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Alsulaiman N, AlTayash SF, Alkadi DY, Alsuhaibani AH. The Art of Upper Eyelid Retraction Repair. Int Ophthalmol Clin 2023; 63:59-73. [PMID: 37439610 DOI: 10.1097/iio.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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A Surgeon's Armamentarium for Ocular Management in Facial Paralysis: A Comprehensive Review. J Craniofac Surg 2023; 34:214-221. [PMID: 36608099 DOI: 10.1097/scs.0000000000009089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/04/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To review the current management paradigm of the eye in patients with facial paralysis. METHODS A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were "ocular," "facial," "synkinesis," "palsy," "neurotization," and various combinations of the terms. A total of 65 articles were included. RESULTS Facial paralysis may result in devastating ocular sequelae. Therefore, assessment of the eye in facial paralysis is a critical component of patient management. Although the management should be individualized to the patient, the primary objective should include an ophthalmologic evaluation to implement measures to protect the ocular surface and preserve visual acuity. The degree of facial paralysis, lacrimal secretion, corneal sensation, and position of the eyelids should be assessed thoroughly. Patients with the anticipated recovery of facial nerve function may respond to more conservative temporizing measures to protect the ocular surface. Conversely, patients with expected prolonged paralysis should be appropriately identified as they will benefit from surgical reconstruction and rehabilitation of the periorbital complex. The majority of reconstructive measures within a facial surgeon's armamentarium augment coverage of the eye but are unable to restore blink. Eyelid reanimation restores the esthetic proportionality of the eye with blinking and reestablishes protective functions necessary for ocular preservation and function. CONCLUSIONS Ocular preservation is the primary priority in the initial management of the patient with facial paralysis. An accurate assessment is a critical component in identifying the type of paralysis and developing an individualized treatment plan.
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Landsberger H, Wang Y, Douglas RS. The Prominent Eye-What to Watch Out For. Facial Plast Surg Clin North Am 2021; 29:311-321. [PMID: 33906763 DOI: 10.1016/j.fsc.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Globe prominence (proptosis) may be caused by a variety of congenital or acquired conditions and poses unique challenges to aesthetic and reconstructive surgery. Once the underlying cause of proptosis is determined, a treatment plan consisting of surgical and medical procedures can be formed. Thyroid eye disease is the most common cause of proptosis and helps guide treatment options for proptosis. Although common eyelid and orbital procedures are used for proptosis correction, special care must be taken due to the unique difficulties of the distorted anatomy. Various surgical procedures and less invasive treatments can be combined to provide optimal aesthetic and functional results.
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Affiliation(s)
- Hannah Landsberger
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, 11766 Wilshire Blvd, Suite 325, Los Angeles, CA 90025, USA
| | - Yao Wang
- Department of Surgery, Division of Ophthalmology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raymond S Douglas
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Levator-Muller's recession using labial mucosa as a spacer in severe eyelid retraction. Can J Ophthalmol 2019; 54:678-681. [PMID: 31836099 DOI: 10.1016/j.jcjo.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the use of labial mucosa as a spacer for levator-Muller's recession in correction of severe eyelid retraction. DESIGN Retrospective interventional study. PARTICIPANTS We retrospectively reviewed records of 4 patients with severe upper eyelid retraction not associated with cicatricial diseases of the conjunctiva. METHOD Surgical correction of eyelid retraction was performed by Levator-Muller's recession using autologous mucosal graft (from lip) as a spacer through transconjunctival approach. Eyelid height and contour were the main outcome measures evaluated after surgery. RESULTS There was resolution of dry eye symptoms in all 4 cases. In 2 cases the corrected eyelid height was within 1 mm of the desired lid position. The lid contour was good in 2 cases and satisfactory in 2 cases because of mild lateral flare. The eyelid height remained stationary till the last follow-up, which ranged from Eyelid height and contour were the main outcome measures evaluated after surgery. 6-30 months (mean: 18 months). CONCLUSIONS Labial mucosal graft as a spacer for levator-Muller's recession is a good option for correction of severe upper eyelid retraction. It provides stable eyelid position within 3 months of surgery with no corneal complications.
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Olayanju JA, Griepentrog GJ, Mohney BG. Incidence and clinical characteristics of pediatric eyelid retraction. J AAPOS 2019; 23:213.e1-213.e4. [PMID: 31229605 PMCID: PMC7006648 DOI: 10.1016/j.jaapos.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/26/2019] [Accepted: 03/16/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the incidence and clinical characteristics of upper and lower eyelid retraction in children. METHODS The medical records of all pediatric patients (<19 years of age) diagnosed with upper and/or lower eyelid retraction from January 1, 1976, through December 31, 2010, were retrospectively reviewed. RESULTS A total of 85 patients were diagnosed during the 35-year period, of whom 15 were residents of Olmsted County, Minnesota, yielding an annual age- and sex-adjusted annual incidence of 1.38 per 100,000 persons (95% CI, 0.70-2.05), or 1 in 72,463. Upper eyelid retraction was documented in 38 patients (45%; 24 unilateral and 14 bilateral); lower, in 25 (29%; 12 unilateral and 13 bilateral); and both upper and lower in 18 (21%; 3 unilateral and 15 bilateral). It was not recorded in 4 patients. The most common causes of eyelid retraction were thyroid eye disease (48 [56%]), primary congenital eyelid retraction (11 [13%]), and trauma (9 [11%]). Although there were no cases of visual impairment secondary to eyelid retraction, tearing, ocular surface irritation, and photophobia were noted in 38 patients (45%). Nineteen patients (22%) underwent surgical eyelid correction. CONCLUSIONS Pediatric eyelid retraction is relatively rare, occurring in approximately 1 in 72,000. The leading causes of childhood eyelid retraction in this cohort were thyroid eye disease, primary congenital eyelid retraction, and trauma. No visual disturbances due to eyelid retraction were noted, and approximately 1 in 5 patients required corrective eyelid surgery.
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Affiliation(s)
- Jessica A Olayanju
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina
| | - Gregory J Griepentrog
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin Eye Institute, Milwaukee, Wisconsin
| | - Brian G Mohney
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
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Young SM, Kim YD, Lang SS, Woo KI. Transconjunctival Triamcinolone Injection for Upper Lid Retraction in Thyroid Eye Disease—A New Injection Method. Ophthalmic Plast Reconstr Surg 2018; 34:587-593. [DOI: 10.1097/iop.0000000000001120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rethinking Our Definition of Postoperative Success: A Comparative Analysis of Three Upper Eyelid Retraction Repair Techniques Using Novel Metrics to Capture Functional and Aesthetic Outcomes. Ophthalmic Plast Reconstr Surg 2018; 34:55-63. [DOI: 10.1097/iop.0000000000000868] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Joseph SS, Joseph AW, Smith JI, Niziol LM, Musch DC, Nelson CC. Evaluation of Patients with Facial Palsy and Ophthalmic Sequelae: A 23-Year Retrospective Review. Ophthalmic Epidemiol 2017; 24:341-345. [DOI: 10.1080/09286586.2017.1294186] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shannon S. Joseph
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew W. Joseph
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jane I. Smith
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Christine C. Nelson
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
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Joseph SS, Joseph AW, Douglas RS, Massry GG. Periocular Reconstruction in Patients with Facial Paralysis. Otolaryngol Clin North Am 2017; 49:475-87. [PMID: 27040589 DOI: 10.1016/j.otc.2015.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Facial paralysis can result in serious ocular consequences. All patients with orbicularis oculi weakness in the setting of facial nerve injury should undergo a thorough ophthalmologic evaluation. The main goal of management in these patients is to protect the ocular surface and preserve visual function. Patients with expected recovery of facial nerve function may only require temporary and conservative measures to protect the ocular surface. Patients with prolonged or unlikely recovery of facial nerve function benefit from surgical rehabilitation of the periorbital complex. Current reconstructive procedures are most commonly intended to improve coverage of the eye but cannot restore blink.
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Affiliation(s)
- Shannon S Joseph
- Division of Oculoplastic Surgery, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
| | - Andrew W Joseph
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Raymond S Douglas
- Division of Oculoplastic Surgery, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA
| | - Guy G Massry
- Ophthalmic Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 150 North Robertson Boulevard, Suite 314, Beverly Hills, CA 90211, USA.
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Wolkow N, Chodosh J, Freitag SK. Innovations in Treatment of Lagophthalmos and Exposure Keratopathy. Int Ophthalmol Clin 2017; 57:85-103. [PMID: 28885249 DOI: 10.1097/iio.0000000000000185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Abstract
Although reoperation rates for upper lid retraction surgery for thyroid eye disease (TED) typically range between 8% and 23%, there is little literature describing the outcomes of these second operations. In this retrospective observational cohort study, all patients that underwent surgery for upper eyelid retraction over a 14-year period at a single institution were included. Cases were included if a second eyelid retraction surgery was performed during the study period. Success of surgery was defined as a marginal reflex distance (MRD1) of 2.5 to 4.5 mm in each eye and less than 1 mm difference in MRD1 between the eyes. Overcorrection and undercorrection were defined as above and below these bounds, respectively. 72 eyes in 49 patients were included in the study. The mean age was 56.6 (±11.5) years. By definition, all patients had at least 1 lid lengthening surgery for upper eyelid retraction, and at least 1 subsequent surgery. For this second surgery, 61 eyes (85%) underwent retraction surgery and 11 eyes (15%) underwent ptosis surgery. After this second operation, 31% were undercorrected and 33% were overcorrected. A third surgery was performed in 19 eyes (25%), 12 had surgery for residual retraction and 7 for ptosis. After the third operation 10% of eyes were under corrected and 11% were over corrected. Four patients underwent a fourth surgery: one for retraction and three for ptosis. Success was noted in 35% after the second surgery and 44% after the third. Surgical success in eyelid retraction surgery increases from a second to a third consecutive surgery, and residual asymmetry was roughly equally distributed between over- and undercorrection.
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Affiliation(s)
- Shani Golan
- a Department of Ophthalmology , University of California-Los Angeles , Los Angeles , California , USA
| | - Dan B Rootman
- a Department of Ophthalmology , University of California-Los Angeles , Los Angeles , California , USA
| | - Robert A Goldberg
- a Department of Ophthalmology , University of California-Los Angeles , Los Angeles , California , USA
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Rajabi MT, Shadravan M, Mazloumi M, Tabatabaie SZ, Hosseini SS, Rajabi MB. Bupivacaine Injection for Management of Lagophthalmos Due to Long-Standing Idiopathic Facial Nerve Palsy. Ophthalmic Plast Reconstr Surg 2015; 31:459-62. [PMID: 25675168 DOI: 10.1097/iop.0000000000000387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the results of bupivacaine injection into the orbicularis oculi muscle to treat lagophthalmos in patients with long-standing Bell palsy. METHODS In this prospective interventional case series, bupivacaine, 5 ml of a 0.750% solution, was injected into the preseptal and pretarsal area of the orbicularis oculi in each of 10 patients with idiopathic peripheral facial nerve palsy. The measures of vertical eyelid apertures during open and closed eyes were made before the procedure and 1, 3, and 6 months after injection. RESULTS A total of 10 eyes including 2 men and 8 women with an average age of 43 years (26-64 years) were studied. The mean amount of lagophthalmos before injection and after 6 months of follow up were 3.9 mm and 2.3 mm, respectively (p = 0.01)). The mean amount of corneal exposure before injection and after 6 months of follow up was 1.05 mm and 0.25 mm, respectively (p < 0.01). The mean scleral show in open eyes before injection and after 6 months of follow up were 1.20 mm and 0.75 mm, respectively (p = 0.08). The mean scleral show in closed eyes before injection and after 6 months of follow up were 1.95 mm and 1.15 mm, respectively (p = 0.01). All the patients reported significant decrease in epiphora. CONCLUSION Bupivacaine injection in the paretic orbicularis oculi muscle improves eyelid closure and lagophthalmos and epiphora.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Department of Ophtalmology, Tehran University of Medical Sciences, Tehran, Iran
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Modified full-thickness anterior blepharotomy for upper eyelid retraction in children. J AAPOS 2013; 17:223-4. [PMID: 23522943 DOI: 10.1016/j.jaapos.2012.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/19/2012] [Accepted: 11/19/2012] [Indexed: 11/20/2022]
Abstract
Graded full-thickness anterior blepharotomy has been used to treat eyelid retraction in adult patients with thyroid eye disease. We report 2 children diagnosed with upper eyelid retraction who underwent a modified full-thickness anterior blepharotomy. In both cases, symptoms resolved and cosmetically acceptable outcomes were achieved.
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Treatment of upper eyelid retraction related to thyroid-associated ophthalmopathy using subconjunctival triamcinolone injections. Graefes Arch Clin Exp Ophthalmol 2012; 251:261-70. [PMID: 22968823 DOI: 10.1007/s00417-012-2153-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 08/24/2012] [Accepted: 08/24/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To evaluate the efficacy of subconjunctival triamcinolone injection for treating upper eyelid retraction caused by thyroid-associated ophthalmopathy (TAO). METHODS Prospective single blind randomized clinical trial. Patients diagnosed with TAO-associated eyelid retraction and/or swelling <6 months before study onset were randomly assigned to triamcinolone-injected (group I; 55 patients, 75 eyes) or observation-only (group II; 40 patients, 59 eyes) populations. Group I received 1-3 injections of 20 mg triamcinolone acetate into the subconjunctival eyelid, between the conjunctiva and Muller's muscle, at 3-week intervals. Group I was followed up at 3, 6, 9, and 24 weeks post-injection, and group II was evaluated at 9 and 24 weeks after initial visit. Eyelid swelling and retraction were each graded on a 0-3 scale. Treatment was stopped after 1-2 injections if both swelling and retraction resolved completely or if retraction and swelling scored 0/1 or 1/0 without functional or cosmetic patient concerns. Treatment success was defined at 9 and 24 weeks post-injection if eyelids were normal or when treatment was terminated because of early clinical resolution. We compared baseline clinical data between success and failure group evaluated at 9 and 24 weeks in group I, and investigated short-term and long-term success prognostic factor using multiple logistic regression analysis in each group I and II. RESULTS Swelling and retraction decreased significantly more in group I than in group II. Significantly more eyes had severe swelling (≥ grade 2) in group I (67 %) than in group II (34 %) upon initial evaluation (p < 0.01); this difference disappeared at 9 and 24 weeks. Fewer severely retracted eyes were observed in group I than in group II at 9 and 24 weeks (p < 0.01). Significantly more eyes in group I achieved success at both 9 and 24 weeks (59 %, 75 %) than in group II (39 %, 57 %) (p = 0.03, p = 0.04 respectively). Higher initial retraction grades (2-3) predicted a higher chance of post-injection failure versus the reference group (grade 0-1) at 9 and 24 weeks in group I, with adjusted odds ratios (aOR) 45.4 (95 % CI = 5.9-351.1, p < 0.01) and aOR 11.6 (95 % CI = 2.3-58.5, p < 0.01) respectively. Similarly in group II, initial retraction grade was associated with the failure at 9 and 24 weeks, with aOR 10.3 (95 % CI = 1.8-59.6, p < 0.01) and aOR 5.9 (95 % CI = 1.3-25.9, p < 0.05) respectively. Transient intraocular pressure elevation was observed in three eyes of two patients, although all ocular pressures were normalized within 1 month using anti-glaucoma medication. CONCLUSIONS Subconjunctival triamcinolone injections were very effective in resolving eyelid swelling and retraction in recent-onset TAO. However, the symptom-reducing effect of triamcinolone was modest and less effective in patients initially presenting with severe retraction grades. As intraocular pressure may rise after steroid injection at upper eyelid, the treatment should be avoided in patients suspected to have glaucoma.
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Periodic Unilateral Eyelid Retraction in a Pediatric Patient. J Neuroophthalmol 2012. [DOI: 10.1097/01.wno.0000415556.63269.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A review of surgical techniques to correct upper eyelid retraction associated with thyroid eye disease. Curr Opin Ophthalmol 2012; 22:391-3. [PMID: 21730842 DOI: 10.1097/icu.0b013e3283499433] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We review the literature pertinent to surgical correction of upper eyelid retraction resulting from thyroid eye disease (TED). RECENT FINDINGS Although novel nonsurgical treatment of TED-upper eyelid retraction has been described, with botulinum A toxin and hyaluronic acid; graded full-thickness blepharotomy remains the mainstay of treatment for the condition. SUMMARY Graded full-thickness anterior blepharotomy provides predictable, reproducible results and is a simple surgical procedure to master. For patients who cannot undergo surgical intervention, botulinum toxin offers a novel nonsurgical answer to lid retraction, but may be complicated by overcorrection and introduces an additional variable that needs to be considered when following the patient.
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Shortt AJ, Bhogal M, Rose GE, Shah-Desai S. Stability of eyelid height after graded anterior-approach lid lowering for dysthyroid upper lid retraction. Orbit 2011; 30:280-288. [PMID: 22132845 DOI: 10.3109/01676830.2011.604897] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the outcome of a modified anterior approach surgical procedure for the correction of primary upper eyelid retraction in thyroid eye disease. METHODS A retrospective review of 52 consecutive cases (in 32 patients) of anterior-approach graded upper lid lowering for the treatment of primary eyelid retraction, carried out at Moorfields Eye Hospital between 2006-2009 was conducted. Measurements of upper margin-reflex distance (MRD), upper lid skin crease height and skin fold height were taken from clinical records and photographs. A comparison between pre-operative and both early and late post-operative measurements was conducted, with a maximal follow-up of 12 months. Surgery was considered successful when all of the following criteria were met; an upper lid margin covering 0.5-1.5 mm of the superior cornea in the 12 o'clock position, smooth eyelid contour, skin crease height within 6-10 mm or upper lid skin fold within 2-5 mm of the lid margin, symmetry of lid position (difference in MRD of < 1 mm between both eyes) and patient satisfaction. RESULTS A successful outcome was achieved in 86.5% (45/52) of lids with a single procedure. For the whole group, the mean MRD was 7.0 mm pre-operatively and 3.6 mm at 1 month after surgery. The corresponding values from photographic estimates were 6.5 mm and 3.6 mm, respectively. These values remained stable over the maximum follow-up period of 12 months. Under-correction occurred in 6/52 (11.5%) lids, one of which had persistent lateral flare, whereas over-correction occurred in 1/52 (2%). CONCLUSIONS The described surgical approach produces reasonably predictable and stable outcome for upper eyelid lowering in patients with thyroid eye disease.
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Abstract
PURPOSE To report 2 cases of severe keratopathy in patients with AIDS with delayed diagnosis of lagophthalmos. METHODS Observational case report. RESULTS The first patient presented with a corneal abscess attributed to old trauma. He responded poorly to topical treatment and suffered corneal penetration. Penetrating keratoplasty was performed, but persistent epithelial defects appeared. Finally, occult lagophthalmos was discovered. Topical ocular lubrication, eye occlusion, and lateral tarsorrhaphy were insufficient, and the graft became conjunctivalized. The second patient had corneal opacity and severe pannus in his right eye and mild punctate keratopathy in his left eye. The left cornea worsened despite treatment with lubricants. In an examination 2 weeks later, we detected a subtle lagophthalmos, which was complicated by upper eyelid retraction in the right eye. A bilateral upper blepharotomy improved the keratopathy. CONCLUSIONS Patients with AIDS with severe weight loss can present with lagophthalmos because of adipose and muscular atrophy in the so-called wasting syndrome. Lagophthalmos in patients with AIDS can be difficult to detect. Clinically significant lagophthalmos is associated with ocular surface lesions in patients with AIDS with wasting syndrome.
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Palpebral spring in the management of lagophthalmos and exposure keratopathy secondary to facial nerve palsy. Ophthalmic Plast Reconstr Surg 2009; 25:270-5. [PMID: 19617783 DOI: 10.1097/iop.0b013e3181ab6f08] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the use of a palpebral spring, a dynamic facial reanimation technique, in the management of lagophthalmos and exposure keratopathy secondary to facial nerve palsy. METHODS A palpebral spring was placed in 29 eyelids of 28 patients with symptomatic facial nerve palsy. Preoperative and postoperative symptoms, upper eyelid margin to midpupil distance, lagophthalmos, and exposure keratopathy were evaluated. RESULTS At an average of 83 months follow-up, preoperative symptoms improved or resolved in 26 (90%) eyes. The upper eyelid margin to midpupil distance decreased and lagophthalmos and exposure keratopathy significantly improved after palpebral spring placement (p < 0.001). After modification of the technique by suturing the spring to the anterior tarsal surface, rather than encasing the tip in a silicone tube and letting it ride freely, tension of the spring required adjustment in 4 eyes (27%). Dislocation of the spring from the tarsus without exposure through the skin was observed in 1 eyelid (7%). The spring was replaced because of loss of function secondary to metal fatigue in 5 eyelids (33%) after an average of 43 months. Exposure of the spring through the skin was observed in 2 eyelids (14%) and required spring removal from 1 eyelid and replacement of the spring in the other. CONCLUSION A palpebral spring is an effective treatment for lagophthalmos and exposure keratopathy in patients with facial nerve palsy who do not receive adequate relief from the static procedures of lower eyelid tightening and upper eyelid lowering. This technique significantly improved symptoms and signs in these patients while allowing some of the blink reflex.
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Saldana M, Gupta D, Khandwala M, Beigi B. Lid retraction following glaucoma filtering surgery: a case series and literature review. Orbit 2009; 28:363-367. [PMID: 19929660 DOI: 10.3109/01676830903180306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To describe 5 cases of lid retraction associated with large cystic glaucoma filtering blebs. METHODS Retrospective case reports and literature review. RESULTS All 5 patients had lid retraction due to glaucoma filtering blebs. Two were successfully managed surgically by graded blepharotomy with resolution of lid retraction and bleb dysesthesia symptoms. Three patients were managed symptomatically. CONCLUSIONS Lid retraction due to cystic glaucoma blebs is an unusual entity and a diagnosis of exclusion. The exact pathogenesis of the condition is unclear. Conservative, medical and surgical interventions exist to manage the lid retraction and any associated bleb dysesthesia.
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Affiliation(s)
- Manuel Saldana
- Norfolk and Norwich NHS Trust, Ophthalmology, Colney Lane, Norwich, United Kingdom
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Bibliography. Current world literature. Pediatrics and strabismus. Curr Opin Ophthalmol 2007; 18:434-6. [PMID: 17700239 DOI: 10.1097/icu.0b013e3282f0361d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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