Eyelash line resection for cilial entropion in patients with Down's syndrome.

AIM: To describe a surgical procedure for excising the eyelash line to treat cilial entropion in patients with Down's syndrome. METHODS: 24 Down's patients with cilial entropion and medial epiblepharon underwent eyelash line resection bilaterally. The area and density of fluorescein staining of the superficial punctate keratopathy (SPK; 0=none to 3=wide or severe) and the frequency of spectacle wear (0=no wear to 2=all day wear) were evaluated prospectively. RESULTS: The postoperative area and density of the SPK improved significantly in both eyes (p<0.001, p<0.001). The score of spectacle wear was 1.3 ± 0.8 preoperatively which improved significantly to 1.7 ± 0.5 after surgery (p=0.018). Five patients had a partial recurrence of misdirected eyelashes adjacent to the site of the excision. Two patients had extended excisions of the misdirected eyelashes 3 years after the initial surgery, and they did not have any further recurrences. Three other patients were followed without additional treatment because lacrimation and eye discharge were mild even with some eyelashes misdirected toward cornea. CONCLUSIONS: Eyelash line resection is a simple and effective technique for cilial entropion and medial epiblepharon in patients with Down's syndrome. The surgery improves the SPK and frequency of spectacle wear. TRIAL REGISTRATION NUMBER: NCT01758718.

Perforating eyelid injury extending to the brain stem in a 17-year-old woman: a case report.

INTRODUCTION: This case report describes a patient who had a perforating eyelid injury that extended to the brain stem. CASE PRESENTATION: A 17-year-old Japanese woman complained of decreased vision in her right eye, with severe ocular pain and headaches, after the metal tip of an umbrella struck her upper right eyelid accidentally. Her vision in the right eye decreased to light perception with commotio retinae, intraretinal hemorrhage, and severe lid swelling. Magnetic resonance imaging (MRI) demonstrated edema of the head of the caudate nucleus and putamen, and the edema extended to the hypothalamus. The MRI findings indicated that the umbrella tip had penetrated through the eyelid and the posterior orbital wall. Vision improved to 20/50 in the right eye, with subretinal fibrosis caused by the choroidal rupture. CONCLUSIONS: We recommend that MRI be performed on the orbit and brain in patients who appear to have symptoms that are inconsistent with the observed injury and when a severe orbitocranial injury is suspected.