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.
Tran, Ann Q.; DeMaria, Lauren N.; Nair, Archana A.; Tooley, Andrea A.; Godfrey, Kyle J.; Lisman, Richard D.
To report the surgical technique and outcomes for adjustable ptosis correction using a posterior levator advancement with minimal superior tarsectomy.
A retrospective single-center study was conducted on patients who underwent adjustable ptosis repair via posterior levator advancement with minimal superior tarsectomy by a single surgeon from 2002 to 2018. Patients with greater than 1 mm asymmetry between eyes or contour abnormalities underwent nonsurgical adjustment in the office within 6 days of surgery.
A total of 79 patients (146 eyelids) were included in this study. The patients were female (67%), underwent bilateral surgery (87%) with mean age of 63 years (range, 20–92). The mean improvement in marginal reflex distance 1 at postoperative month 1 was 2.56 ± 1.04 mm (p ≤ 0.0001). Postoperative symmetry of 1 mm or less between eyes was achieved in 96.6% of patients. Only 8 eyes (5.4%) underwent in-office adjustment postoperatively. No demographic or clinical differences were noted in eyes that required adjustments. Postoperative complications included dry eyes that resolved by 3 months (13.6%), suture cyst (1.4%), corneal abrasion (1.4%), and persistent eyelid edema (1.4%). Surgical revision was required in 2.8% of eyes.
The adjustable posterior levator advancement with minimal superior tarsectomy is an effective surgical technique for ptosis repair with the added benefit of in-office adjustability to correct minor asymmetries.
Eton, Emily A.; Carniciu, Anaïs L.; Prabhu, Shreya S.; Wang, Grace M.; Kahana, Alon
To determine the efficacy of a frontalis muscle flap eyelid reanimation technique for correction of severe congenital ptosis and associated amblyopia in infants.
The authors performed a retrospective chart review of patients 12 months of age or younger with unilateral or bilateral congenital ptosis and associated amblyopia or deemed at high risk for amblyopia due to visual deprivation. Following ptosis repair via a frontalis muscle flap technique, primary outcomes of postoperative eyelid position and amblyopia reversal were assessed.
Seventeen eyes of 12 participants were included for study. Seven of these patients had simple congenital ptosis, and the remainder had ptosis as part of a syndrome. Nine were diagnosed with amblyopia preoperatively, and the remaining 3 were too young for acuity testing but had occlusion of the visual axis by the ptotic eyelid in primary gaze. Postoperatively, the mean margin-to-reflex distance 1 was 2.4 mm (range: 0.0–4.0), and 9 patients (75%) demonstrated no evidence of amblyopia. Only 2 patients had eyelid asymmetry greater than 2 mm, which in both cases was due to lack of frontalis activation by the patient secondary to ongoing visual impairment. The most common complication was lagophthalmos in 6 eyes (35.3%), with no significant associated surface keratopathy.
The frontalis muscle flap technique may offer a new and effective approach to treating infants with severe congenital ptosis causing poor eyelid excursion and associated amblyopia while avoiding use of an implant.
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
Zhi-Peng You,Yu-Lan Zhang,Ke Shi
This 41-year-old woman had a left eye mass that slowly enlarged from a grain-sized lesion of the eyelid at birth to the present fist-sized mass in the orbit ( Fig. 1A). The left eye was blind since birth. She had no prior ophthalmic treatment. On examination the left eye had no light perception, and no recognizable globe structure was seen in the interpalpebral area or on magnetic resonance imaging ( Fig. 1B). At surgery, exenteration was performed for the 8 cm × 6 cm lesion, which weighed 300 g ( Fig. 1C). Choroid-like tissue, squamous epithelium, ciliated columnar epithelium, adipose tissue, striated muscle tissue, keratinous compounds, as well as many infiltrated multinucleated giant cells were observed in the tumour specimen ( Fig. 1D), which was consistent with the diagnosis of teratoma.
Edsel B. Ing,Anastasia Faggioni,Ying Lu
This healthy 35-year-old woman presented with a 2-year history of painless, progressive proptosis in the right eye. There was no lid retraction or dysthyroidism. Her acuity, pupils, confrontation field, motility, and ocular examination findings were normal. Orbital computed tomography showed a large well-circumscribed retrobulbar cyst with intraluminal contents near the ethmoidal-maxillary suture line. The cyst was drained through a transcaruncular incision. Keratin contents and hair were removed, and the inner lining was cauterized with bipolar. The cyst has not recurred at 9-month follow-up. Dermoids are the most common cystic choristomas of the orbit. However, medial intraconal dermoids are rare.