Daniel B. Azzam, Sanja G. Cypen & Jeremiah P. Tao
Purpose: The authors aim to characterize oculofacial plastic surgery-related online interest that may be useful in forecasting demand and in designing patient-directed online resources.
Methods: The authors queried Google Trends for over 100 oculofacial plastic surgery terms. The main outcome measure was the top 50 oculofacial plastic surgery-related search terms from 2004 to 2020. Secondary outcomes were trends, including seasonality, and search volume changes during the COVID-19 lockdown (March–May 2020) compared to 2018–2019. Terms were analyzed individually and in thematic categories; controlled against generic search terms to account for general internet traffic.
Results: Between 2004 and 2020, searches for oculofacial plastic surgery altogether increased, surpassing the rate of internet traffic growth. One thematic category – eyelid malpositions – decreased month-over-month. The top five terms were “face lift,” “Bell’s palsy,” “puffy eyes,” “dark circles under eyes,” and “chalazion.” Eyelid neoplasms searches peaked in summer (R2 = 0.880) whereas cosmetic (R2 = 0.862), symptoms (R 2 = 0.907), and surgeries (R 2 = 0.140) peaked in winter. Overall, oculofacial-related searches decreased during the COVID-19 lockdown, although thyroid eye disease interest increased compared to 2018 or 2019 (+68.6%; adj. p = .005). Oculofacial plastic surgery interest in 2020 was inversely correlated to “COVID-19” searches (r = −0.76, p < .001).
Conclusions: Oculofacial plastic surgery searches increased since 2004 at a pace greater than that ascribed to internet traffic growth. The most searched terms were “face lift,” “Bell’s palsy,” “puffy eyes,” “dark circles under eyes,” and “chalazion.” Almost all oculofacial-related searches decreased during the COVID-19 lockdown.
Adam R. Sweeney, Christopher R. Dermarkarian, Katherine J. Williams, Richard C. Allen & Michael T. Yen
Purpose: To report the efficacy of polytetrafluoroethylene (PTFE) frontalis suspension for blepharospasm with eyelid apraxia and postoperative botulinum toxin requirements.
Methods: Retrospective chart review of patients with blepharospasm and eyelid apraxia who underwent frontalis suspension. The primary outcome was a surgical success, defined by surgeon- and patient-reported success in postoperative eyelid opening. Comparative statistical analyses of botulinum toxin dosage and treatment intervals were performed amongst patients before and after frontalis suspension ptosis repair.
Results: Five patients (10 eyelids) met the study criteria, of which 40% were female. Mean age was 63.2 years. All patients had successful surgical outcomes based on physician-reported and patient reported satisfaction with the postoperative eyelid opening. Average follow-up was 14 months. Preoperative botulinum toxin treatments averaged 80.4 units (range 32–110, SD 33.2) to the periocular region over an average of 9.6-week intervals. Postoperative botulinum toxin treatments averaged 61.4 units (range 24–110, SD 34.7) to the periocular region over an overage of 9.8-week intervals. No patients experienced postoperative exposure keratopathy, extrusion of the sling, or postoperative infection.
Conclusions: Frontalis suspension using PTFE suture in the setting of blepharospasm with eyelid apraxia was found to be a safe and effective procedure. Frontalis suspension in this population is not a substitute for botulinum toxin treatment but may allow for reduced treatment dosage. Frontalis suspension appears to increase patient functionality with improved eyelid opening in patients with blepharospasm with eyelid apraxia.
Phillip M. Radke, Tal J. Rubinstein, Daniel J. Repp & Bryan S. Sires
Purpose: To directly compare an algorithmic external levator resection technique with the choice of intraoperative adjustment to the same technique without intraoperative adjustments.
Methods: A sequential controlled prospective comparative cohort study. Two cohorts were compared: a historical control adjustment, and an experimental non-adjustment group. Fourteen patients, 25 eyelids, were in the historical cohort; and 15 patients, 23 eyelids, were in the non-adjustment cohort. Primary acquired ptosis patients who met inclusion criteria were considered. All patients underwent a standardized external levator resection technique. Intraoperative adjustments were performed only in the historical cohort. Age, follow-up time, surgical time, and marginal reflex distance 1 (MRD1) were collected. Statistical analysis was performed using the Mann–Whitney U test. Statistical significance was p < 0.05. Primary and secondary outcome measures were postoperative MRD1 minus goal MRD1, and surgical time, respectively.
Results: Twenty-five historical eyelids were compared with 23 non-adjusted eyelids. The average patient age was 68.4 years (range 19–84) and 59.3 years (range 24–83) for the adjusted and non-adjusted groups. Six-month postoperative (postoperative minus goal) MRD1 was −0.1 mm (95% CI −0.3–0.1) and −0.2 mm (95% −0.5–0.0) (p = 0.33), and surgical time was 13.8 min (95% CI 12.6–15.1) and 9.5 min (95% CI 9.0–10.1) (p < 0.001) for the adjusted and non-adjusted cohort, respectively.
Conclusions: The external levator resection, utilizing a standardized algorithm approach, is an efficacious technique for involutional eyelid ptosis. With sound technique, this method can be performed without the need for intraoperative adjustment, thereby saving operative time and achieving similar results.
Namita Kumari, Sweety Girijashankar Tiple, Sima Das & Nitish Arora
Katja Ullrich & Raman Malhotra
Background: Facial nerve palsy (FNP) is known to worsen Meibomian gland dysfunction on the affected side. Chronic Meibomian gland dysfunction leads to a variant of upper eyelid marginal entropion associated with excessive tarsal curling, termed Meibomian gland inversion (MGI). Surgical correction with grey line split, tarsoplasty and anterior lamellar repositioning (GLS surgery) appears to further improve the ocular surface in these patients who have previously undergone upper eyelid loading.
Methods: Retrospective, 3 year, non-comparative, single-centre study of patients with FNP identified as having MGI and treated by GLS surgery under the supervision of a single surgeon. We present specific examination findings and a useful test (cotton tip test) to determine suitability for GLS surgery. We assessed changes in symptoms and CADS (Cornea, static Asymmetry, Dynamic function and Synkinesis) score, along with cosmetic grading of lash loss and contour and report complications.
Results: 23 patients with acquired FNP underwent GLS surgery for MGI with or without lash ptosis. 17 out of the 23 patients (74%) demonstrated an improvement in their CADS score after GLS surgery. Seven patients had insufficient records with scores missing and no conclusion could be reached for this group. Improvement of corneal staining, static and dynamic symmetry were all statistically significant. No patient worsened. The cosmetic outcome including lashes, lid contour and lid margin appearance is acceptable. Whilst it is possible to achieve minimal difference between the operated and unoperated eyelids, many patients will have a small difference.
Conclusion: We report outcomes of MGI treatment and useful diagnostic features.
Yuming Chong, Jingyu Li, Xinyu Liu, Jiuzuo Huang, Nanze Yu, Xiao Long
Eyelid morphology is highly susceptible to aging. Previous studies have described the process of eyelid aging in Caucasians; however, anthropometric data describing aging in Chinese eyelids are lacking. Therefore, this study aimed to quantitatively analyze the effect of aging on the eyelids of Chinese women through a three-dimensional (3D) anthropometry.
In this prospective, cross-sectional study, 3D photos were captured from 188 healthy Chinese Han women, who were categorized into four age groups. Anthropometric landmarks were identified for the measurement of eyelid parameters, and a unified coordinate system was built into each subject. Linear and angular measurements were computed from the coordinates and were compared between the groups.
An age-related decrease was observed in the ocular width, outer canthal width, palpebral fissure height, and multiple angular measurements. This indicated upper eyelid ptosis, which reduced the lateral and superior visual field. Lateral shift of the upper eyelid arc was not observed. The lower eyelid underwent slight elevation with increasing age. Aging rendered the periorbital region esthetically less pleasing, as shown by changes in the multiple proportion indices computed. Furthermore, an intergroup comparison indicated that eyelid aging was accelerated after the age of 40 years among Chinese women.
This study used 3D photography to quantitatively analyze how eyelids in Chinese women changed with age. The anthropometric data collected could help with antiaging cosmetic surgery planning and postoperative assessment.
Tatiana Sofia Monteiro Queirós MD Hae‐Ryung Won‐Kim MD Andrea Sales‐Sanz MD Marco Sales‐Sanz MD. PhD.
To investigate the effect of Phenylephrine test on the upper eyelid crease position.
Material and Methods
This study follows a prospective and analytical design and included patients with unilateral acquired involutional ptosis recruited between January 2015 and January 2018. In the Phenylephrine test, 1 drop of Phenylephrine 10% was instilled on the inferior fornix of the ptotic eye and the eyelid crease position was evaluated 10 min after.
A total of 60 patients were included in the final sample. The mean Margin‐to‐reflex distance 1 (MRD1) of the ptotic eye was 2.1 ± 1.0 and 3.8 ± 0.6 mm before and 10 min after the instillation of Phenylephrine, respectively. The difference between the means was statistically significant (p < 0.001). Ninety‐five per cent of the eyes had a positive Phenylephrine test result. Of this, 100% showed a decrease in the height of eyelid crease after the drop. There was a statistically significant decrease in the height of eyelid crease from 10.3 ± 2.5 to 7.8 ± 2.0 mm (p < 0.001).
Phenylephrine test not only affects the eyelid position but also the eyelid crease height. We show a significative decrease in eyelid crease height to a symmetrical level with the contralateral lid in all patients that had a positive Phenylephrine test result. This effect is probably due to a posterior lamella shortening secondary to Müller’s muscle contraction and suggests that the eyelid crease is not only determined by the projections of levator aponeurosis, but also by the entire force vector of the upper eyelid retractors.
Rukaiya Malik , James English & Thomas G. Hardy
Conjunctival orbital cysts are rare; they are typically either conjunctival dermoid or conjunctival epithelial cysts – congenital or acquired (inclusion). We describe the case of a 15-month-old girl presenting with strabismus and proptosis who had a retrobulbar intraconal cystic lesion displacing the optic nerve, with an adjacent middle cranial fossa anomaly. Aspiration of the orbital cyst tested positive for asialotransferrin, raising the suspicion of a direct communication with cerebrospinal fluid (CSF). Subsequent fine cut CT scanning disproved any connection with the intracranial space, and the cyst was excised complete and intact. Histopathology showed a conjunctival epithelial cyst. To our knowledge, this is the first case report in the literature of an asialotransferrin positive pediatric orbital conjunctival epithelial cyst. It is of clinical relevance as it explores the possibility of either a false positive asialotransferrin or potentially a prior developmental communication with the subarachnoid space. These two diagnostic possibilities are discussed.
Shahid Alam & Madhuri V. Thallam