Apparent glaucomatous visual field defects caused by dermatochalasis

Evaluation of visual field and ocular surface parameters by clinical comparison after blepharoplasty for dermatochalasis

PURPOSE

To evaluate the effect of upper eyelid blepharoplasty surgery on corneal topography, visual field, ocular surface, meibography, corneal biomechanics and dry eye parameters.

METHODS

This prospective study included a total 80 eyes of 40 patients. Following a detailed ophthalmological examination, standardized patient satisfaction questions were posed to patients before and after upper eyelid blepharoplasty surgery. Visual field test, non-invasive break up time (NIBUT), meibography, and corneal topography parameters were analyzed and evaluated.

RESULTS

The mean (+) visible areas in the visual field were found to be 46.20±24.96 preoperatively, 56.73±21.98 at the 1st postoperative month and 65.96±18.5 at the 3rd month, which were statistically significant. NIBUT values preoperatively, at 1 month and at 3 months were 11.26±4.48, 11.16±4.5 and 10.14±4.0, respectively, which were statistically significant. Meibomian gland loss rates on meibography preoperatively and postoperatively at 1 and 3 months were found to be 30.24±8.3, 29.36±8.2 and 28.22±7.7 respectively and were statistically significant. With the scoring system after blepharoplasty, patients reported improvement in their symptoms.

CONCLUSION

Upper eyelid blepharoplasty surgery is predicted to increase the quality of vision. It was observed that there was a functional and cosmetic improvement in the complaints of the patients after blepharoplasty. However, blepharoplasty may cause changes in eyelid dynamics and cause dry eye syndrome.

Evaluating for unrecognized deficits in perimetry associated with functional upper eyelid malposition

Objective

To investigate whether functional upper eyelid malposition is associated with unrecognized deficits in automated perimetry among glaucoma patients by examining patients undergoing eyelid surgery who had not been identified as requiring eyelid taping during glaucoma field testing.

Methods

In this retrospective pre-post study, an automated database search followed by manual chart review was used to identify eligible patients from January 2012 to March 2020. Included patients had reliable visual field testing within two years before and after functional upper blepharoplasty or ptosis repair and no comorbid ocular diagnoses. As part of routine practice, glaucoma visual field technicians taped patients with pupil-obstructing eyelid malposition; taped examinations were excluded from analysis. Clinical and demographic characteristics, mean deviation, and pattern standard deviation were evaluated within a two year period before and after eyelid surgery.

Results

The final analysis included 60 eyes of 38 patients. Change in visual field parameters after eyelid surgery did not reach statistical significance in crude or adjusted analyses. Among patients with ptosis, the margin reflex distance-1 was not associated with change in mean deviation after surgery (Pearson R2 ​= ​0.0061; P ​= ​0.700). Five of 17 eyes excluded from analysis due to unreliable pre-operative visual fields demonstrated substantial improvement after surgery.

Conclusions

Functional upper eyelid malposition does not appear to cause spurious visual field abnormalities among glaucoma patients with reliable visual fields who were determined not to require eyelid taping at the time of their visual fields. Unreliable visual fields could be a sign of eyelid interference in this population.

Effect of Upper Lid Blepharoplasty Surgery on Corneal Topography and Corneal High-Order Aberrations

The objective of this study was to prospectively investigate the effect of upper eyelid blepharoplasty surgery for dermatochalasis on corneal topographic data and high-order aberrations (HOAs). Fifty eyelids of 50 patients with dermatochalasis who underwent upper lid blepharoplasty surgery were prospectively studied. A Pentacam (Scheimpflug camera, Oculus) device was used to measure corneal topographic values, astigmatism degree, and HOAs before and at 2 months after upper eyelid blepharoplasty. The mean age of the patients included in the study was 55.96 ± 12.4 years, 40 (80%) were female and 10 (20%) were male. We found no statistically significant difference in the pre-and postoperative values of corneal topographic parameters (p > 0.05 for all). In addition, we observed no significant postoperative change in the root mean square values of low, high, and total aberration values. In HOAs, we detected no significant change in spherical aberration, horizontal and vertical coma, and vertical trefoil; we only found a statistically significant increase in horizontal trefoil values after surgery (p < 0.05). In our study, we found that upper eyelid blepharoplasty did not cause significant changes in corneal topography, astigmatism, and ocular HOAs. However, studies are reporting different results in the literature. For this reason, it is important for patients considering upper eyelid surgery to be warned about visual changes that may occur after surgery.

Glaucoma Mimickers: A major review of causes, diagnostic evaluation, and recommendations

Background: Glaucoma is characterized by chronic progressive optic neuropathy with corresponding visual field changes, with or without raised intraocular pressure (IOP). When diagnosing glaucoma or monitoring its progression, the examiner has to rely on the appearance of the optic disc, characteristic retinal nerve fiber layer defects, and corresponding visual field defects. However, similar changes and symptoms may be observed in several other disorders of the optic nerve and retina that may mimic glaucoma, often leading to misdiagnosis. Methods and result: The consequences of misdiagnosis not only result in improper treatment that may impact vision but also would negatively affect the overall health, psychological well-being of the patient, and may have considerable economic implications.Conclusion: The current review describes various conditions that mimic glaucoma and the features that help differentiate these conditions from glaucoma.

A novel ablative radiofrequency microplasma nonsurgical blepharoplasty for dermatochalasis

Dermatochalasis (DC) is part of the aging process of the eyelids, characterized by lax, redundant, and overhanging excess eyelid skin. Mostly, it is treated by surgical blepharoplasty. Lately alternative nonsurgical blepharoplasty technologies have been introduced. In this study, we evaluated the efficacy and safety of a novel noninvasive RF microplasma technology for upper eyelid DC. A prospective single center study included 17 patients with moderate to severe upper eyelid DC. Subjects were treated by controlled micro-plasma sparks via a single tip leading to superficial ablation and coagulation at the treatment area. One to three treatment sessions at 2 months interval were performed. Three blinded observers evaluated the photographs taken at baseline and at 6 to 8 months follow-up visit following the final treatment session. Treatment efficacy was assessed using a 4-point grading scale. Seven out of 17 patients (41%) treated for DC by the single microplasma spark exhibited a 2 grade improvement on a 4 point DC scale. 10 out of 17 (59%) patients showed a single grade improvement on a 4 point DC scale. No adverse side effects were observed. Noninvasive ablative microplasma may offer safe and effective therapy for upper eyelid DC.

Evaluation of Visual Field and Balance Function Alterations in Patients Who Underwent Dermatochalasis Surgery

Purpose

To compare perioperative visual field (VF), balance functions (BF), and changes in the other ocular parameters in patients undergoing upper eyelid dermatochalasis (DC) surgery.

Methods

One hundred and fifty-eight eyes of 79 patients who underwent DC surgery were included in the study. The VF, BF, intraocular pressure (IOP), pachymetry (PM), macular, and optic nerve measurements were recorded. Measurements were repeated at postoperative month 1. The preoperative and postoperative ocular measurements and the balance data were compared.

Results

Nineteen of 79 (24.05%) patients were male and 60 of 79 (75.95%) were female, while the mean age of the patients was 58.65 ± 7.38 years. There were statistically significant differences in terms of VF and macular thickness between the preoperative and postoperative values. The improvements in mean defect, standard loss variance, and mean sensitivity values of global VF parameters in both eyes were statistically significant after surgery. Central macular thickness, mean macular thickness, and macular volume decreased significantly in all eyes after surgery (p < 0.05).

Conclusions

Although a marked improvement was observed in VF and peripheral vision after surgery, no significant change was found in BF parameters including primarily falling risk. The significant change in the macular parameters was only remarkable, and we think that the decrease was due to subtle vasospasm. There is a need for further comprehensive studies including especially patients older than 65 with a view to understanding the effect of DC surgery on BF.

Prospective analysis of visual function changes in patients with dermatochalasis after upper eyelid blepharoplasty

OBJECTIVE

To evaluate the changes of visual acuity, contrast sensitivity, astigmatism, and higher order aberrations after blepharoplasty in patients with dermatochalasis.

METHODS

Two hundred six eyelids of 103 patients with dermatochalasis were prospectively studied. Visual acuity, contrast sensitivity, corneal topography, astigmatism degree, and higher order aberrations were examined and recorded before and at 1 month after upper eyelid blepharoplasty. Change in contrast sensitivity and astigmatism values were determined according to margin reflex distance of patients, which were classified into three following groups: <2 mm, 2-3 mm, and ⩾ 4 mm. A Wilcoxon signed rank test was performed to compare the difference.

RESULTS

No significant differences were observed for visual acuity (p = 0.157). The contrast sensitivity of patients significantly increased at all spatial frequencies both under glare and nonglare conditions (p < 0.05). The mean refractive astigmatism significantly decreased from ‒1.01 ± 1.3 to ‒0.79 ± 0.71, postoperatively (p = 0.029). In patients with marginal reflex distance < 2 mm, mean contrast sensitivity was increased (p < 0.001) and mean astigmatism was decreased significantly (p < 0.001) compared with those with ⩾ 2 mm. Higher order aberrations decreased significantly from 0.62 ± 0.41 µm to 0.55 ± 0.38 µm (p = 0.038) after blepharoplasty. Root mean square of the vertical trefoil (p = 0.038), vertical coma (p = 0.002), horizontal trefoil (p = 0.027), third-order aberration (p = 0.005), secondary vertical stigmatism (p = 0.001), spherical aberration (p = 0.023), secondary horizontal astigmatism (p = 0.002), fourth-order aberration (p = 0.024), vertical pentafoil (p = 0.015), secondary horizontal coma (p = 0.035), secondary horizontal trefoil (p = 0.030), and horizontal pentafoil (p = 0.048) were decreased significantly.

CONCLUSION

Upper eyelid blepharoplasty in patients with dermatochalasis has a significant improvement in visual function in terms of contrast sensitivity, astigmatism, and higher order aberrations.

Updates on upper eyelid blepharoplasty

The human face is composed of small functional and cosmetic units, of which the eyes and periocular region constitute the main point of focus in routine face-to-face interactions. This dynamic region plays a pivotal role in the expression of mood, emotion, and character, thus making it the most relevant component of the facial esthetic and functional unit. Any change in the periocular unit leads to facial imbalance and functional disharmony, leading both the young and the elderly to seek consultation, thus making blepharoplasty the surgical procedure of choice for both cosmetic and functional amelioration. The applied anatomy, indications of upper eyelid blepharoplasty, preoperative workup, surgical procedure, postoperative care, and complications would be discussed in detail in this review article.

Contrast Sensitivity Testing in Functional Ptosis and Dermatochalasis Surgery

PURPOSE

To assess whether taped versus untaped contrast sensitivity testing reliably predicts improvement following eyelid-lifting surgery in patients with ptosis and/or dermatochalasis.

METHODS

This prospective study compared pre- and postoperative near contrast sensitivity in patients presenting to 2 ophthalmic plastic surgery practices with functional dermatochalasis and/or ptosis as determined by Humphrey visual field testing. Contrast sensitivity was measured using Mars near cards, held at 40 cm under standard lighting conditions. Logarithmic contrast sensitivity scoring cards were used for analysis. Marginal reflex distance was also collected. Pairwise comparison was used to assess the preoperative and postoperative contrast sensitivity scores. This study was conducted under the approval of the institutional review board.

RESULTS

Seventy-eight eyes of 41 patients with ptosis +/ dermatochalasis underwent eyelid-lifting surgery. The mean preoperative untaped contrast sensitivity was 1.30. The mean preoperative taped and postoperative log contrast sensitivities were 1.52 (11.85% increase) and 1.51 (11.44% increase), respectively. The difference between the 2 groups was not statistically significant (p = 0.864). The marginal reflex distance improved by a mean of 2.0 (p < 0.0005).

CONCLUSIONS

Contrast sensitivity improves significantly following blepharoplasty and ptosis surgery. The degree of improvement in contrast sensitivity can accurately be predicted by preoperative taped/untaped testing. Contrast sensitivity testing may provide an additional screening modality for functional dermatochalasis and ptosis. In the future, contrast sensitivity may provide an additional preoperative assessment tool in patients who do not meet traditional visual field screening standards or who are unable to perform classic visual field testing.

Dermatochalasis causing apparent bitemporal hemianopsia

We describe a previously unreported cause of apparent bitemporal hemianopsia. Three patients with bilateral dermatochalasis underwent Humphrey visual field (HVF) testing in anticipation of corrective blepharoplasty. Unexpectedly, the HVF showed bitemporal hemianopsia in each case, prompting magnetic resonance imaging of the brain in one case. The scan was negative. The HVF tests were repeated with the upper eyelids taped in elevation, and were normal. We conclude that the bitemporal hemianopic defects in our patients resulted from the testing strategy employed by the HVF analyzer software to measure the visual field. Reasons for these artifactual results are discussed. Clinicians should be aware of this uncommon cause of bitemporal hemianopic visual field defects.