests. CONCLUSIONS: The Schirmer test was shown to be incapable of detecting meibomian gland disease. However, a low Schirmer result was significantly associated with dry-eye symptoms in this elderly Chinese population. This result differs from that of previous reports of elderly white populations. Further studies are needed to determine whether this difference indicates racial diversity in the distribution and behavior of dry-eye diseases.

Trichiasis and disability in a trachoma-endemic area of Tanzania.

OBJECTIVE: To measure limitations in the daily activities of village life associated with having trichiasis for individuals with and without visual acuity loss. METHODS: Men and women 40 years and older in 6 randomly chosen rural villages in the Kongwa district of Tanzania had visual acuity measured and were examined by an ophthalmologist. Subjects indicated the degree of difficulty with daily activities of village life and whether the difficulty was related, in any way, to vision. Limitations were scored using an indicator of "any difficulty" and using a 4-point scale ranging from "no difficulty" to "unable to do." Scores of individuals with and without trichiasis were compared separately for men and women. RESULTS: Among men, trichiasis was associated with excess functional limitation only for those with visual acuity loss (adjusted difference in proportion of tasks [AD] compared with men with neither trichiasis nor visual impairment, 0.35; 95% confidence interval [CI], 0.23-0.47). For women, trichiasis alone was limiting (AD, 0.15; 95% CI, 0.08-0.22) similarly to visual acuity loss alone (AD, 0.09; 95% CI 0.06-0.13), and the combination led to greater limitations (AD, 0.32; 95% CI, 0.26-0.39). CONCLUSION: The burden of trichiasis is likely greater than previously estimated, especially in women for whom trichiasis alone was disabling.

Prevalence and risk factors of meibomian gland dysfunction: the Singapore Malay eye study.

PURPOSE: To describe the prevalence and associations of meibomian gland dysfunction (MGD) in an urban Malay population in Singapore. METHODS: Population-based cross-sectional study of 3280 (78.7% response rate) Malay persons aged 40 to 80 years, living in Singapore. MGD was defined by a slit-lamp clinical examination as either lid margin telangiectasia or meibomian gland orifice plugging in at least one eye. Participants underwent a standardized questionnaire and clinical examination, including laboratory investigations. Data were analyzed for 3271 persons. RESULTS: The age-standardized prevalence of MGD was 56.3% [95% confidence interval (CI), 53.3-59.4]. A higher MGD prevalence was found in male participants across all age groups [odds ratio (OR), 1.30; 95% CI, 1.35-1.79], postmenopausal women (OR, 1.64; 95% CI, 1.19-2.33), and all participants with pinguecula (OR, 2.43; 95% CI, 2.08-2.85), high diastolic blood pressure (OR, 1.32; 95% CI, 1.08-1.62), and use of angiotensin II receptor blockers (OR, 4.02; 95% CI, 1.74-9.27). CONCLUSIONS: MGD was highly prevalent in this Asian population and associated with various systemic and ocular conditions.

Surgical correction of multiple upper eyelid folds in East Asians.

BACKGROUND: Unwanted multiple upper eyelid folds may occur after various blepharoplasty procedures used in Asian "double-eyelid" surgery. These multiple lines are caused by adhesions that may occur after inappropriate manipulation during blepharoplasty. Correction is difficult in cases of multiple reoperations because the adhesions in such cases are severe and an insufficient amount of tissue remains for reconstruction. METHODS: The authors divided 62 patients into three groups. Patients in group 1 developed lines for reasons unrelated to eyelid surgery, those in group 2 developed lines after blepharoplasty, and those in group 3 developed lines after secondary operations. After skin incision, the authors performed a complete dissection and release of the scar tissue. Then, the authors augmented the preorbital area using eyelid tissues such as the orbicularis oculi muscle and orbital fat to prevent readhesion of the orbicularis oculi and levator muscles. For severe cases, unwanted creases were prevented by rolling the orbicularis oculi muscle and attaching a thick piece of tape to the problem area after surgery. RESULTS: In 57 patients (92 percent), the unwanted lines disappeared completely. Five patients (8 percent) experienced recurrence of the lines, but these lines were successfully corrected by reoperation. All cases with recurrence were in groups 2 and 3, in which the adhesions were very severe. CONCLUSIONS: The most important factors for correction of unwanted multiple fold lines are accurate dissection, the maintenance of sufficient tissue, and prevention of readhesion between the skin and levator using other soft-tissue augmentation. This method can provide very satisfactory results, even in severe cases.

Epiblepharon related to high body mass index in Korean children.

PURPOSE: To evaluate the clinical manifestations of epiblepharon in Korean children and the relationship between this condition and body mass index. METHODS: In a retrospective case-control study, 223 children 6 to 15 years of age treated surgically for epiblepharon were studied and compared with an age-matched control group of 264 children. Data on age, sex, weight, height, and recurrence were recorded. RESULTS: Mean age of the patients was 8.63 ± 4.43 years. Lower eyelids were commonly involved bilaterally. Chief complaints included ocular discomfort, eye rubbing, visual disturbances, photophobia, and epiphora. Minimal resection of orbicularis oculi with full-thickness eyelid rotatory suture for epiblepharon was performed on 223 patients. The body mass index in girls 12 to 15 years old with epiblepharon was significantly higher than that in children without epiblepharon (P < .05). There was a statistically significant correlation between the incidence of epiblepharon and obesity with aging in girls (P < .05). Reoperation was performed on 12 patients (4.4%) because of recurrence of corneal irritation with inverted eyelashes. Clinical factors such as sex, age, and body mass index did not affect the rate of recurrence. CONCLUSION: Epiblepharon is one of the most common eyelid abnormalities among Asian children. Obese Korean girls aged 12 to 15 years demonstrated symptomatic epiblepharon at a statistically significant level.

Lower lid epiblepharon as the presenting feature of spontaneous dural carotid cavernous fistula in an Asian patient.

Lower lid epiblepharon is a relatively common problem among young Asian patients. Occasionally, it may be secondary to underlying orbital pathology. We report a 33-year-old Chinese patient with a dural carotid cavernous fistula who presented with an ipsilateral lower lid epiblepharon in the absence of any other significant signs. After a recurrence following primary corrective lid surgery, she was investigated further because of mild ipsilateral proptosis. CT-scans of the orbit revealed an enlarged superior ophthalmic vein and a dural carotid cavernous fistula was confirmed on angiography. Subsequent embolisation of the fistula led to resolution of the proptosis as well as the epiblepharon. We believe that extension of orbital fat to the inferior tarsal border in Asian eyelids together with a poorly fixed anterior lamella contributes to the occurrence of epiblepharon when the Asian orbit becomes congested. The new onset of such features in the Asian patient should lead one to suspect underlying orbital pathology, even in the absence of other, more classic signs.

Trichiasis in Aboriginal people of the Kimberley region of Western Australia.

BACKGROUND: Trachoma is a significant public health problem in the Kimberley region of Western Australia. The prevalence of follicular trachoma in the region has been well documented and control of active trachoma is well established. In contrast, trichiasis prevalence in recent years is less well documented. This study aimed to determine trichiasis prevalence in the Kimberley population and to document an appropriate intervention. METHODS: A collaborative programme was established involving the Kimberley Public Health Unit, Kimberley Aged Care Services and the visiting ophthalmology service. After training, medical students screened the aged-care population for trichiasis and the aged-care services staff were educated about identification and referral procedures for patients with trichiasis. The Kimberley Public Health Unit was responsible for ensuring specialist assessment, and correction, of trichiasis and appropriate post-treatment follow up. RESULTS: A total of 597 Kimberley Aboriginal people aged 50 years or more were screened for trichiasis, representing 42% of that age group. Trichiasis was suspected in 40 people. Of the 28 people with suspected trichiasis who underwent ophthalmological assessment, 17 were found to have trachomatous trichiasis. The observed prevalence of trachomatous trichiasis was 2.8%. The trichiasis screening programme has been adopted by most aged-care organizations in the Kimberley. CONCLUSIONS: The results show that trichiasis continues to affect elderly Aboriginal people, especially those from Halls Creek Shire. Health professionals and aged-care workers should be alert to the possibility of this preventable cause of blindness and work collaboratively to ensure that patients receive timely and appropriate treatment.