Entropion-ectropion: the influence of axial globe length on lower eyelid malposition

Prediction of exophthalmos by body mass index for craniofacial reconstruction: consequences for cold cases

It is inconvenient for a forensic practitioner to gather population-specific data before performing a facial reconstruction. The inconvenience may defeat the point of creating the reconstruction. The objective of this study was to evaluate a non-population-dependent method of determining exophthalmos. The protrusion of the eyeball is known to vary with the contents of the orbital cavity based on bony orbital resorption or increased or decreased fat contents, as well as according to relative eyeball size. Of use are available statistics on body mass index, and this is discussed within the context of eyeball protrusion. A weak positive correlation (0.3263) between the body mass index of the country where the study originated, and the degree of exophthalmos was found. The results suggest that eyeball protrusion rates can be established according to body mass index, and this framework may be more useful considering conventional police practices.

Involutional ectropion: etiological factors and therapeutic management

PURPOSE

Involutional Ectropion is commonly prevalent disorder of eyelid malposition caused by age-related degeneration of the periocular tissues. This study conducted to provide a summary and review of surgical practice for the management of lower eyelid involutional ectropion and enlist various causative factors that explain the pathogenesis.

METHODS

The review of literature on risk factors and surgical approaches for involutional lower eyelid ectropion, searched on PubMed from 1980 onwards.

RESULT

Multiple factors contribute to horizontal and vertical lower eyelid involutional ectropion. Several surgical practices have been described over the last years to address these factors. Lateral tarsal strip is the most used and effective surgery to treat horizontal laxity.

CONCLUSION

Knowledge of various contributing factors and surgical procedures will enable to design the most effective therapeutic management for lower eyelid involutional ectropion. surgical approaches are individualized depending on preoperative clinical evaluation of possible causative factors and concerning the predominant location of the ectropion will result in a high success rate.

A novel standardized distraction test to evaluate lower eyelid tension using three-dimensional stereophotogrammetry

Background

Standardized pre-operative assessment of the lower eyelid tension is essential to determine the optimal surgical technique. However, quantitative analysis using the conventional distraction test is inaccurate and user-dependent. Our purpose was to introduce a novel, standardized three-dimensional distraction test for measuring lower eyelid tension and to determine its standard values in a Caucasian population.

Methods

In 94 participants (50 men and 44 women; age 21-85 years), a 15.9-g weighted eyelid hook was used to pull down the lower eyelid. Two three-dimensional images were acquired with a VECTRA M3 stereophotogrammetry device-one in the neutral position without a hook and the other in the distracted position with the eyelid hook. The images of all participants in both positions were measured twice by a single observer.

Results

There was no clinical (>1 mm) or statistically significant difference between the two repeated measurements of all the inter-landmark linear distances in both positions (P≥0.05, respectively). The mean distracted displacement between the neutral and distracted position for margin reflex distance was 5.50±1.53 mm, without any age-specific difference (P=0.08); however, a significant gender-specific difference was observed as men had significantly greater displacement than women (P<0.001).

Conclusions

Our proposed standardized three-dimensional distraction test for assessing lower eyelid tension using an eyelid hook and a simple landmark-based system seems to provide high reliability. This novel and simple method might be helpful for the preoperative planning of eyelid surgeries.

A retrospective study of tailored surgery based on the mechanical balance principle for involutional entropion in the lower eyelid

OBJECTIVE

Involutional entropion in the lower eyelid is one of the most common eyelid disorders of the elderly. Despite the effectiveness of the widely used surgical procedures, recurrence rates have failed to improve. In this retrospective study, we aimed to assess surgical plans, effectiveness and safety of tailored surgery based on the mechanical balance principal in treating involutional entropion in the lower eyelid.

METHODS

A retrospective analysis of 47 patients (54 eyelids) diagnosed with involutional entropion in the lower eyelid and receiving tailored surgical treatment based on mechanical balance principle from 1 January 2016 to 31 December 2018 was carried out. Tailored surgical plans were developed according to the mechanical balance analysis of vertical, horizontal and sagittal directions.

RESULTS

All 54 eyelids with involutional entropion in the lower eyelid underwent advancement of the lower eyelid retractor (LER) through the conjunctiva. For patients with mild horizontal eyelid laxity, only LER advancement was performed. For moderate and severe horizontal eyelid laxities, combined horizontal reinforcement procedures were performed, including lateral canthopexy, lateral tarsal strip (LTS) surgery and wedge resection. The orbicularis oculi muscle (OOM) tightening or transposition was performed for OOM overriding. The follow-up time was 1 to 4 years, and there were no cases experiencing recurrence. Thus, the rates of effectiveness and recurrence were 100% and 0%, respectively.

CONCLUSIONS

This is the first descriptive study on the tailored surgical strategies designed according to the mechanism of mechanical imbalance involved in involutional entropion. Tailored surgery based on the mechanical balance principle is safe and effective with low recurrence.

Lower Eyelid Distraction Test: New Insights on the Reference Value

PURPOSE

The evaluation of palpebral laxity can be performed by the distraction test (DT). Although widely used in ophthalmologic practice, there is no consensus about the results considered normal by the test. The objectives of this study are to obtain the value of DT in a group of individuals with healthy eyelids and to compare with the measurements in subjects with senile ectropion.

METHODS

Lower eyelid DT was performed in 200 individuals without any eyelid pathology and in 30 individuals with lower lid ectropion. The results were analyzed by age and sex in the control group and compared with the results of the ectropion group.

RESULTS

The mean value of DT in the control group was 6.96 mm, lower than in the ectropion group (9.48 mm) (p < 0.001). In the control group, the mean female DT was 6.70 mm, while the male was 7.22 mm. There were differences in the DT values in the subgroups of 20-39 and 40-59-year old according to gender, with men presenting higher measurements than women. In the other age subgroups, both genders presented similar DT values. Even when considering only individuals in the control group with the same range of age as in the ectropion group, the DT value was higher in individuals with ectropion (7.23 and 9.48 mm, respectively, p < 0.001).

CONCLUSIONS

The mean DT value is 6.96 mm; however, the measurement varies according to age and sex in people without palpebral pathology. Individuals with senile eyelid ectropion present higher measurements than healthy ones.In this study, the authors performed the eyelid distraction test in 200 healthy individuals, bringing to the literature the new information that there is a variability of the normal test's value regarding age and gender.

Assessment of the Safety and Efficacy of Prolapsed Orbital Fat Resection During Involutional Entropion Repair

PURPOSE

To assess the recurrence rate of involutional entropion in patients treated with a combined approach including a modified Bick procedure, excision of preseptal orbicularis muscle, and conservative resection of prolapsed orbital fat.

METHODS

A retrospective chart review of patients undergoing repair of involutional entropion with the combined procedure including orbital fat resection and a second group with standard entropion repair without orbital fat resection was performed. Only patients with follow-up greater than 6 months were included in the study.

RESULTS

Seventy eyelids of 54 patients met all inclusion criteria for the combined procedure group over a 9-year period from 2008 to 2016. Average follow-up was 46.9 months. There was a documented recurrence of entropion in 1 eyelid during the follow-up period (1.4%). The remaining 69 cases had successful subjective and objective results without need for any additional procedures. In the group undergoing entropion repair without fat resection, 22 eyelids of 19 patients had the required follow-up period with a recurrence rate of 4.5% (p > 0.05).

CONCLUSIONS

The authors demonstrate good surgical success with a combined approach of a modified Bick procedure, preseptal orbicularis excision, and conservative orbital fat resection. Conservative fat resection during entropion repair was found to be safe, and the combined procedure was found to be effective with a rate of recurrent entropion of 1.4% on extended follow-up.The authors propose that orbital fat prolapse contributes to the mechanics of involutional entropion and that conservative orbital fat resection during surgical repair of entropion can be done safely, resulting in low recurrence rates.

A Comparison of Surgical Outcomes of Two Combination Surgeries for Involutional Entropion: Fixing 3 vs 2 Pathologic Components

The purpose of this study was to compare the surgical outcomes of two combinational surgeries for involutional entropion: Inferior retractor tightening (IRT) + lateral tarsal strip (LTS) + skin muscle excision (SME) vs LTS + SME. The authors reviewed the records of 2 groups which were made up of 80 (85 eyelids) and 58 (63 eyelids) involutional entropion patients with 71.4 and 71.8 years on average respectively. The 2 groups were categorized into Group A and Group B by different surgical techniques. The former underwent IRT + LTS + SME surgery between April 2004 and February 2014, while the latter received LTS + SME surgery between March 2014 and February 2018. The authors evaluated the surgical outcomes of 2 combinational surgeries. In Group A, 84 out of 85 (98.8%) lids were successfully corrected and 1 (1.2%) lower eyelid suffered from recurrence during the follow-up period of 26.5 ± 4.6 months. Two canthal deformity cases occurred in this group. In Group B, 62 out of 63 (98.2%) lids were successfully treated and there was 1 (1.8%) case of recurrence during the follow-up period of 21.0 ± 10.0 months. No cases of complications were noted. IRT + LTS + SME procedure took 26.4 ± 2.4 minutes and LTS + SME procedure took 20.6 ± 3.9 minutes (P < 0.001). The LTS + SME technique exhibited a comparable success rate with the IRT + LTS + SME operation. LTS + SME appeared to be significantly faster and safer compared to the IRT + LTS + SME procedure.

"The influence of orbital vector on involutional entropion and ectropion"

PURPOSE

This study aimed to evaluate the effect of orbital vector and other biometric parameters (i.e. axial globe length, axial globe projection) on the development of involutional entropion or ectropion.

METHODS

In this cross-sectional study, 167 eyes from 132 patients were included. Of these eyes, 128 had involutional entropion and 39 had involutional ectropion, all of lower lids. The axial globe projection was measured using Hertel exophthalmometry; axial globe length was assessed by A-mode ultrasound; and orbital vector was determined clinically. Patient-specific categorical variables and continuous variables were compared using the chi-square test and the two-sided t test, respectively. Correlations were derived using the Pearson correlation.

RESULTS

The percentage of females was 59% and 33.3% in the entropion group and in the ectropion group, respectively. A significant association was found between the gender and type of eyelid malposition (p = 0.015). Exophthalmometry reading was greater in the ectropion group than in the entropion group (17.7 ± 2.5 versus 10.8 ± 3.7 mm, respectively; p < 0.001). There was no significant correlation between axial globe length and exophthalmometry reading. Positive orbital vectors were observed in 87.5% of eyelids with involutional entropion. Negative orbital vectors were observed in 92.3% of eyelids with involutional ectropion (p < 0.001). Patients with negative orbital vectors showed greater axial globe projection than patients with positive orbital vectors (18.0 ± 2.1 versus 10.6 ± 3.5 mm, respectively; p < 0.001).

CONCLUSIONS

There is an association between orbital vector measurement and involutional entropion and ectropion. Measuring the orbital vector may help predict the development of these lid malpositions.

Association of Involutional Lower Eyelid Entropion with Reduced Upper Eyelid Position Relative to the Corneal Light Reflex: Quantification of Facial Asymmetry

PURPOSE

To investigate the association between upper eyelid position relative to the corneal light reflex (MRD1) and to delineate an association between eyelid height and involutional lower eyelid entropion.

METHODS

Retrospective study of patients presenting for entropion repair to an academic ophthalmic plastic surgery service. A total of 111 patients were included in the study; 95 had unilateral involutional lower eyelid entropion, and 16 had bilateral lower eyelid entropion. Patients with a history of previous eyelid surgery, trauma, upper eyelid entropion, or cicatricial changes were excluded from the study.

RESULTS

Of the 95 patients with unilateral involutional lower eyelid entropion, 45 (47.4%) had a lesser MRD1 on the side ipsilateral to the involutional lower eyelid entropion. In this unilateral group, the mean MRD1 (± standard deviation) on the ipsilateral to the involutional lower eyelid entropion was 2.9 (±1.2) mm, while the mean MRD1 on the contralateral side was 3.3 (±1.0) mm. This difference was 0.4 mm and was statistically significant (p < 0.0001). Most patients with unilateral involutional entropion demonstrated a right-sided involutional lower eyelid entropion (56 of 95; 58.9%), although this finding was not statistically significant (p = 0.083). The frequency of true blepharoptosis (MRD1 ≤ 2.0 mm) was 24 of 95 (25.3%) in the unilateral involutional entropion group and was even higher in the bilateral involutional lower eyelid entropion group, with 7 of 16 (43.8%) patients exhibiting bilateral blepharoptosis.

CONCLUSIONS

Patients presenting with involutional lower eyelid entropion tend to have a relatively reduced MRD1 on the ipsilateral (affected) side. When both lower eyelids are affected by involutional entropion, the reduced MRD1 tends to be more pronounced.

Recent Advances in Ophthalmic Plastic Surgery: Part 1-Eyelid

PURPOSE

The objective of this study was to provide an update of the current literature in ophthalmic and facial plastic surgery, specifically related to disorders of the eyelid.

DESIGN

This was a review of published literature from January 2012 to June 2013 METHODS: The authors conducted a PubMed literature search of English-language articles published between January 2012 and June 2013 using the following search terms: eyelid, congenital, acquired, infection, inflammation, trauma, tumor, ptosis, entropion, ectropion, lagophthalmos, botulinum toxin, fillers, blepharoplasty, and miscellaneous topics related to the disorders of the eyelid. The authors included original articles, review articles, and case reports with relevant new information that is of potential clinical use to a comprehensive ophthalmologist as well as to the subspecialist.

RESULTS

Current literature on the disorders of the eyelid is replete with useful clinical information of relevance to a practicing ophthalmologist. Major advances have been reported in understanding of the surgical anatomy and its applications, ptosis, entropion, ectropion, lagophthalmos, infection, inflammation, trauma, and tumors.

CONCLUSIONS

There seems to be tremendous excitement in revisiting the anatomy and pathology and modifying the management protocols and surgical procedures to achieve optimal results, as the subspecialty continues to advance at a brisk pace.

Influence of axial length on conjunctivochalasis

PURPOSE

To investigate the relation between the severity of conjunctivochalasis and the axial length (AL) of the eyeball.

METHODS

A prospective nonrandomized study was performed on 165 patients aged 51 to 88 years. The age, gender, medical history, ocular history, grade and other parameters of inferior conjunctivochalasis (classified as nasal, middle, and temporal), and AL were determined in all patients. Patients were divided into a short AL group (≤ 22.0 mm), a medium AL group (>22.0 to ≤ 24.0 mm), and a long AL group (>24.0 mm).

RESULTS

The short AL group tended to have higher grades of temporal and nasal conjunctivochalasis compared with the medium and long AL groups. Multivariate logistic regression analysis showed that the total conjunctivochalasis score (the sum of the scores for the temporal, middle, and nasal regions) was significantly associated with the age [odds ratio (OR) = 1.32, P = 0.001] and the AL (OR = 0.81, P = 0.029). In addition, the AL was independently associated with the grade of conjunctivochalasis after adjustment for age (OR = 0.80, P = 0.020).

CONCLUSIONS

This was the first assessment of the relationship between the AL and the grade of conjunctivochalasis. Our findings suggest that the severity of conjunctivochalasis is dependent on the AL, with a short AL contributing to the pathogenesis of conjunctivochalasis.