Charles, Norman C.; Patel, Payal
A cystic lesion of the eyelid margin in a 37-year-old man was diagnosed clinically as an apocrine hidrocystoma, a common lesion in that location. Histopathologic examination confirmed the presence of a hidrocystoma but also disclosed an extensive proliferation of bland epithelial cells arising from the inner layer of the cyst. The authors further characterized this unique occurrence on the spectrum of Moll gland eyelid tumors by immunohistochemical analysis.
Gildener-Leapman, Juliana R.; Sheps, Iyar; Stein, Ran; Benyamini, Oren; Milstein, Asher; Hartstein, Morris E.
Purpose: Müller’s muscle-conjunctival resection (MMCR) is a well-known approach for ptosis repair. In its standard fashion, it involves resection of Müller’s muscle and conjunctiva, followed by suturing of the conjunctiva and Müller’s muscle to the tarsus with absorbable or nonabsorbable sutures. The authors herein present their experience in performing MMCR without sutures.
Methods: The study was conducted as a retrospective review of 19 patients (34 eyelids) undergoing sutureless MMCR. Thirty-three eyelids had acquired ptosis and 1 eyelid had congenital ptosis. Surgery consisted of a standard approach and placement of a Putterman clamp. Following excision of the clamped tissues, no internal sutures were placed. Preoperative and postoperative upper margin-to-reflex distances were measured and patients were evaluated for symmetry within 1 mm and the incidence of any complications.
Results: Nineteen patients underwent 34 sutureless MMCR procedures. Of these, 13 patients had bilateral ptosis repair. Thirty-three of 34 eyelids (97%) showed improvement in margin-to-reflex distances, with an average improvement of 1.4 mm (range, 0–3.5 mm, SD = 0.64) among all patients. Eighteen of the 19 patients (94.7%) showed postoperative symmetry of margin-to-reflex distances within 1 mm (p < 0.001, χ2 test). One patient who underwent unilateral surgery demonstrated a Herring’s response postoperatively, leading to the single case of asymmetry. There was 1 case of corneal abrasion seen postoperatively.
Conclusions: The sutureless technique is a rapid and effective method for performing MMCR. This technique is especially useful as an adjunct to blepharoplasty where mild ptosis exists for an added rejuvenating effect. It is low-risk and potentially corneoprotective when compared to the standard suture technique. Further studies could determine if a modified algorithm needs to be applied.
Dave, Tarjani Vivek; Sharma, Pranjali; Nayak, Arpita; Moharana, Ruby; Naik, Milind N.
Purpose: To compare outcomes of frontalis sling (FS) silicone and levator resection (LR) in ptosis associated with monocular elevation deficiency.
Methods: Retrospective interventional comparative case series of FS and LR in monocular elevation deficiency associated ptosis. Favorable outcome was defined as difference in margin reflex distance 1 of ≤1 mm between the 2 eyes in unilateral cases and margin reflex distance 1 of 4 mm in bilateral cases at last follow-up visit.
Results: One hundred four eyes of 95 patients were included. Median age at surgery was 14 years, and the mean follow-up period was 19.75 ± 34.55 months. Ptosis was severe in 91 (87.5%) patients. Associated Marcus Gunn jaw-winking (MGJW) phenomenon was seen in 43 (42%) patients. Frontalis sling was performed in 76 (73%) and LR in 28 (27%). Mean pre- and postoperative margin reflex distance 1 were −1.27 ± 2.17 mm and 2.18 ± 1.49 mm (p < 0.0001). The mean improvement in margin reflex distance 1 was significantly more with FS (4.46 ± 2.19) compared with LR (1.85 + 2.5) (p < 0.0001). There were no cases of exposure keratopathy requiring reversal of surgery in either group. The number of resurgeries required was 42 (55%) in the FS group and 10 (36%) (p = 0.08) in the LR group. Favorable outcome was seen in 54 (71%) in FS group and 16 (57%) (p = 0.17) in LR group.
Conclusions: When compared with levator resection, frontalis suspension with silicone gives a better eyelid elevation but has greater regression requiring more resurgeries. In spite of a poor Bells phenomenon, exposure keratopathy is not a concern.
Zhan, Senmiao; Hoang, Amber; Escaravage, George K. Jr; Oester, Alan E. Jr
Purpose: To report a recent outbreak of atypical mycobacterial infection following upper eyelid surgery and the results of a prevention protocol that was successfully instituted to dramatically reduce the infection rate.
Methods: This is a multicenter retrospective nonrandomized comparative interventional case series. A chart review of 7 patients who developed atypical mycobacterium infection after undergoing blepharoplasty was conducted. Preventative intervention included exchanging ice compresses for reusable gel packs and substituting tap water with bottled or distilled water for facial cleaning during postoperative care. The main outcome measure was disease incidence.
Results: Of the 368 patients who underwent upper eyelid blepharoplasty and/or blepharoptosis repair from December 2014 to May 2015, 7 people developed cutaneous atypical mycobacterium infection with an incidence of 1.9%. Eighty-six percent of patients received clarithromycin as part of their treatment with average treatment length of 2.8 months. Debridement was performed in 71% of the patients. Biopsy was performed in all patients, and all had histopathology showing granulomatous inflammation. A prevention protocol was developed to reduce potential inoculation in the immediate postoperative period, which successfully reduced the infection rate from 1.9% to 0.06% (p = 0.019).
Conclusions: Atypical mycobacterium infection, although rare, should be considered as a possible diagnosis in a blepharoplasty patient with delayed development of nodular lesions. Long-term clarithromycin therapy and debridement have shown good outcomes for these patients; however, the best treatment for any infection is prevention. This study provides the first evidence based approach within the ophthalmic literature for reducing the mycobacterium infection rate in blepharoplasty patients.
Kapoor, Anasua Ganguly; V.S., Vijitha; Mittal, Ruchi
Trichofolliculoma is a rare benign tumor of the skin, with distinct pilar differentiation and a predilection for the head and neck. To the best of the authors’ knowledge, only 10 cases of eyelid trichofolliculoma has been described in the English literature. Moreover, these benign hair follicle lesions have been reported to clinically mimic eyelid malignancy. The authors report a case of a 58-year-old woman with a nodule on the eyelid margin, with typical clinical features and characteristic histopathological findings aiding the diagnosis of trichofolliculoma. Complete resection was performed to prevent recurrence. The authors also reviewed all the cases of eyelid trichofolliculoma reported in literature to highlight the demography, clinical features, and management of this rare eyelid tumor.
Justin H. Dredge, Timothy W. Winter, Adel E. Alset
A 74-year-old man presented with 1-month history of chronic eyelid irritation (Fig A). Physical examination was remarkable for lice (Fig B, arrow 1) and egg casings (Fig B, arrows 2-3) on eyelashes consistent with Phthiriasis palpebrarum infection. A thorough sexual and social history revealed possible source contamination of facial use of a public, reusable cloth roll towel system. The patient was prescribed oral ivermectin 200 mcg/kg × 2 doses spaced 2 weeks apart. On follow up examination 4 weeks later, the patient had resolution of symptoms and no evidence of continued infection (Fig C).
Abhidnya Surve, M. C. Sharma, Neelam Pushker, M. S. Bajaj, Rachna Meel, Seema Kashyap
To study microscopic and ultrastructural changes of levator palpebrae superioris (LPS) muscle in congenital ptosis.
In this prospective observational study, LPS muscle was studied in 77 eyelids with congenital ptosis; 35—simple congenital ptosis (SCP), 12—Marcus Gunn jaw winking phenomenon (MGJWP), and 30—blepharophimosis epicanthus inversus syndrome (BPES). Light microscopy, enzyme histochemistry, immunohistochemistry and electron microscopy were performed, and results were analyzed.
Muscle fibers were detected in 83.33% of MGJWP, 22.86% of SCP and 16.67% of BPES eyelids. Fibers were detected significantly more in individuals with moderate ptosis, LPS action > 4 mm, present eyelid crease and eyelid fold. Severe endomysial and perimysial fibrosis was seen significantly more in individuals with MGJWP. Fat infiltration and nuclei internalization were seen in all three groups. The absence of degenerating or regenerating fibers and inflammatory cells, normal staining pattern on immunohistochemistry and absence of accumulation of any abnormal substance were found in all three groups. Abnormal mitochondrial staining pattern was seen occasionally in three groups. On electron microscopy, muscle was detected in 1 SCP eyelid and 8 MGJWP eyelids out of which 4 had myofibrillary disruption. All other eyelids where muscle fibers were not detected had only fibrocollagenous tissue.
Fibrocollagenous tissue predominated in all the cases, and muscle fibers detected correlated inversely with the severity of ptosis. The absence of degenerating, regenerating fibers and inflammatory cells supported the theory of dysgenesis of muscle. However, internalization of nucleus seen in all the subtypes is a feature favoring dystrophy.