Embryonic Development of the Orbit

Determining Asymmetry Thresholds in Anophthalmia/Microphthalmia Using a Three-dimensional Animated Model

PURPOSE

Congenital microphthalmia and anophthalmia are rare development disorders with underdevelopment of the orbital region, resulting in asymmetry of the face. No clear guidelines exist to determine when these deviations are acceptable.

METHODS

The face of a healthy 6-year-old child was three-dimensionally scanned. On this scan, we modeled various incremental degrees of facial asymmetries using three-dimensional modeling software. We modeled for smaller palpebral fissures, sunken eyes, and downward displacement of the eye. We also tested whether adjusting the vertical palpebral fissure height in relation to the horizontal palpebral fissure width affected perception. A total of 22 videos were created in which the model turned the head horizontally and vertically. We created a questionnaire asking raters how acceptable the face is, on a linear scale from 0 to 10.

RESULTS

Results showed a correlation between the degree of asymmetry and the acceptability score of the raters. Enophthalmos of ≥6 mm, palpebral fissure width ≤79% compared with the other eye, and 2 mm or more downward displacement of the eye resulted in a significant different acceptability score. The desire for correction was strongly increased when these thresholds were exceeded. Adjusting the vertical palpebral fissure height to the horizontal palpebral fissure width resulted in a worse acceptability score.

CONCLUSION

A unilateral sunken eye (enophthalmos) of 6 mm or more, asymmetric horizontal palpebral fissure length of ≤79%, and a lower position of one eye of more than 2 mm resulted in unacceptable judgment. These data can be used to evaluate treatment outcome in children treated for congenital microphthalmia and anophthalmia.

[Therapeutic management of a kissing nevus of the eyelid]

Congenital divided melanocytic nevi of the upper and lower eyelid are rare pigmented changes of the eyelids. These processes are also known as "kissing nevi," "panda nevi," and "split ocular nevi," and were first described by Fuchs in 1919. About 120 cases have been described in the literature so far. Congenital melanocytic nevi are either present at birth (small nevi are already found in about 1% of neonates) or manifest predominantly during the first decade of life. These rare melanocytic changes of the eyelids should be controlled regularly, as malignant transformation can occur. The actual incidence of malignant transformation is highly variable in the literature, ranging from 2 to 40% depending on the duration of follow-up, with an average of 14% for the whole lifetime. Moreover, nevi of the eyelids may be considered cosmetically disturbing and cause functional problems. Therapeutic removal (dermabrasion, cryotherapy, laser therapy, and surgical excision with ophthalmoplastic reconstruction) is rarely medically indicated due to the low risk of malignant transformation. Removal can be performed in cases of secondary amblyopia in ptosis, compression of the lacrimal point, epiphora, or cosmetic desire. Treatment becomes necessary not only in case of suspicious manifestation or impairment of eyelid function, but it also helps to avoid possible bullying at school among children and is recommended at age 4 to 6 (before school age).

A Novel Strategy to Achieve Stable and Lasting Double Eyelids in Upper Blepharoplasty

BACKGROUND

Incision blepharoplasty is very common among aesthetic surgery, but the effect of it varies considerably. The quality of incision blepharoplasty is mainly defined by operator's ability, which will result in the uncertainty of operation result. We are committed to seeking a principle to guide every operator to achieve optimum success.

MATERIALS AND METHODS

A retrospective study of 150 patients experienced the new method from January 2020 to May 2022. This method was mainly divided into 4 steps. Firstly, released adhesion between the orbital septum and the levator aponeurosis and the connection between the orbital septum and the pretarsal fascia. Then, dealt with the epicanthus to reduce the resistance. Third, improve the lifting force of opening eyes or decrease the resistance of opening eyes to keep the balance of biomechanics in the upper eyelid. Last, sutured and closed the incision. The postoperative outcomes were assessed by "Global Aesthetic Improvement Scale."

RESULT

The follow-up period at last for 3 months.-The results showed that the rate of "Very much improve" was 88% (132 patients); that of "Much improve" was 9.3% (14 patients); that of "Not change" was 0.6% (1 patient); and that of "Worse" was 2% (3 patients). The recovery time of patients varied from 2 weeks to 1 month. And the complications of the narrowing and lightening of the double-eyelid line decreased.

CONCLUSION

Applying the biomechanical balance principle to incision blepharoplasty can generate a more beautiful double-eyelid line and is less likely to trigger off complications.