Complications and Adverse Effects of Periocular Aesthetic Treatments

Beauty versus Health-How Eyelash Extensions May Affect Dry Eye Disease?

Background: Eyelash extensions (EEs) are among the most popular cosmetic procedures today. There is no prospective study demonstrating how this procedure affects the ocular surface and eye dryness in particular. The goal of this study is to evaluate the effect of EEs removal on dry eye symptoms and signs. Materials and Methods: The subjects were prospectively recruited from routine clinical examinations for dry eye complaints. Only subjects with an OSDI score above 31 were included in the study. The subjects also planned to have the EEs removed and agreed to abstain from makeup use and new cosmetic procedures for 4 weeks. The presence of dry eye was evaluated by an OSDI questionnaire, and objectively by tear breakup time (TBUT), staining (Oxford scale) and blinking intervals. All tests for dry eye were performed at baseline and 4 weeks after EEs removal. Results: The mean age of our patients, all female, was 28 years. The size and type of EEs was diverse. The decision process was mainly based on appearance and models. None of the subjects had any health conditions. The mean result from the score from the OSDI questionnaire at the baseline was 33.4 and improved to 26.7 points 4 weeks after EEs removal. Objectively, the mean TBUT increased from 11.25 to 13.96 s. For the same period, the blinks increased by two per minute, and the staining was reduced by 1.0 grade. Conclusions: Removal of EEs improves the symptoms and the objective signs of dry eye. The most popular beauty procedure regarding eyelashes might not be innocuous to eye health.

Causes and management of sight threatening complications of dermal filler injections: A review

Injectable dermal fillers continue to increase in popularity in aesthetic medicine. Although rare, vision loss secondary to filler injections is a devastating complication associated with a poor visual prognosis. The mechanism for vision loss is thought to be related to retrograde embolization of the dermal filler from peripheral vessels in the face into the ophthalmic arterial system. Early recognition and prompt management are essential if vision is to be salvaged. The use of retrobulbar hyaluronidase is still contentious, however when administered by a specialist, this treatment gives the best chance at visual recovery and should be considered for all cases.

The effects of eyelash extensions on the ocular surface

PURPOSE

To investigate the effects of eyelash extensions on the ocular surface.

METHODS

This prospective study included 32 participants with eyelash extensions in both eyes. Symptoms and clinical parameters such as conjunctival vascular density, tear meniscus height (TMH), noninvasive tear break-up time, bulbar redness, meibography, lipid layer thickness, and corneal staining were assessed in the right eyes. These measurements were taken at baseline and 1 h, 1 day, 1 week, and 1 month after eyelash extensions were applied.

RESULTS

At 1 h after eyelash extensions, ocular symptoms were reported by 27 participants (84.44 %), the most common being foreign body sensation (59.38 %). However, the Ocular Surface Disease Index scores were not statistically different between baseline, 1 week, and 1 month after eyelash extension (P > 0.05). TMH increased significantly at 1 h after eyelash extensions, from 0.27 ± 0.08 mm (baseline) to 0.29 ± 0.07 mm (P = 0.02). Subsequently, TMH decreased and was the lowest at 1 week at 0.24 ± 0.08 mm. First tear break-up time and average tear break-up time decreased to the lowest at 1 week after eyelash extension, with 8.36 ± 4.6 s and 10.71 ± 4.99 s, respectively, both of which were statistically different from baseline (P < 0.05). Corneal staining score was highest at 1 h after eyelash extensions at 0.78 ± 1.34. However, there were no significant differences in the conjunctival vascular density, bulbar redness, meiboscore, or lipid layer thickness.

CONCLUSION

This study demonstrates that eyelash extensions can lead to an imbalance in ocular surface homeostasis, resulting in corneal epithelial defects and short-term decreased tear film stability.

Ocular Side Effects of Eyelash Extension Use Among Female Students of the University of Benin, Benin City, Edo State, Nigeria

Introduction Eyelash extensions have become a trendy cosmetic procedure, especially among young female students at various universities. This study assessed the relationship between the usage pattern of eyelash extensions and the ocular side effects arising from eyelash extension use. Methods The study was conducted using 400 female undergraduate students at the University of Benin with an age range of 15-30 years and a mean age of 22.50 ± 3.79 years. This observational cross-sectional study was conducted by evaluating the usage pattern of eyelash extensions, ocular side effects, and the relationship between them. Data obtained from the participants were processed using the Pearson correlation analysis in the Statistical Product and Service Solutions (SPSS) (version 22.0; IBM SPSS Statistics for Windows, Armonk, NY) software. Results The results showed that only 16% (n=64) of the participants had any side effects before fixing eyelash extensions, while 54% (n=216) of the participants had experienced one or more side effects during/after artificial eyelash wear. The most common side effects experienced were itching (n=152, 38%), lashes pulling out (n=144, 36%), heavy eyelids (n=136, 34%), and red eyes (n=136, 34%). Other ocular side effects were grittiness/foreign body sensation (n=128, 32%), tearing (n=96, 24%), burning sensation (n=96, 24%), pain on the eyelids (n=88, 22%), misdirected lashes (n=40,10%), eyelids swelling (n=24, 6%), a boil on eyelids (n=16, 4%), and discharge (n=8, 2%). Moreover, the result showed statistically significant correlation between the usage pattern and the ocular side effects such as pain (r=0.22), itching (r=0.23), tearing (r=0.21), burning sensation (r=0.17), a boil on the eyelids (r=0.21), heavy eyelids (r=0.16), misdirected lashes (r=0.22), red eyes (r=0.15), lashes pulling out (r=0.12), eyelids swelling (r=0.18), grittiness (r=0.10), and discharge (r=0.10) (p<0.05). Conclusions It is concluded that there is a relationship between the usage pattern of eyelash extensions and the ocular side effects. Adequate and proper attention should be paid to this ever-growing cosmetic procedure's potential visual health risks.

Dacryolithogenesis or Dacryolithiasis-The Story So Far

The term dacryoliths refers to the concretions found within the lacrimal system. When the term dacryoliths is unspecified, it usually refers to the noninfectious dacryoliths commonly isolated from the lacrimal sac and the nasolacrimal duct. More often, they are diagnosed incidentally during a dacryocystorhinostomy, and the reported incidence among all dacryocystorhinostomy surgeries is 5.7% to as high as 18%. Dacryolithiasis is a complex process occurring within the lacrimal system, and current evidence suggests a multifactorial etiology. The sequence of events can be summarized broadly into 4 stages: stage of susceptibility, stage of initiation/trigger, stage of development, and stage of maintenance. The triggering event is the breach of the lacrimal sac or nasolacrimal duct epithelium, resulting in microtrauma with blood leakage. The blood clots act as a nidus for subsequent sequential laying of mucopeptides, cellular debris present locally, debris washed from the ocular surface, and extraneous agents in tears. This process is aided by altered rheology and composition of the tear film. After the formation of dacryoliths, extracellular neutrophil traps usually form on the surface, which help to maintain the dacryoliths (which do not dissolve). This review highlights and discusses the possible sequence of events during dacryolithiasis.

Investigating the effects of Argireline in a skin serum containing hyaluronic acids on skin surface wrinkles using the Visia® Complexion Analysis camera system for objective skin analysis

Objective

To analyze the effects of Argireline on skin surface wrinkles using the Visia® camera system developed by Canfield Scientific Inc., U.S.A., for facial image capture.

Method

Nineteen female participants were recruited from a plastic surgery clinic. Initial facial images captured the left, front, and right sides of the participants' faces, which were documented as timepoint one. Following this, the participants immediately began to apply a facial skin serum containing triple hyaluronic acids produced by CNC cosmetic GmbH, Philippsburg, Germany. The serum was applied once in the morning and once in the evening. Participants received two identical containers labeled L for left and R for right, with each container to be used on the corresponding facial side, particularly around the eye area. One container contained Argireline, a synthetic hexapeptide, which previously was deemed to be a biosafe alternative to botulinum neurotoxin. The study was conducted as double-blind; neither the participants nor researchers knew which of the two containers contained Argireline. Participants were allowed to use their own cosmetic products throughout the study. After four weeks, the participants returned to have their faces recaptured using the Visia® camera, which was documented as timepoint two. The absolute scores of the wrinkles were noted, and results on both sides of the face were calculated and compared. The "TruSkinAge®" measurement provided by the Visia® camera was reviewed for each face side. Results between both time points and both sides of the face were compared. After the data analysis was complete, the company was contacted to determine which container contained Argireline.

Results

Nineteen participants returned for facial image capture. There were no significant adverse events, allergic reactions, or skin irritations. The investigation revealed that the wrinkle score slightly decreased for the right and left side of the face following four weeks of serum application. However, this decrease was not significant (p>0.05) based on the Wilcoxon matched pairs tests for the wrinkle scores (right side p=0.060 and left side p=0.176) and Truskin Ages® results (right side p=0.096 and left side p=0.489).Comparing the data from the right side with that from the left side of the face revealed that neither demonstrated a significant reduction in wrinkle score (p=0.829) or Truskin Ages® results (p=0.804). Argireline was included in the serum applied to the right side of the face. However, no statistical significance was seen in the results on this side of the face indicating any possible effects.

Conclusion

Wrinkle scores and Truskin Ages® results were observed to decrease non-significantly following the application of a skin serum involving hyaluronic acid. The Visia® imaging method was used to analyze the data objectively. Differences between both sides of the face that were treated with and without Argireline were not statistically significant. Therefore, the effect of Argireline was not proven. While Argireline presented with low toxicity, its efficacy was found not to be significant. Therefore, it is not deemed to be an alternative treatment to botulinum toxin.

Etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO)

Primary acquired nasolacrimal duct obstruction, or PANDO, is a common adult lacrimal drainage disorder. The current treatment modality of dacryocystorhinostomy to bypass the obstructed nasolacrimal duct has excellent outcomes. However, the understanding of the disease etiopathogenesis needs to be revisited. There are not many studies that specifically assessed any hypothesis or ones that convincingly put forth the presumed or confirmed interpretations regarding the PANDO pathogenesis or the mechanisms or pathways involved therein. Histopathological evidence points to recurrent inflammation of the nasolacrimal duct, subsequent fibrosis, and the resultant obstruction. The disease etiopathogenesis is considered multifactorial. Several implicated suspects include anatomical narrowing of the bony nasolacrimal duct, vascular factors, local hormonal imbalance, microbial influence, nasal abnormalities, autonomic dysregulation, surfactants, lysosomal dysfunction, gastroesophageal reflux, tear proteins, and deranged local host defenses. The present work reviewed the literature on the etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO) to gain insights into the present state of the understanding and the high-value translational implications of precisely decoding the disease etiology.

Efficacy and tolerability of a novel skin cream for improving periocular rhytids and dryness

OBJECTIVE

A novel topical cream was developed to address the appearance of aging periorbital skin. The goal of this study was to evaluate the efficacy and tolerability of this product (Total Eye® Firm & Repair Cream; Colorescience, Inc., Carlsbad, CA) for improving periorbital wrinkles, dryness, laxity, and dark circles.

METHODS

This 8-week open-label trial enrolled subjects 35-65 years old seeking periocular rejuvenation (N = 25; 22 female, 3 male). The product was applied each morning and evening after facial cleansing. Study endpoints were changes in Investigator Clinical Grading and Eye Appearance Assessments, Subject Self-assessment Questionnaires, and tolerability after 4 and 8 weeks of treatment.

RESULTS

Among subjects completing the study (n = 23), all (100%) showed some global improvement at Weeks 4 and 8 and almost half (48%) achieved moderate or marked improvement. Improvements were observed for all parameters and were most pronounced for wrinkles, laxity, and dark circles. Improvements for laxity and dryness were significant by Week 4 and for dark circles by Week 8. At Week 8, subjects agreed or strongly agreed that the product made their eyes feel more hydrated (100%), look and feel healthier (95%), and increased confidence in their eye appearance (91%). The product was well-tolerated.

LIMITATIONS

Modest number of subjects and open-label study design.

CONCLUSION

Twice-daily Total Eye® Firm & Repair Cream improved the overall appearance of the periorbital area. The product was well-tolerated and most treated subjects were satisfied with their results. The product is a viable option for treating periorbital wrinkles and laxity and should be considered a safe and effective skincare option.

Superselective Ophthalmic Artery Thrombolytic Therapy for Hyaluronic Acid Embolization: A Case Report

Blindness caused by embolization of fillers is a rare but catastrophic complication after cosmetic injection. Vision improvement is rarely reported among the various studies on potential clinical treatments. In this case, the patient suffered from ophthalmic artery occlusion with no light perception 48 h after hyaluronic acid injection. After two intra-arterial thrombolytic therapy sessions and traditional sequential therapy, ocular appearance was restored to normal, blood supply to the retina and visual function were improved, and visual acuity was restored to hand motion levels. Our results suggest that intra-arterial thrombolytic therapy with hyaluronidase and papaverine has a positive effect on hyaluronic acid-induced visual loss and is worthy of clinical promotion.

Botulinum Toxin Type A: Adverse Events and Management

Aesthetic medicine is witnessing an increasing exploitation of all the procedures. The demand has never been higher than it is today. The number of practitioners is also increasing year by year. Consequently complications and other kinds of related troubles and procedures are also rising. Never like today is fundamental, in case of troubles, how to properly manage with the most frequent issues. In aesthetic medicine field, botulinum toxin procedures are the safest. Lot of patients are worried about botulinum toxin despite the available scientific literature. Rare short-term complications are observed. In the most of cases, nothing severe occurs if the international recommendations and the most recent guidelines are closely followed, the majority of them are injection related. This study is a review of rare or common problems that can occur and how to manage or solve the situations.