Measurement of upper eyelid implants curvature by ultrasound

Determining Tarsus Curvature in Relation To Direction of Gaze Using Non-contact Ultrasound Video Assistance

PURPOSE

Plastic surgery on the eyelids for the purpose of aesthetic or functional correction requires precise knowledge of lid anatomy. Changes in the tarsal curvature of the upper eyelid relative to line of vision are important, particularly when a surgical correction of paralytic lagophthalmos is undertaken. We used a computer-based image-processing algorithm to establish a relationship between changes in the curvature of the tarsus relative to the line of vision.

MATERIAL AND METHODS

A dynamic, ultrasound examination of the upper eyelids of 100 participants (100 eyes) was performed transpalpebrally using a 7.5 MHz scanner with the patient looking straight ahead, away from and towards the midline of the body. A computer-aided examination of the upper eyelid tarsus was then performed, followed by the calculation of the radius of curvature of the tarsus relative to the line of vision in each position.

RESULTS

Using regression of a Taylor polynomial, the shape of the tarsus was mapped by a quadratic function, and the change in tarsal curvature relative to line of sight could be demonstrated.

CONCLUSION

With objective evidence of change in the tarsal curvature relative to the line of sight, this may influence the treatment of pathological changes in the upper eyelid.

Lid loading for treatment of paralytic lagophthalmos

Lagophthalmos secondary to facial palsy is a most clinically important condition that requires effective and early treatment because prolonged corneal exposure may cause corneal lesions, ranging from corneal spots to corneal ulceration and finally blindness. Lid loading is the therapy used most commonly to treat the condition. This method was first described in 1950, modified in 1966, and popularized in 1974. Since its inception, only several reviews have referred to the technology, but they talked about only parts of this technology and did not provide information on the technology overall. This review discusses lid loading in detail. This method now often uses gold and platinum as the material for the implant and should be done as early as possible in those patients whose paralytic lagophthalmos has little chance of being reversed. This method has shown good clinical results and given patients a better perspective. Of course, this method has its intrinsic complications such as allergic reactions, extrusion, and migration. However, with modification of the implant and the surgical procedure, the complication rate has decreased. In conclusion, although lid loading cannot solve all the problems associated with the paralyzed eyelid, it is a simple, reversible, and effective way to treat paralytic lagophthalmos.

Patient satisfaction after lid loading in facial palsy

Paralytic lagophthalmos is treated by pretarsal implantation of eyelid weights consisting either of rigid gold weights or flexible platinum chains. Functional results being good, subjective patient satisfaction has been examined only by a small number of studies. The aim of our study, conducted by means of a questionnaire, was to assess subjective patient satisfaction after implantation of different eyelid implants. Questionnaires were sent to 42 patients treated by pretarsal implantation of a gold weight (group 1) and 51 patients with a pretarsally fixed platinum chain (group 2). In total, 46 response sheets were evaluated (16 x gold weight, 30 x platinum chain) and the results were compared. In group 1, 75% of patients were very satisfied to satisfied with the overall result. In group 2, 100% of patients were very satisfied to satisfied with the overall result. In group 1, an infection occurred in 6.5% of patients, an extrusion in 6.5%, and a change of vision in 31%. In group 2, inflammation occurred in 13%, extrusion in 0%, and a change of vision occurred in 13% of patients. On a visual analogous scale from 1 to 10 (1, very good; 10, very poor), group 1 assessed the cosmetic result with an average grade of 3.8 and the functional result with an average grade of 3.1. Group 2 assessed the cosmetic result with the grade 2.9 and the functional result with grade 3.0. The implantation of an eyelid weight for treatment of paralytic lagophthalmos was assessed as positive by a majority of patients. When compared with conventional gold implants, patients who have been treated with a flexible platinum chain are overall more satisfied and have a more favorable subjective view of the cosmetic results.

Microscopic findings of lateral tarsal fixation in Asians

PURPOSE

To identify microscopically lateral tarsal fixation in Asians.

METHODS

Specimens from 19 postmortem lateral eyelids and orbits of 11 Asians (11 right, 8 left; aged 45-96 years at death) were used. Samples damaged on sectioning and samples without tarsal plates were excluded. The samples were fixed in 10% buffered formalin and examined under a microscope. Two levels of tarsus were observed in the upper and lower eyelids, suggesting the possibility of different means of fixation. The first and second sections, which were incised parallel to the eyelid margin, were obtained at 1 mm and 5 mm from the upper eyelid margin, and at 1 mm and 3 mm from the lower eyelid margin. The sections were stained with Masson trichrome.

RESULTS

The first sections of all upper eyelids and those of the lower eyelids except one showed tarsal fixation by both the lateral rectus capsulopalpebral fascia (lr-CPF) and the tendon-ligament complex of the lateral canthal tendon (LCT), which in several cases received the muscle of Riolan. The second sections of all upper eyelids showed fixation by the lr-CPF and the ligamentous part of the LCT. The second sections of the lower eyelids were mostly similar to the second sections of upper eyelids, though some showed only ligamentous fixation. The lr-CPF in all cases included a small amount of smooth muscle fibers.

CONCLUSIONS

The lateral aspect of the tarsus is supported by the lr-CPF and the LCT, which in some cases includes the muscle of Riolan.

Ultrasonographic measurement of upper eyelid thickness in Korean children with epicanthus

Purpose

Upper eyelid thickness was measured to determine whether there is a difference in the thickness of the upper eyelids in children with and without epicanthus.

Methods

Children were enrolled into the epicanthus group or non-epicanthus (control) group. The children with epicanthus were classified into four subgroups according to the Duke-Elder's classification. The thickness of the upper eyelid was measured at five points with A-scan ultrasonography.

Results

There was no significant difference in upper eyelid thickness between the epicanthus group and control group (P>0.05) or between the subgroups of the epicanthus group (P>0.05).

Conclusions

This result suggests that the etiology of epicanthus may not be hypertrophy of soft tissue.