EYELID POSTERS
Anatomy Of The Medial Lower Eyelid: Implications For Eyelid
Reconstruction In This Region
Neha Patel, MD, Nancy A. Tucker, MD.
University of Chicago, Chicago, IL.
Introductory Sentence:
Removal of medial lower eyelid tumors that include the punctum may lead to a scalloping deformity when reconstruction
is acheived via direct closure.We propose that if the margins are closed by supra-pacing the lateral edge of the wound
higher than the nasal edge, one may alleviate this dilemma. This study was conducted to measure the natural upward
projection in the medial eyelid in the region of the punctum in normal eyelids, to provide some guidance to eyelid
reconstruction in this region.
Methods: Lid measurements were taken in a group of normal patients who had not undergone previous eyelid surgery
between the ages of 19 and 65 years. Sixty six eyelids of 33 patients (20 female and 13 male) were photographed. The
upward vertical projection of the lid at the punctum was calculated. This was done by drawing a line connecting the
medial canthus to the lowest point of the lid in its mid portion. A perpendicular line was then drawn to the punctum. The
perpendicular vertical displacement at the punctum was calculated.
Results: The mean vertical eyelid displacement at the punctum was 0.757 +/- 0.396mm. Measurements varied from
0mm to1.5mm, the median was 0.75mm. No significant difference was found between males and females.
Conclusions: We found the mean punctal height to be 0.75 mm and concluded that when removing lower eyelid tumors
by wedge resection in this region, it is beneficial to appose the lateral edge of the wound 1 to 1.5 mm higher than the
nasal edge. This preserves the contour of the lower lid after the punctum is removed. This technique has not been
previously described but when employed, we feel decreases the incidence of unfavorable side effects and maintains
eyelid symmetry.
Bibliography:
1. Barraco P, Hamedani M, Ameline-Audelan V, et al. Surgical treatment of eyelid tumors. J Fr d"Ophtalmol 2003;
26(1):92-102
2. Jelks GW, Glat PM, Jelks EB, Longaker MT. Medial reconstruction using a medially based upper eyelid myocutaneous
flap. Plast Reconstr Surg 2002; 110(7):1636-43
3. Wittkampf AR, Mourits MP. A simple method for medial canthal reconstruction. Int J Oral Maxillofacial Surg 2001;
30(4):342-3
Author Disclosure Block:
N. Patel, None; N.A. Tucker, None.
Pain Associated With Eyelid Local Infiltration: A Prospective Study
Comparing Standard Technique With A Computer Generated Infiltration
Device
Nancy A. Tucker, MD.
University of Chicago, Orland Park, IL.
Introductory Sentence: This study was designed to determine if the pain associated with local infiltration of the eyelid for
minor eyelid surgery could be reduced using computerized local anesthesia delivery (WAND) as compared to standard
infiltration technique.
Methods: 40 patients undergoing minor eyelid surgery were randomized into receiving local infiltration via a standard
infiltration technique (20 patients) or the WAND (20 patients). All patients were infiltrated with 2% lidocaine epinephrine
using a 32 gauge needle. A visual analogue scale was used to determine the severity of pain experienced (on a scale of 0
to 10), and the total duration of pain was also recorded.
Results: The mean pain experienced (on the visual analogue scale) was 5, lasting 32 seconds with standard technique as
compared to 1 lasting 3 seconds using the WAND. Patient age, volume of injection, and total duration of injection did not
differ significantly between the two groups.
Conclusions: The pain associated with infiltration into the eyelid during minor eyelid surgery can be significantly reduced
using a computer generated infiltration technique (WAND). This device has been used primarily in pediatric dentistry, but
has not previously been evaluated in eyelid surgery.
Bibliography:
1. Hochman M, Chiarello D, Hochman CB et al. Computerized local anesthetic delivery vs traditional syringe technique.
Subjective pain response. NY State Dent J 1997; 63(7):24-9
2. Nicholson JW, Berry TG, Summit JB, et al. Pain perception and utility: a comparison of the syringe and computerized
local injection techniques. Gen Dent 2001; 49(2):167-73
3. Ram D, Peretz B. The assessment of pain sensation during local anesthesia using a computerized local anesthesia
(WAND) and a conventional syringe. J Dent Child 2003:70(2):130-3.
4. Palm AM, Kirkegaard U, Poulsen S. The wand versus traditional injection for mandibular nerve block in children and
adolescents: perceived pain and time of onset. Pediatr Dent 2004; 26(6):481-4
Author Disclosure Block:
N.A. Tucker, None.
Superior Tarsectomy Augments Super-Maximum Levator Resection in
Correction of Severe Blepharoptosis With Poor Levator Function
John Pak, M.D., Ph.D., Allen M. Putterman, M.D..
University of Illinois, Chicago, IL.
Abstract Body:
Introductory Sentence:
Objective: To determine if a superior tarsectomy improves the ptosis corrective ability of the super maximum levator
resection in cases of severe blepharoptosis with poor levator function (less than 5 mm).
Methods: Design: Retrospective, consecutive case series.
Participants: Patients who underwent super maximum levator resection with (8 eyelids) or without superior tarsectomy
(10 eyelids) at one institution.
Methods: Chart review of patients who underwent super maximum levator resection with or without superior tarsectomy.
Data regarding eyelid position, surgical outcome and postoperative complications were evaluated.
Main Outcome Measures: Margin reflex distance-1, bilateral eyelid symmetry, postoperative complications. Results: A
statistically significant improvement in ptosis correction was demonstrated when integrating the superior tarsectomy with
the super maximum levator resection (P=0.029). In addition, the superior tarsectomy significantly decreased the
incidence of undercorrection (margin reflex distance-1 values less than 2.0 mm) compared with the super-maximum
levator resection alone (12.5% vs 70%, P = 0.023). Improved postoperative eyelid symmetry within 1.0 and 1.5 mm
was demonstrated in cases treated by the superior tarsectomy. Postoperative complications were similar in both
treatments. Conclusions: The super maximum levator resection combined with superior tarsectomy is safe and
efficacious in the correction of severely ptotic eyelids with Berke levator function ranging from 3 mm to 4.5 mm.
Bibliography: References
1. Callahan M, Beard C. Beard’s Ptosis, 4th ed. Birmingham, Ala: Aesculapius Publishing Co; 1990:113-167.
2. Holds JB, McLeish WM, Anderson RL. Whitnall's sling with superior tarsectomy for the correction of severe unilateral
blepharoptosis. Arch Ophthalmol 1993;111:1285-91.
3. Anderson RL, Jordan DR, Dutton JJ. Whitnall's sling for poor function ptosis.
Arch Ophthalmol(9) 1990;108:1628-32.
3. Epstein GA, Putterman AM. Super-maximum levator resection for severe unilateral congenital blepharoptosis.
Ophthalmic Surg 1984;15:971-79.
4. Sarver BL, Putterman AM. Margin limbal distance to determine amount of levator resection. Arch Ophthalmol
1985;103(3):354-6.
5. Putterman AM: Congenital ptosis of the eyelid. In: Cohen M, ed. Mastery of Plastic and Reconstructive Surgery.
Boston: Little, Brown; 1994:chap 56.
6. McCord CD Jr. An external minimal ptosis procedure: external tarsoaponeurectomy. Trans Am Acad Ophthalmol
Otolaryngol 1975;79:683-86.
7. Baylis HI, Shorr N. Anterior tarsectomy reoperation for upper eyelid blepharoptosis or contour abnormalities. Am J
Ophthalmol 1977;84:67-71.
8. Lesavoy MA, Dubrow TJ, Eisenhauer DM, Sanders G. Upper eyelid ptosis correction by a revised tarsal resection
technique. Ann Plast Surg 1990;25:7-13.
9. Anderson RL, Dixon RS. Aponeurotic ptosis surgery. Arch Ophthalmol 1979;97:1123-28.
Biography:
Author Disclosure Block:
J. Pak, None; A.M. Putterman, None.
Autogenous Temporalis Fascia For Frontalis Suspension In Poor Levator
Function Ptosis
Jane M. OLVER, FRCOphth, Krishna Tumuluri, MD.
Western Eye Hospital, London.
Abstract Body:
Introductory Sentence:
Autogenous Temporalis Fascia (ATF) may be used for frontalis suspension in poor levator function ptosis. We aimed to
demonstrate the harvest technique via a small incision and its use.
Methods:
5 adult patients with myopathic ptosis underwent ATF graft harvest and frontalis suspension in a Fox pentagon
configuration under local anaesthesia.
Results:
A 3 cm x 2 cm sized rectangle of deep temporalis fascia was harvested under local anaesthesia via a 2cm scalp incision.
From this small piece, a longitudinal strip of up to 15 cm long was fashioned and effectively used for frontalis suspension.
Conclusions:
ATF is easy to harvest via a small incison and useful for frontalis suspension.
Bibliography:
Morax S, Longueville E, Hurbli T. Traitement chirurgical des ptosis myopathiques. Annals Chir Plast Esth 1992, 37:408416
Fan J. Frontalis suspension technique with a temporal-fasciae-complex sheet for repairing blepharoptosis. Aesth Plast
Surg 2001,25:147-51
Author Disclosure Block:
J.M. Olver, None; K. Tumuluri, None.
Identification of a Mexican Family with Ptosis and Congenital Fibrosis of
the Extraocular Muscles (CFEOM) and a Heterozygous Mutation of
Kinesin KIF21A
Laryssa R. Dragan, MD1, Douglas Federick, MD2, Stuart R. Seiff, MD2, Reza Vagefi, MD2, Constantine Voyevidka, BS3,
W-M Chan4, Caroline Andrews, MS4, Elizabeth C. Engle, MD4.
1
Colorado Permanente Medical Group, Denver, CO, 2University of California San Francisco, San Francisco, CA, 3University
of Nevada, Reno, NV, 4Harvard University, Boston, MA.
Introductory Sentence:
A new CFEOM1 Mexican pedigree has been identified and evaluated by genetic sequence analysis of KIF21A.
Methods:
A pedigree was constructed from an index case patient with congenital ptosis associated with CFEOM. Available members
of this pedigree were evaluated for CFEOM features via examination of eyelids, ocular motililty, slit lamp examination and
ophthalmoscopy. Samples of blood, or buccal DNA swabs, were collected for genetic analysis.
Results:
Five affected and eleven non-affected family members from three generations of a Mexican CFEOM pedigree participated
in the study. Of the affected participants, all but one had congenital bilateral ptosis and infraduction ophthalmoplegia
consistent with CFEOM1. Genetic evaluation of CFEOM in this family revealed mutations in a kinesin motor protein coded
by KIF21Al on chromosome 12. Of participants scanned with MRI, no structural brain abnormality was noted.
Conclusions:
CFEOM is a congenital non-progressive restrictive ocular motility disorder affecting extraocular muscles innervated by the
oculomotor and trochlear nerves. Many of these patients had previously been classified as congenital third nerve palsies.
Patients classically have congenital ptosis and infraducted globes. Several forms of CFEOM exist, and have been found in
diverse ethnic groups. The addition of a new Mexican pedigree with CFEOM1, with the genetic defect in kinesin KIF21A,
adds to the compendium of knowledge about CFEOM1. Oculoplastic surgeons should be aware of the clinical features of
CFEOM, and its association with aberrant development of cranial nerve motor nuclei in the midbrain and pons. As CFEOM
may be associated with structural abnormalities of the brain, consideration should be given to neuroimaging these
patients as part of their diagnostic evaluation.
Bibliography:
1.
Yamada K, et al. Heterozygous mutations of the kinesin KIF21A in congenital fibrosis of the extraocular muscles type 1
(CFEOM1). Nat Genet. 2003 Dec 35(4):318-21. Epub 2003 Nov 2.
2.
Engle EC, et al. CFEOM1, the classic familial form of congenital fibrosis of the extraocular muscles, is genetically
heterogeneous but does not result from mutations in ARIX. BMC Genet 2002, 3(1):3. Epub 2002 Mar 6.
3.
Engle EC. The molecular basis of the congenital fibrosis syndromes. Strabismus. 2002 Jun;10(2):125-8.
4.
Mackey DA, et al. Congenital fibrosis of the vertically acting extraocular muascles maps to the FEOM3 locus. Hum Genet.
2002 May; 110(5):510-2. Epub 2002 Mar 23.
5.
Sener EC,et al. A clinically variant fibrosis syndrome in a Turkish family maps to the CFEOM1 Locus on Chromosome 12.
Arch Ophth. Aug 2000; 118(8):1090-1097.
Author Disclosure Block:
L.R. Dragan, None; D. Federick, None; S.R. Seiff, None; R. Vagefi, None; C. Voyevidka, None; W. Chan, None; C.
Andrews, None; E.C. Engle, None.
Graded Full-thickness Anterior Blepharotomy for the Treatment of Upper
Eyelid Retraction
Adam S. Hassan, MD, Stephen D. Reck, MD, Hakan Demirci, MD, Bartley R. Frueh, MD, Victor M. Elner, MD, PhD.
University of Michigan, Ann Arbor, MI.
Purpose: Upper eyelid retraction results in exposure keratopathy and cosmetic deformity. We previously reported the
efficacy of graded anterior blepharotomy to treat Graves’ eye disease-induced upper eyelid retraction. This study
examines its use in patients with upper eyelid retraction due to other causes.
Methods: Eleven eyelids of 10 patients with upper eyelid retraction causing symptomatic ocular exposure were treated
with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure
symptoms, upper lid position, lagophthalmos, and keratopathy were compared.
Results: Two men and eight women patients, 4 with paralytic, 3 with post-surgical, and 1 each with cicatricial,
traumatic, and idiopathic upper eyelid retraction, underwent full-thickness blepharotomy. At an average of 11 months
followup, more than 90% of preoperative symptoms resolved. Upper eyelid position (P=.001), lagophthalmos (P=.02),
and keratopathy (P=.03) were significantly improved. No contour abnormalities occurred in any of the eleven eyelids.
Eyelid crease changes, all 1 mm or less, occurred in three patients. There were no intraoperative or postoperative
complications. The average surgical time was 22 + 6.0 minutes per eyelid.
Conclusions: Graded anterior blepharotomy for upper eyelid retraction is a safe and effective surgical treatment for
symptomatic upper eyelid retraction. This technique achieves excellent functional and cosmetic outcomes.
Bibliography: Elner VM, Hassan AS, Frueh BR. Graded full thickness anterior blepharotomy for upper eyelid retraction.
2004. Arch Ophthalmol. 122:55-60.
Elner VM, Hassan AS, Frueh BR. Graded full thickness anterior blepharotomy for upper eyelid retraction. 2003. Trans Am
Ophthalmol Soc. 10:67-76.
Author Disclosure Block:
A.S. Hassan, None; S.D. Reck, None; H. Demirci, None; B.R. Frueh, None; V.M. Elner, None.
Single-unit Retractor Recission for Upper Lid Retraction
Karim Punja, MD, Don O. Kikka, MD, Cintia Comi, MD, Nonette Y. Pasco, MD, Bobby S. Korn, MD.
University of California, San Diego, La Jolla, CA.
Introductory Sentence:
Upper eyelid retraction is a cardinal feature of thyroid orbitopathy. Surgical techniques have addressed this condition but
a reliably predictable method has remained elusive.
Methods:
A retrospective review of 25 patients from 1998-2004. Surgical correction of upper lid retraction on all done by one
surgeon. Technique involves a transcutaneous lid crease approach. The orbital septum is kept intact to prevent upward
migration of the lid crease. The levator aponeurosis and Mueller’s muscle are recessed as a single unit, creating a plane
in between Mueller’s muscle and conjunctiva. The lateral horn is not released. No traction suture is placed. Data obtained
included pre- and post-operative measures of margin reflex distance-one (MRD1), lagophthalmos, presence/absence and
severity of keratopathy, symptomatic ocular discomfort and length of follow-up. A paired t-test was used to determine
statistical significance.
Results: 21 females and 4 males had average age of 57. Follow-up ranged from 3 months to 4 years. Twenty-three
patients underwent bilateral retraction repair; two patients had unilateral retraction repair. Revisions were done in 15
eyes. 7 for consecutive ptosis and 8 cases of residual lid retraction. Consecutive ptosis was managed in office in early
postoperative period with levator advancement. Punctate keratopathy resolved in 23 of 25 patients except in two
subjects who showed improvement , not full resolution of keratopathy at 6 months. Pre-operative MRD1 (mm) mean
value is 7.1 (SD=2.1) and post operative MRD1 value is 3.9 (SD = 1.2); pre-op lagophthalmos (mm) mean value is
0.8(SD=1.0) and post-op mean value is 0.1 (SD=0.38). Paired t-test showed a statistically significant difference between
pre and post-operative lid level (p<0.01) as well as a significant difference between pre and post surgical lagophthalmos
(p<0.01).
Conclusions:
Modified levator-Mueller’s muscle recession technique is effective procedure to address upper lid retraction secondary to
Grave’s disease. Technique differs from previous methods by keeping orbital septum intact, recessing the upper lid
retractors in a single unit, and not cutting the lateral horn of the levator. Early revision allows for precise correction of
consecutive ptosis.
Bibliography:
1. McNab AA, Galbraith JE, Friebel J, Caesar R. Pre-Whitnall Levator Recession with hang-back sutures in Graves
orbitopathy. Ophthal Plast Reconstr Surg 2004; 20(4):301-307.
2. Elner VM, Hassan AS, Frueh BR. Graded full-thickness anterior alepharotomy for upper eyelid retraction. Arch
Ophthalmol 2004; 122(1):55-60.
3. Harvey JT, Corin S, Nixon D, Veloudios A. Modified levator aponeurosis recession for upper eyelid retraction in Graves’
disease. Ophthalmic Surgery 1991;22(6):313-317.
Author Disclosure Block:
K. Punja , None; D.O. Kikka , None; C. Comi , None; N.Y. Pasco , None; B.S. Korn , None.
Small-Incision Lower Eyelid Entropion Repair
Noel Palmero, M.D.1, John G. Rose, Jr., M.D.2, Julie A. Woodward, M.D.3.
1
University of Wisconsin, Madison, WI, 2Oculoplastic & Facial Cosmetic Surgery Service, Dean Health Systems, Madison,
WI, 3Duke University Eye Center, Durham, NC.
Introductory Sentence:
The purpose of this study is to evaluate the effectiveness of small-incision orbicularis myectomy and retractor reinsertion
under local anesthesia in the treatment of spastic lower eyelid entropion.
Methods: A case review was performed on patients who underwent entropion repair from 2003-2005. Patients with
spastic entropion were included, while those with concurrent lower eyelid laxity were excluded. Operative technique
included a 1cm infraciliary lower lid incision, excision of an inverted-triangle-shaped section of orbicularis, and suturing of
the three vertices of the triangle together with single 6-0 polygalactin suture. Patients were assessed with relief of
presenting symptoms, as well as measurement and photographic documentation of eyelid position. Follow-up varied from
6 months to 2 years.
Results: Of the 35 patients treated with this technique, 1 required reoperation for recurrent entropion, while the
remainder were recurrence-free for up to 2 years.
Conclusions: This minimally invasive technique is an effective procedure in treating spastic entropion without substantial
horizontal eyelid laxity.
Bibliography:
1. Biesman BS, Lasers in Facial Aesthetic and Reconstructive Surgery. Williams & Wilkins,
1999.
2. Ben Simon GJ. Molina M. Schwarcz RM. McCann JD. Goldberg RA. External (subciliary) vs
internal (transconjunctival) involutional entropion repair. American Journal of
Ophthalmology. 139(3):482-7, 2005.
3. Altieri M. Kingston AE. Bertagno R. Altieri G. Modified retractor plication technique in lower
lid entropion repair: a 4-year follow-up study. Canadian Journal of Ophthalmology.
39(6):650-5, 2004.
4. Cook T. Lucarelli MJ. Lemke BN. Dortzbach RK. Primary and secondary transconjunctival
involutional entropion repair. Ophthalmology. 108(5):989-93, 2001.
5. Olver JM. Barnes JA. Effective small-incision surgery for involutional lower eyelid
entropion. Ophthalmology. 107(11):1982-8, 2000.
Author Disclosure Block:
N. Palmero, None; J.G. Rose, None; J.A. Woodward, None.
Facial Paralysis: An Unrecognized Cause Of Entropion In The Pediatric
Population
Nonette Y. Pasco, MD, Don O. Kikkawa, MD, Karim G. Punja, MD, Bobby Korn, MD, PhD.
UCSD Shiley Eye Center, La Jolla, CA.
Introductory Sentence:
Facial paralysis in adults commonly results in ectropion. In the pediatric population, however, entropion is observed more
frequently. The goals of this study are to present our case series, to discuss the factors attributing to the development of
entropion in pediatric facial paralysis, and to describe our methods of surgical repair.
Methods: A retrospective case review of five pediatric patients with entropion on the affected side of facial paralysis.
Results: Of the five cases, four were female and one was male. The age range was ten months to six years. Two patients
had Moebius sequence, two had Faucioauriculovertebral syndrome and one had Brachio-oto-renal syndrome. All cases
had unilateral facial involvement except for one with bilateral involvement (Moebius). Of the three patients who
underwent surgery, all three had successful surgical repair with posterior tarsotomy and margin rotation.
Conclusions: Entropion due to facial paralysis in children is rare and unrecognized. Surgical repair is usually successfully.
Bibliography: 1. Shapiro N, Cunningham M, et.al. Congenital Unilateral Facial Paralysis. Obstetrical and Gynecological
Surgery 1996; 51(9): 524-525.
2. Kalachev II, Balarev AI. The Ophthalmological Manifestations of Mobius Syndrome. Vestnik Oftalmologii 1993; 109
(5): 31-2.
3. Van den Bosch WA, Ineke L, Mulder P. Topographic Anatomy of the eyelids and the Effects of Sex and Age. British
Journal of Ophthalmology 1999; 83:347-352.
Author Disclosure Block:
N.Y. Pasco, None; D.O. Kikkawa, None; K.G. Punja, None; B. Korn, None.
Chronic Eyelid Lymphedema - A Report of Three Cases with Discussion
of Etiology and Management
Tarek O. Persaud, MD, David A. Belyea, MD, FACS, Neelam Gor, MD, Jerry W. Tsong, MD, Craig E. Geist, MD, FACS.
George Washington University, Washington, DC.
Abstract Body:
Introductory Sentence:
This manuscript seeks to outline the causes and treatment options in chronic eyelid lymphedema, with attention to the
use of orbicularis myectomy as an option.
Methods: Three retrospective, interventional cases are presented with clinical and histological photos. A review of the
literature is made with emphasis on previous management strategies and outcomes.
Results: The first patient is a forty four year old male with chronic inflammatory skin disease who developed massive
lymphedema of all four lids. His condition showed modest improvement on high dose oral steroids. The second patient is
a forty two year old male who developed eyelid lymphedema after partial excision and radiation of a parotid malignancy.
The patient was treated with eyelid debulking and a partial orbicularis myectomy. He achieved a roughly fifty percent
improvement in cosmesis postoperatively and remained stable thereafter. The third patient is a forty one year old female
who developed chronic left upper lid swelling after undergoing a partial parotidectomy and radiation for malignancy. She
underwent eyelid debulking and complete orbicularis myectomy with good postoperative cosmesis. Review of the
literature demonstrates that chronic eyelid lymphedema can occur as a result of numerous etiologies including infection,
inflammation, trauma, malignancy and irradiation. Numerous medical regimens have had varying degrees of success.
There are no large series or prospective trials present in the literature to guide therapy. Orbicularis myectomy has been
reported in three previous patients as a successful option and has achieved acceptable results in our patient as well.
Conclusions: Chronic eyelid lymphedema is a disfiguring process that can arise in many clinical situations. Medical and
surgical treatments are often unsatisfactory. Eyelid debulking and orbicularis myectomy is a reasonable treatment option
for refractory cases. This may be due to a predilection of interstitial lymph fluid for the orbicularis muscle.
Bibliography: 1. Bernardini FP, Kersten RC, Khouri LM, Moin M, Kulwin DR and Mutasim DF. Chronic Eyelid Lymphedema
and Acne Rosacea. Report of Two Cases. Ophthalmology. 2000;107:2220-2223.
2. James JH. Lypmhedema of the Eyelids. Plastic & Reconstructive Surgery. May 1978; 703-706.
3. Jordan DR. Eyelid Lymphedema. Arch Ophthalmol. Feb 1991; 109:1788-719.
4. Kabir SMR, Raurell A, Ramakrishnan V. Lymphoedema of the eyelids. British Journal of Plastic Surgery 2002; 153-154.
5. Harvey DT, Fenske NA and Glass LF. Rosaceous Lymphedema: A Rare Variant of a Common Disorder. Cutis. June
1998; Vol 61:321-24.
Author Disclosure Block:
T.O. Persaud, None; D.A. Belyea, None; N. Gor, None; J.W. Tsong, None; C.E. Geist, None.
Splitting Of The Eyelid Margin During Repair Of Lower Eyelid
Epiblepharon
Sang Won Hwang, MD1, Jong Hyun Kim, MD2, Nam Ju Kim, MD3, Ho-Kyung Choung, MD4, Sang In Khwarg, MD1.
1
Seounl National University Hospital, Seoul, 2National Cancer Center, Goyang, Kyungki, 3Seounl National University
Bundang Hospital, Seongnam, Kyungki, 4Seoul National University Boramae Hospital, Seoul.
Introductory Sentence:
Epiblepharon of the lower eyelid usually involves medial one third or half of the eyelid. Several surgical procedures such
as suture technique, incision and reconstruction, and excision of the skin and orbicularis muscle have been used for the
treatment of epiblepharon, but there have been many cases of undercorrection or recurrence of epiblpharon at the
medial part of the lower eyelids.1 The authors added the lid margin splitting technique in the surgical correction of the
epiblepharon such as excision of skin and muscle and cilia-everting suture technique1,2 to prevent undercorrection or
recurrence. This marginal splitting between anterior and posterior lamella permits an easier eversion of cilia. This study is
to describe the technique of this combined procedure and its results.
Methods:
These combined procedure was performed consecutively on 26 eyes of 16 patients with the lower eyelid epiblepharon,
and their medical records were reviewed retrospectively.For lid margin splitting, 1mm-deep incision was made along with
the gray line on the medial one third of the lower eyelid from just lateral to punctum with a # 15 scalpel blade. After
transverse subciliary skin incision and inferior dissection between tarsus and orbicularis oculi muscle, the subcutaneous
tissue of the superior edge of the incision was secured to the lower border of the tarsus with 4 or 5 interrupted sutures of
8-0 nylon to evert cilia. The redundant skin-orbicularis tissue was elliptically excised, and the skin was closed with a
continuous fast absorbing plain gut.
Results:
Mean postoperative follow-up period was 3months. The surgical results were successful in all 26 eyelids of 16 patients.
All subjective symptoms disappeared, and cilia did not touch the cornea even at down gaze. There were no complications
including, ectropion and lid retraction postoperatively. The wounds of splitted lid margin healed without problem.
Conclusions:
Combined procedure of lid margin splitting, excision of skin and muscle and cilia-everting suture might ensure an easier
reposition of the anterior lamella, eversion of cilia, and higher rate of success for epiblepharon repair.
Bibliography: 1. Khwarg SI, Choung HK. Epiblepharon of the lower eyelid: Technique of surgical repair and quantification
of excision according to the skin fold height. Ophthqlmic Surg Lasers 2002;33:280-7.
2. Woo KI, Yi K, Kim YD. Surgical correction for lower lid epiblepharon in Asians. Br J Ophthalmol 2000;84:1407-10.
Author Disclosure Block:
S. Hwang, None; J. Kim, None; N. Kim, None; H. Choung, None; S. Khwarg, None.
Surgical Correction Of Epiblepharon In Asian Children: Minimal Skin
Resection With Full-Thickness Rotating Suture
Heebae Ahn, MD, dongwon park, yoonhyung Kwon.
Dept. of Ophthalmology, Dong-A university Hospital, Busan.
Abstract Body:
Introductory Sentence:
The purpose of this study was to know the effect of minimal redundant skin resection with rotating suture for asian
epiblepharon children.
Methods: We performed a quick and simple surgical technique to correct epiblepharon on 252 patients. Minimal amount
of the redundant skin and orbicularis muscle were removed with 1 or 2 full-thickness rotating 7-0 nylon sutures.
Results: The average age at operation was 5.6 years. 230 patients(91.2%) showed satisfactory results with 4.5 months
of average follow-up period. 22 patients(8.8%) showed recurrence of cilia touch. Complications were minimal including 6
wound dehiscence and 11 conjunctival injections.
Conclusions: Minimal skin resection is helpful to reduce the postoperative lid retraction and scleral show.
Bibliography: Woo.K, Kim YD Surgical correction for lower lid epiblepharon in Asians, Br J Ophthalmol. 2000
Dec;84(12):1407-10.
Author Disclosure Block:
H. Ahn, None; D. park, None; Y. Kwon, None.
Focal Cutaneous Mucinosis of the Eyelid
Arthur C. Tutela, MD1, W. Clark Lambert, MD2, Fan Chen, MD2, Paul D. Langer, MD1.
1
Institute of Ophthalmology and Visual Science, New Jersey Medical School, Newark, NJ, 2Department of Pathology, New
Jersey Medical School, Newark, NJ.
Abstract Body:
Introductory Sentence: The cutaneous mucinoses are a rare, heterogeeous group of disorders characterized by an
abnormal deposition of mucin in the skin. We herein describe the first reported case of primary focal cutaneous mucinosis
of the eyelid.
Methods: The chart of one patient with focal cutaneous mucinosis of the eyelid was reviewed.
Results: A 39 year old man noted a right lower eyelid lesion horizontally expanding over a six month period of time. The
lesion was not associated with any visual loss, pain, or tenderness. On external examination, a linear white subciliary
lesion was noted on the right lower eyelid, measuring approximately 15 mm horizontally and 2-3 mm vertically. Slit lamp
examination revealed no signs of associated inflammation. The patient underwent biopsy of the lesion. Pathologically, a
normal epidermis overlay a thickened dermis that contained cleft-like spaces. The diagnosis of localized solitary focal
cutaneous mucinosis was made when both colloidal iron (Image 1) and alician blue (Image 2), stained positive for
dermal mucin.
Conclusions: Cutaneous mucinoses are divided into two categories: primary mucinoses, in which the mucin deposition is
the main histologic feature; and secondary mucinoses, in which the mucin deposition is associated with another systemic
or cutaneous disorder, such as granuloma annulare. Focal cutaneous mucinosis results from overproduction of fibroblasts
in a localized area of dermis, and is not associated with systemic disease. The lesion is benign and can be treated
conservatively by observation or complete excision. Clinicians should be aware of this rare group of disorders and include
it in the differential diagnosis of white, macular eyelid lesions.
Bibliography: 1. Rongioletti F, Rebora A. Updated classification of popular mucinosis, lichen myxedematosus, and
scleromyxedema. J. Am. Acad. Dermatol., 2001; 44(2): 273-281.
2. Rongioletti F, Rebora A. Cutaneous mucinoses: Microscopic criteria for diagnosis. J. Am. Acad. Dermatol., 2001;
23(3): 257-267.
3.del Pozo J et al. Dermatomyositis and mucinosis. J. Am. Acad. Dermatol., 2001; 40(2): 120-124.
Author Disclosure Block:
A.C. Tutela, None; W.C. Lambert, None; F. Chen, None; P.D. Langer, None.